[Malic]

I'm more interested in UNR844-Cl (by Novartis). It appears that it has longer lasting, possibly age-correcting, effects.

"This prodrug is topically instilled binocularly, whereupon it penetrates the cornea and degrades into two naturally occurring substances, lipoic acid and choline. The lipoic acid is then hydrolyzed by esterase in the tear film into dihydrolipoic acid, which destroys the disulfide bonds in the lens, improving flexibility as noted earlier. An interesting hypothesis regarding this medication is that it may potentially halt or even reverse the natural lens hardening that occurs with age, thereby allowing a potential restoration of natural accommodation."

Source - https://modernod.com/articles/2020-sept/coming-soon-presbyop...

[wallaBBB]

This is the second attempt of this kind at tackling aging of the lens by Novartis (formerly Alcon). Unfortunately previous drug (some 10ish years ago) got pulled off the market after studies couldn't confirm the claims - basically it did nothing. Hopefully this time it works, because this is the only real solution, and not pupil size manipulation.

[the_d3f4ult]

Not the only real solution. Maybe the only pharmacologic solution, but it's only a matter of time before someone hits the nail on the head with an accommodating IOL.

[wallaBBB]

Considering how often a mistake is made at calculation the patient's lens even for the standard monofocals, I would not expect it to be a solution around the corner. And really it's not always your doctor's fault. Formulas are empirical, and it is more difficult for post-LASIK patients, as the standard formulas are not that good for them, and specialized ones are still maturing.

And this is not including various complications in cataracts that could easily make you ineligible for progressives.

[phkahler]

>> Hopefully this time it works, because this is the only real solution, and not pupil size manipulation.

My optometrist told me something I had a hard time believing. He said there are progressive lenses you can get with cataract surgery. I still can't believe that. This came up after talking about the long term problems with lasik. I said what if I just got cataract surgery now? I still can't believe they can do progressives.

[dbcurtis]

Its a multi-focal lens. My optometrist and another friend both have them. It splits the incoming light and you need to focus with your attention, not mechanically, which is interesting. The downside my friend reports is that reading requires a very bright light because not all of the light is falling on your retina.

I just got an implant in one eye a month ago. I chose single-focus at distance. I would rather deal with reading glasses than the other oddities, but I did consider the option.

BTW the implant surgery was quick and simple and life is much better afterwards. Recommend.

[quitit]

There are a range of IOLs (intraocular lenses) which can provide more than a single range (monofocal) of vision. While bifocal has existed on the market for some time, trifocal iols now also exist and mostly use a lenticular lens to present focus of near, intermediate and far vision together - however like other multifocal technologies an adjustment period is required and they are not for everyone (your brain needs to adjust to the fuzziness and the fact that the image is not resultant from the natural lens being manipulated can be difficult for some people to work with). There are also other approaches to this problem such as crystalens which is an iol that attempts to solve the same issue by moving forwards and backwards - however this kind of approach is falling out of favour.

The names in this space are johnson and johnson, alcon (novartis), zeiss, bausch and lomb and hoya. This field is rapidly developing with new iols every year, some newer products are promising a wide range of vision without the use of a lenticular lens which seems promising but might be more hype than reality. As for you and your vision: only your ophthalmologist can truly advise if any of these will work for you as there are a myriad of factors at play including some that might not seem obvious such as the patient’s behaviour and expectations.

[tenken]

Do you mean progressive inter ocular lens? Or like progressive lens (glasses)?

[wallaBBB]

Both options exist, but both are actually trade offs in all 3 segments (near-mid-far field). Intraocular ones have been existing and evolving in the market for a long time now, but really none are perfect. If your job or lifestyle dictates a good visual acuity at a certain distance don't go with these options.

[loceng]

There's a stromal stem cell treatment that's been developed, went through very successful human clinical trials, and so will likely become standard practice for everyone to heal age related degeneration; it won't be a daily use, recurring monthly revenue stream however, so pharma industry isn't going to push it.

[Retric]

Even once a lifetime treatments like vaccines represent a significant customer base as new people are born every year.

The reality is stem cells alone don’t fix aging, stuff like rates of cancer more inherent than can be cured by such things. Stem cells might possibly slow or reverse bone deterioration etc which would be a massive boon, but this stuff isn’t easy or risk free.

[melling]

is the loss of flexibility caused by hardening of proteins? is this the same or similar to what causes cataracts?

[gardaani]

Do you mean nuclear sclerosis? This explains it well: https://www.healthline.com/health/nuclear-sclerosis

The solutions would be to get the protein fibers sorted out. But how?

[the_d3f4ult]

yes

[BurningFrog]

> This prodrug is topically instilled binocularly

Can anyone translate?

[bavent]

It’s put on your eyeballs, both of them.

[BurningFrog]

prodrug: "a biologically inactive compound which can be metabolized in the body to produce a drug."

[germinalphrase]

Eyedropper into both eyes?

[Malic]

Yup. Twice a day, results show up somewhere before 90 days, ceasing treatment after point appears to continue to provide results.

"In phase 1 and 2 studies, UNR844 exhibited a good safety profile and there were no treatment-related study discontinuations. In addition, all patients showed substantial near visual acuity improvements by day 15.3,4 By day 91, 82% of patients had 20/40 or better near vision and 36% had 20/25 or better near vision. Novartis expects the drop to be labeled for use twice daily for approximately 90 days. The effects of this dosing regimen have been found to last up to 7 months without further dosing. "

https://modernod.com/articles/2020-sept/coming-soon-presbyop...

Article mentions a marketing file year of 2021 but I have read that they did a Phase IIa trial that should finish in 2022 (2023? Can't find the citation ATM)

[interestica]

Interestingly, one treatment for the degenerative eye disorder keratoconus aims to stiffen the cornea (corneal crosslinking) through drops+surgery.

[the_d3f4ult]

The cornea and the lens are different anatomical entities.