A new study published in the American Journal of Ophthalmology documented three retinal detachments in two patients shortly after they began using pilocarpine 1.25% (Vuity).
Tell me more.
The first patient had started using Vuity in both eyes 1 month prior. He noted the onset of flashes and floaters 3 days after he initiated the drops, and examination revealed bilateral retinal detachments.
The second patient presented 5 weeks after starting Vuity and had a retinal detachment in his right eye. Both patients were in their mid-40s.
Were these patients myopic?
The first patient had a history of cataract surgery in his right eye. His refraction was +0.25 +1.00 x 180 OD and +0.25 +0.75 x 010 OS. No lattice degeneration was observed in either eye.
The second patient was phakic, with a refraction of -4.00 +1.50 x 161 OD and -3.25 +1.00 x 180 OS. Dilated fundus examination revealed cobblestone retinal degeneration in the temporal periphery OU.
Why might pilocarpine cause a retinal detachment?
According to the authors, miotics, including pilocarpine, have long been suspected of carrying a risk of retinal detachment. The proposed mechanism is anterior displacement of the lens with associated anterior migration of vitreous, which may lead to tractional forces on the peripheral retina. Patients with myopia or retinal degeneration such as lattice are thought to be at higher risk of retinal detachment with the use of miotics.
What does this all mean?
The authors state that although these cases of retinal detachment cannot be definitively associated with the initiation of pilocarpine therapy, the incidence of retinal detachment shortly after initiation of treatment warrants further investigation.
The authors suggest that, prior to prescribing pilocarpine for presbyopia, physicians should inform patients of these potential adverse events and consider recommending that they undergo a dilated screening examination, particularly if they are myopic, to determine whether they are at higher risk for retinal detachment.