Facing 50: Age is not just a number. I can explain after I find my reading glasses.

The eye drops don’t treat the cause of presbyopia but help treat its symptoms. Instead of targeting the eyes’ lens, the drops make the eyes’ pupils smaller, creating a pinhole effect that increases the depth of focus.

“If you have a camera and you make the aperture small (and) let little light in, the depth of focus – or the distance over which things are in focus – are much greater than if you open up the camera,” Bailey said. “It gives you greater depth of focus not just far away but closer as well.”

The new drug application is based on two randomized trials of 750 participants ages 40 to 55 in which patients were treated either with the drug or with a placebo once a day for 30 days.

The studies found the eye drops were safe and effective, with participants gaining three more lines on the reading chart in low light compared with those who received the placebo, according to trial results published by the company in October 2020. The eye drops began working as soon as 15 minutes after they were applied but reached their peak effectiveness after about an hour.

Side effects that occurred in fewer than 5% of patients included headache, red eyes, blurred vision and some eye pain.
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If approved by the FDA, AGN-190584 would be the first eye drop that treats presbyopia. However, pilocarpine eye drops have already been approved at a higher concentration for glaucoma patients.
Those patients use it about four times a day at 4% concentration; presbyopia patients may use it only once a day or on demand at 1.25%, said Dr. Michael Robinson, vice president and global therapeutic area head at AbbVie. Future trials will look at how the drug works when used more than once a day, he said.

“In glaucoma, (pilocarpine) improves the outflow of fluid from the eye and that lowers the intraocular pressure,” he said. “Here (with presbyopia patients), we’re using pilocarpine to basically constrict the pupil.”

That could make driving at night dangerous, but the FDA will determine warning labels after the drug is approved, Robinson said. Other warnings could include exercising caution while operating heavy machinery, especially in poor light.

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While the target population now is patients who have mild to moderate presbyopia in their 40s and 50s, he said, the company is planning trials to study the drug in older patients. He doesn’t see the eye drops completely replacing reading glasses but believes they could be another tool. 

“Presbyopia is a frustrating thing for many people in terms of needing reading glasses,” said Bailey of Wills Eye Hospital. “This is one way of potentially dealing with that.” 

Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT. 

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

I turned 50 a few weeks ago and many well-intentioned friends said the same thing to me: “50 is just a number.” That is very kind, and also very untrue. If it were true, then 30 would just be a number and we would say it to 30-year-olds on their birthdays. But we don’t, because most people don’t worry about turning 30 and having to go for a colonoscopy or losing their reading glasses.

Fifty is a real age, with real biological, hormonal, chemical and spiritual consequences. Twenty, 30 and 40 are markers of change as well. But they are usually changes that don’t require as much medical care or trips to the hair colorist. 

I don’t say this bitterly, but matter-of-factly. Facing 50 means facing the fact that dairy isn’t my friend anymore, and that my workouts are becoming more low-impact, and that two glasses of white wine come with a price the next day. It means there is likely less runway ahead of me than behind me and it means my daughter looks better in my jeans than I do.

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If there is truly earned wisdom and inner peace at 50, then those qualities only convince me not to soothe myself with the consolation that along with the elasticity of my skin I have lost the need for others’ approval. Inner growth is a spectacular perk, but it doesn’t mitigate the challenge of seeing your youth in the rear-view mirror. And why must it? I plan to face getting older with dignity while simultaneously being honest about missing so many things about being young. 
Getting honest about aging
I don’t necessarily want to be 30 again and suffer through all the angst I have happily shed. But I do want to spend less on skincare than on food. I do want to have boundless energy and optimism. All the cold-pressed juices and affirmations in the world can’t create the cocktail that is the youthful exuberance of young age. I wish I had that back now that I know exactly what to do with it.

Rebecca Sugar in Miami in January 2019.
What I do want is to be honest about turning 50. In so many ways it is great. And in so many ways it just isn’t. I want to laugh and cry at the down-slope of biological reality I am now navigating, not pretend my way through it. I know Cindy Crawford looks amazing at 55 but put her next to her daughter and let’s discuss. There are certain truths about life that even the most genetically blessed and disciplined among us are subject to. 

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I asked my good friend for her best piece of advice for turning 50. She didn’t have to think long or hard. Remember to clear a path on the floor between your bedroom and bathroom before you go to sleep, she warned me. She may not be Buddha but she gave me a much needed pearl of wisdom rather than a sugar-coated cliché about age being a state of mind. She is headed toward 60, so maybe getting to the point is a perk of that next decade. I will look forward to it.

Rebecca Sugar a philanthropic consultant in New York.