Earlier this year, Tenpoint Therapeutics commercially launched Yuvezzi, the first and only dual-agent eye drop for the treatment of presbyopia. It consists of carbachol 2.75%, a potent pupil-selective miotic agent, and brimonidine tartrate 0.1%, an alpha-2 adrenergic agonist. A single daily drop of Yuvezzi produces miosis, beginning at approximately 30 minutes postinstillation, that lasts up to 10 hours. The therapy is intended as a once-daily treatment option for adults experiencing blurry near vision due to aging.
Payment Model for Yuvezzi
The eye drop is an out-of-pocket treatment that is covered by Flexible Spending Accounts (FSA) or Health Savings Accounts (HSA) funds even though it is not directly covered by insurance. It is broadly available in the US at retail pharmacies and through the company’s e-pharmacy partner PHILRx, with both 30 single-dose vials and 90 single-dose vial prescription options.
“Yuvezzi is a great option for the mild to moderate presbyope who is frustrated by the way their loss of near vision affects their ability to enjoy a dynamic lifestyle,” says Carol Kearney, chief commercial officer at Tenpoint Therapeutics. “Because of its dual-action formulation, Yuvezzi works well for active individuals who would prefer to have the benefits of a presbyopia-correcting drop throughout a full day.”
The FDA approval of Yuvezzi was based on positive data from 2 phase 3 studies—BRIO I and BRIO II. According to Ms. Kearney, the clinical trials included the largest and longest safety trial in the category, which lasted 12 months. “The miotic effects of the drop were maintained for up to 10 hours, providing patients with functional near vision,” she says. “Patients saw up to a 6-fold improvement in reading speed with Yuvezzi compared to vehicle. We also saw favorable tolerability results, including low rates of hyperemia and no serious adverse events.”
From an optometrist’s perspective, Mile Brujic, OD, FAAO, practice owner of Premier Vision Group in Bowling Green, Ohio, says that because optometrists regularly perform pinhole testing, it has always been understood that miotic agents could increase depth of focus. “The challenge has been to come up with an eye drop that offers the right duration of miosis and is tolerable for patients to use as a lifestyle medication. Yuvezzi seems to get this balance right.”
The Ideal and Non-Ideal Candidates
Dr. Brujic says that he has learned a lot more about patient selection since the first presbyopia-correcting eye drops were introduced a few years ago, and fortunately, the range of good candidates for Yuvezzi is very broad. “They include emmetropes who have never needed to wear glasses and people with low myopia or astigmatism who dislike wearing glasses,” he explains. “Others who can benefit are postrefractive surgery patients who already made a choice to get rid of glasses and are unhappy to be back in glasses with the onset of presbyopia.”
Dr. Brujic also points out that an often-overlooked group of candidates for this treatment are former contact lens wearers who have been unsuccessful in multifocal contact lenses or monovision. “While many of these patients have gone back to glasses—either readers or progressives—I find that they are eager to wear distance contact lenses and utilize Yuvezzi prior to contact lens application to improve their near vision,” he explains.
While it is important to identify the ideal candidates, Dr. Brujic explains that it is just as important to address which patients are not good candidates for Yuvezzi (or any of the other presbyopia-correcting drops). “All of these eye drops are intended for patients with healthy eyes,” he explains. “I do a comprehensive exam before prescribing them and do not recommend them for patients with any retinal thinning, lattice or peripheral holes, active diabetic retinopathy, or severe ocular surface disease.”
Building Patient Trust and Loyalty
According to Dr. Brujic, offering a new option is a big part of how his practice builds patient trust and loyalty. “I never want a patient to hear about presbyopia-improving eye drops from a friend at dinner and wonder why I never mentioned them,” he says. “I tell patients about all the options for presbyopia and why they are (or are not) a candidate.”
Dr. Brujic further adds that this is a great opportunity for optometrists to step back and re-evaluate their approach to presbyopia in general. “Our patients are really bothered by the loss of near vision as they age, and we have the opportunity to address that need with glasses, with contact lenses, and with topical drops like Yuvezzi—or with some combination of the 3 that will best suit the patient’s lifestyle and vision needs,” he concludes. OM