REVIEW Presbyopia – A Review of Current Treatment Options and Emerging Therapies James A Katz 1 Paul M Karpecki 2 Alexandra Dorca 3 Sima Chiva-Razavi 4 Heather Floyd 4 Elizabeth Barnes 4 Mark Wuttke 4 Eric Donnenfeld 5 1 The Midwest Center for Sight, Des Plaines, IL, USA; 2 Kentucky Eye Institute, Lexington, KY, USA; 3 Favoris AG, Basel, Switzerland; 4 Novartis Pharma AG, Basel, Switzerland; 5 Ophthalmic Consultants of Long Island, Garden City, NY, USA Abstract: Presbyopia is a common age-related vision disorder characterized by a progressive inability to focus on near objects. If uncorrected or under-corrected, presbyopia can signifcantly impact patients’ quality of life. Presbyopia represents an area of consider- able unmet need due to its rising prevalence worldwide as the population ages, the high proportion of under-treated individuals in some parts of the world, and the limitations of currently available corrective methods. Progressive or bifocal spectacles are associated with peripheral blur, a restricted visual feld and impaired depth perception, which have been linked to an increased risk of falls in the elderly. Contact lens options can be diffcult to maintain due to the development of age-related dry eye symptoms and reduced manual dexterity. Other corrective methods involve surgical interventions that modify the optics of the cornea, replace the crystalline lens, or attempt to restore active accommodation. While patients undergoing surgery report satisfactory outcomes post-operatively, many of them eventually require reading glasses. Non-invasive therapies with novel mechanisms of action are currently being investigated; these include miotic agents and UNR844, a lipoic acid choline ester. In this narrative review, available evidence on presbyopia prevalence, quality of life impact and risk factors are described, with a focus on observational studies in non- clinical settings. The diagnosis pathway and patient journey in presbyopia are outlined, and various treatment options are analyzed. The data reviewed herein reveals signifcant gaps in the provision of vision correction for this common condition, with a paucity of effective, non-invasive treatment options broadly accessible to presbyopic individuals. Keywords: presbyopia, epidemiology, patient characterization, vision correction, pharmacological therapies Plain Language Summary This review was carried out to i) explore available evidence on the causes and risk factors of presbyopia, ii) summarize how the condition is currently diagnosed and managed, including residual unmet needs and iii) provide an overview of potential future treatment options that are currently in development. Presbyopia is an age-related decline in the ability to focus on near tasks, thought to be caused by a loss of fexibility, increase in size and hardening of the lens and/ or the muscle fbers surrounding the lens inside the eye. Our research found that the onset of presbyopia may be earlier in women and in individuals who live closer to the equator. Presbyopia onset may also be infuenced by an individual’s distance glasses prescription. We discovered that presbyopia is typically diagnosed around 50 years of age, with optometrists being the major providers of vision correction. However, current treatment options for presbyopia, which include glasses, contact lenses and surgery, mostly manage the symptom of blurred near vision, without addressing the underlying cause of the condition. This review highlights the need for effective, broadly accessible, non-invasive presbyopic treatment options. Correspondence: Eric Donnenfeld Ophthalmic Consultants of Long Island, 711 Stewart Avenue, Suite 160, Garden City, NY, 11530, USA Email ericdonnenfeld@gmail.com Clinical Ophthalmology 2021:15 2167–2178 2167 © 2021 Katz et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Clinical Ophthalmology Dovepress open access to scientific and medical research Open Access Full Text Article Received: 8 March 2021 Accepted: 11 May 2021 Published: 24 May 2021 Clinical Ophthalmology downloaded from https://www.dovepress.com/ by 54.198.225.167 on 28-Jun-2021 For personal use only.