阅读说明：本技术 眼用制剂及用于改善老花眼的方法 (Ophthalmic formulation and method for improving presbyopia ) 是由 雷斯特雷波 路易斯·费莉佩·贝哈拉诺 于 2013-07-18 设计创作，主要内容包括：本发明涉及眼用制剂及用于改善老花眼的方法。本发明公开了具有有效量的包含匹鲁卡品或其药学上可接受的盐的拟副交感神经药以及一种或多种α1肾上腺素能激动剂或拮抗剂的眼用制剂。眼用制剂可以使得能够治疗不利地影响患者的视敏度的病况,包括老花眼。还公开了使用所公开的眼用制剂来治疗或改善老花眼症状的方法。(The present invention relates to ophthalmic formulations and methods for improving presbyopia. Ophthalmic formulations having an effective amount of a parasympathomimetic agent comprising pilocarpine or a pharmaceutically acceptable salt thereof and one or more alpha 1 adrenergic agonists or antagonists are disclosed. Ophthalmic formulations may enable treatment of conditions that adversely affect the visual acuity of a patient, including presbyopia. Also disclosed are methods of treating or ameliorating symptoms of presbyopia using the disclosed ophthalmic formulations.)

1. An ophthalmic formulation comprising an effective amount of pilocarpine, or a pharmaceutically acceptable salt thereof, and one or more alpha 1 adrenergic agonists or antagonists.

2. The ophthalmic formulation of claim 1, wherein the one or more alpha 1 adrenergic agonists or antagonists are selected from the group consisting of: phenylephrine, phenylpropanolamine, etifovir, oxymetazoline, xylometazoline, tramazoline, and pharmaceutically acceptable salts thereof.

3. The ophthalmic formulation of claim 1, wherein one alpha 1 adrenergic agonist is present and the alpha 1 adrenergic agonist is phenylephrine or a pharmaceutically acceptable salt thereof.

4. The ophthalmic formulation of any one of claims 1-3, further comprising a vasoconstrictor.

5. The ophthalmic formulation of claim 4, further comprising an antihistamine.

6. The ophthalmic formulation of claim 4, further comprising a non-steroidal anti-inflammatory drug.

7. A method of improving, reducing or treating presbyopia, comprising administering to the eye of a patient an effective amount of an ophthalmic formulation of any one of claims 1-6.

8. The method of claim 7, wherein the alpha 1 adrenergic agonist is phenylephrine or a pharmaceutically acceptable salt thereof.

9. Use of an ophthalmic formulation according to any one of claims 1-6 in the manufacture of a medicament for the improvement, alleviation or treatment of presbyopia.

10. The use of claim 9, wherein the alpha 1 adrenergic agonist is phenylephrine or a pharmaceutically acceptable salt thereof.

Technical Field

The present application relates to pharmaceutical formulations comprising a parasympathomimetic and an alpha 1 (alpha 1) adrenergic agonist or antagonist for improving, reducing, or treating presbyopia.

Background

Presbyopia is an age-related decrease in visual acuity due to a decrease in near focusing power, often associated with a blurry appearance of objects at near distances. Presbyopia symptoms typically become noticeable before the age of about 40 to about 45 years. Presbyopia is often associated with reduced accommodative ability of the eye. For example, with age, the flexibility or elasticity of the lens and the strength of the ciliary muscle generally decrease. A decrease in the flexibility or elasticity of the lens or the strength of the ciliary muscle may be associated with a decrease in the ability of the eye to adjust the curvature of the lens to focus on objects at nearby distances, including objects at around normal reading distances.

Common treatments for presbyopia include the use of glasses, such as presbyopic glasses typically worn for near vision (vision), and bifocal or multifocal glasses that provide improved near and far vision for patients who have used distance vision correction. Corrective contact lenses (contact lenses) may also be used to treat presbyopia, including bifocal, multifocal, or monocular vision (monovision) contact lenses. Monocular contact lenses typically include a lens for distance vision in one eye (e.g., the dominant eye) and a lens for near vision in the other eye (e.g., the non-dominant eye). Surgical options are also available for treating presbyopia, including corrective eye surgery. For example, refractive eye surgery typically involves reshaping the cornea. Refractive surgery may allow the cornea of one eye to be reshaped without treating the other eye, e.g., correcting only the vision of non-dominant eyes for improved near vision while allowing the dominant eye to maintain distance vision. Implanting an intraocular lens (IOL) may be another surgical option for treating presbyopia, and typically involves replacing the natural lens with a synthetic lens. However, glasses or corrective lenses can be cumbersome or provide inadequate treatment, while surgical correction can be invasive and not without risk. Because these techniques only compensate for the loss of accommodation by changing the way light enters the eye, the patient will have to wear glasses for near vision and have to remove glasses for distance vision, or correct only one eye for near vision while the other eye remains uncorrected to maintain distance vision. Thus, there is a need for methods of ameliorating or alleviating symptoms of presbyopia while allowing for accommodation.

Disclosure of Invention

In some embodiments, the ophthalmic formulation comprises an effective amount of pilocarpine (pilocarpine), or a pharmaceutically acceptable salt thereof, and one or more alpha 1 adrenergic agonists or antagonists. The one or more alpha 1 adrenergic agonists or antagonists can be selected from the group consisting of: phenylephrine (phenylephrine), phenylpropanolamine, etilefrine (ethylefrine), oxymetazoline, xylometazoline (xilometazoline), tramazoline, and pharmaceutically acceptable salts thereof.

In some embodiments, a method of improving, reducing, or treating presbyopia comprises administering to the eye of a patient an effective amount of an ophthalmic formulation. The ophthalmic formulation may comprise an effective amount of pilocarpine, or a pharmaceutically acceptable salt thereof, and one or more alpha 1 adrenergic agonists or antagonists. The alpha 1 adrenergic agonist can include phenylephrine or a pharmaceutically acceptable salt thereof.

Detailed Description

Embodiments described herein relate to pharmaceutical formulations comprising a parasympathomimetic and one or more alpha 1 (alpha 1) adrenergic agonists or antagonists. In some embodiments, the pharmaceutical formulations described herein are useful for ameliorating, reducing, and/or treating presbyopia or a symptom thereof. The pharmaceutical formulation can alleviate or eliminate symptoms of presbyopia while maintaining the accommodative function of the eye and allowing a patient with presbyopia to have the ability to focus far and near. In some embodiments, the pharmaceutical formulation can improve near vision without affecting far vision in patients with presbyopia. In some embodiments, the pharmaceutical formulation may be formulated as an ophthalmic formulation that may be administered to the eye of a patient suffering from a condition associated with presbyopia.

As used herein, the terms improve, treat or treat refer to reducing the severity of symptoms of an ocular condition that adversely affects visual acuity. In some embodiments, the ophthalmic formulations described herein are suitable for treating or reducing the severity of symptoms of presbyopia. For example, the ophthalmic formulations described herein may be suitable for treating presbyopia by enabling a patient to visually focus on objects at nearby distances, including objects at the periphery of normal reading distances.

As used herein, the term effective amount includes an amount of one or more active ingredients described herein sufficient to treat a condition of the eye that adversely affects visual acuity, including achieving a temporary improvement in the symptoms of presbyopia. For example, an effective amount of an active ingredient may enable a patient to visually focus on objects at nearby distances (including objects at distances surrounding normal reading distances) when administered to one or both eyes of the patient.

Some embodiments describe pharmaceutical formulations (preperation) comprising an effective amount of a parasympathomimetic and one or more alpha 1 adrenergic agonists or antagonists. In some embodiments, the pharmaceutical formulation is an ophthalmic formulation. In some embodiments, an ophthalmic formulation comprising an effective amount of a parasympathomimetic and one or more alpha 1 adrenergic agonists or antagonists can further comprise one or more of a member selected from the group consisting of a vasoconstrictor, an antihistamine, a non-steroidal anti-inflammatory agent, and a lubricant.

In some embodiments, the parasympathomimetic is pilocarpine or a pharmaceutically acceptable salt thereof. Pilocarpine is in pair M₃Direct acting parasympathomimetics that function at muscarinic receptors. Which can cause ciliary muscle contraction in the eye and provide near focus. However, it may also cause constriction of the pupil or miosis (miosis).

In some embodiments, the one or more alpha 1 adrenergic agonists or antagonists can be independently selected from phenylephrine, phenylpropanolamine, etifovir, oxymetazoline, xylometazoline, or tramazoline or pharmaceutically acceptable salts thereof. In some embodiments, the alpha 1 adrenergic agonist or antagonist can be phenylephrine. Phenylephrine may dilate the pupil and may reduce pupil constriction caused by pilocarpine. In some embodiments, phenylephrine may contribute to the normal movement of the pupil under any light conditions, and/or reduce miosis. With appropriate concentrations of pilocarpine and phenylephrine, spontaneous accommodation (volentary accommodation) of the eye can be maintained or restored while presbyopia symptoms are ameliorated or treated.

In some embodiments of the ophthalmic formulation, pilocarpine, or a pharmaceutically acceptable salt thereof, may be present in the following amounts by weight: from about 0.1% to about 2.0%, from about 0.1% to about 1.9%, from about 0.2% to about 1.9%, including from about 0.3% to about 1.9%, from about 0.4% to about 1.9%, from about 0.2% to about 1.8%, from about 0.3% to about 1.7%, from about 0.1% to about 1.8%, from about 0.1% to about 1.5%, from about 0.1% to about 1.3%, from about 0.1% to about 1.2%, from about 0.1% to about 0.9%, from about 0.1% to about 0.7%, from about 0.4% to about 1.6%, from about 0.5% to about 1.3%, or at about 0.4%, about 0.5%, about 0.6%, about 0.7%, about 0.8%, about 0.9%, about 1.1%, about 1.1.2%.

In some embodiments of the ophthalmic formulation, phenylephrine or a pharmaceutically acceptable salt thereof may be present in the following amounts by weight: from about 0.1% to about 7%, from about 0.1% to about 6%, from about 0.1% to about 5.5%, from about 0.1% to about 4.5%, from about 0.1% to about 3%, from about 0.2% to about 3.5%, from about 0.2% to about 4.5%, from about 0.2% to about 5.5%, from about 0.2% to about 6%, from about 0.3% to about 5%, from about 0.4% to about 4%, from about 0.5% to about 3%, from about 0.6% to about 2.5%, from about 0.7% to about 2.0%, or about 0.5%, about 1%, about 1.5%, about 2%, about 2.5%, about 3, about 3.5%, about 4%, about 5%.

In some embodiments, the ophthalmic formulation may further comprise a vasoconstrictor. In some embodiments, a suitable vasoconstrictor or drug includes naphazoline or a pharmaceutically acceptable salt thereof. Ophthalmic formulations suitable for treating ocular conditions that adversely affect visual acuity in a patient (e.g., presbyopia) may comprise an effective amount of one or more vasoconstrictors. Alternatively, the ophthalmic formulation may not comprise a vasoconstrictor.

For example, the ophthalmic formulation may comprise naphazoline or a pharmaceutically acceptable salt thereof in the following amounts by weight: from about 0.001% to about 0.020%, including from about 0.002% to about 0.018%, including from about 0.004% to about 0.016%, including from about 0.006% to about 0.01% 2, including from about 0.001% to about 0.015%, including from about 0.001% to about 0.012%, including from about 0.001% to about 0.011%, including from about 0.001% to about 0.010%, including from about 0.001% to about 0.009%, including from about 0.001% to about 0.008%, including from about 0.002% to about 0.008%, including from about 0.003% to about 0.009%, including about 0.002%, about 0.003%, about 0.004%, about 0.005%, about 0.006%, about 0.007%, about 0.008%, about 0.009%, about 0.010%, or about 0.012%.

In some embodiments, the ophthalmic formulation further optionally comprises one or more antihistamines. Suitable antihistamines or drugs may be independently selected from the group consisting of pheniramine, chlorpheniramine, dexchlorpheniramine (dexchlorpheniramine), dexbrompheniramine, deschlopheniramine (deschlopriramine), triprolidine, brompheniramine, iodopheniramine, fluphenamine or pharmaceutically acceptable salts thereof. In some embodiments, the antihistamine is non-nilapamine or a pharmaceutically acceptable salt thereof. Non-nilapamine may be used to avoid conjunctival congestion (injection) or congestion (congestion) and to reduce red eye. It also has minimal effect on the ciliary muscle and can improve accommodation. The pheniramine or a pharmaceutically acceptable salt thereof may be present in the ophthalmic formulation in the following amounts by weight: from about 0.01% to about 0.20%, from about 0.05% to about 0.15%, from about 0.02% to about 0.10%, from about 0.03% to about 0.09%, from about 0.04% to about 0.08%, from about 0.02% to about 0.20%, from about 0.04% to about 0.15%, at about 0.01%, about 0.02%, about 0.03%, about 0.04%, about 0.05%, about 0.06%, about 0.07%, about 0.08%, about 0.09%, or about 0.10%. Alternatively, the ophthalmic formulation may not comprise an antihistamine.

In some embodiments, the ophthalmic formulation may further comprise a non-steroidal anti-inflammatory drug (NSAID). NSAIDs may reduce or eliminate anterior segment (anterior segment) inflammation. In some embodiments, suitable NSAIDs are independently selected from the group consisting of: nepafenac, meloxicam, diclofenac, benzydac, ketorolac, oxybuprazone, bromfenac, flurbiprofen, pranoprofen, suprofen (suprofen), or indomethacin, and pharmaceutically acceptable salts thereof. In some embodiments, the ophthalmic formulation comprises at least one of nepafenac or meloxicam. Alternatively, the ophthalmic formulation may not contain a non-steroidal anti-inflammatory drug.

In some embodiments, the ophthalmic formulation may be formulated to further comprise an effective amount of the NSAID nepafenac. For example, an ophthalmic formulation formulated to contain nepafenac may contain nepafenac or a pharmaceutically acceptable salt thereof in the following amounts by weight: from about 0.01% to about 0.10%, including from about 0.02% to about 0.09%, including from about 0.03% to about 0.08%, including from about 0.04% to about 0.07%, including from about 0.01% to about 0.09%, including from about 0.01% to about 0.08%, including from about 0.01% to about 0.07%, including from about 0.01% to about 0.06%, including from about 0.01% to about 0.05%, including from about 0.01% to about 0.04%, including from about 0.01% to about 0.03%, including from about 0.02% to about 0.08%, including from about 0.02% to about 0.07%, including from about 0.02% to about 0.06%, including from about 0.02% to about 0.05%, including about 0.02%, about 0.04%, about 0.03%, about 0.04%, or about 0.05%.

Alternatively, the NSAID may be meloxicam. For example, an ophthalmic formulation may comprise meloxicam or a pharmaceutically acceptable salt thereof in the following amounts by weight: from about 0.001% to about 0.015%, including from about 0.001% to about 0.014%, including from about 0.001% to about 0.013%, including from about 0.001% to about 0.014%, including from about 0.001% to about 0.012%, including from about 0.01% to about 0.009%, including from about 0.001% to about 0.008%, including from about 0.002% to about 0.007%, including from about 0.002% to about 0.006%, including from about 0.003% to about 0.012%, including from about 0.003% to about 0.009%, including from about 0.004% to about 0.012%, including about 0.003%, about 0.004%, about 0.005%, about 0.003%, about 0.007%, about 0.008%, about 0.011%, or about 0.011%.

As described herein, the ophthalmic formulation may further comprise a lubricant or a lubricating agent. In some embodiments, the lubricant or lubricious agent may facilitate administration of the ophthalmic formulation. Suitable lubricants may be independently selected from polyethylene glycol 400 or propylene glycol. In some embodiments, the ophthalmic formulation comprises one or more suitable lubricants or lubricating agents. Alternatively, the ophthalmic formulation may not contain a lubricant or a lubricating agent.

In some embodiments, when polyethylene glycol 400 is selected as the lubricant for the ophthalmic formulation, the ophthalmic formulation may comprise polyethylene glycol 400, or a pharmaceutically acceptable salt thereof, in the following amounts by weight: from about 0.01% to about 0.30%, including from about 0.02% to about 0.25%, 0.03% to about 0.20%, 0.04% to about 0.15%, 0.05% to about 0.10%, 0.10% to about 0.30%, 0.10% to about 0.20%, 0.06% to about 0.20%, 0.05% to about 0.20%, including about 0.05%, about 0.10%, or about 0.15%.

In some embodiments, the lubricant may be propylene glycol. For example, the ophthalmic formulation may comprise propylene glycol or a pharmaceutically acceptable salt thereof in the following amounts: from about 0.01% to about 0.20%, including from about 0.02% to about 0.10%, including from about 0.04% to about 0.09%, including from about 0.04% to about 0.08%, including from about 0.04% to about 0.06%, including from about 0.02% to about 0.10%, including from about 0.02% to about 0.12%, including from about 0.02% to about 0.14%, including from about 0.05% to about 0.20%, including from about 0.05% to about 0.15%, including about 0.01%, about 0.02%, about 0.03%, about 0.04%, about 0.05%, about 0.06%, about 0.07%, about 0.08%, about 0.09%, or about 0.10% by weight.

In some embodiments, the ophthalmic formulation comprises one or more components to facilitate administration of the ophthalmic formulation. For example, the ophthalmic formulation may also optionally comprise a pharmaceutically acceptable carrier, an antibacterial agent or a preservative. In some embodiments, the pharmaceutically acceptable carrier comprises purified water.

Some embodiments described herein relate to methods of treating ocular conditions that adversely affect the near vision acuity of a patient, including improving symptoms of presbyopia. Methods of treating symptoms of presbyopia may comprise administering an ophthalmic formulation described herein to one or both eyes of a patient. The ophthalmic formulation may be administered to the eye of the patient as a liquid, gel, solution, suspension, or any combination thereof. In some embodiments, the ophthalmic formulation is administered to the eye via an ocular route, including topical application to the conjunctiva.

Ophthalmic formulations may comprise one or more components, each of which may be administered to one or both eyes of a patient sequentially or simultaneously for improving visual acuity, including for treating symptoms of presbyopia. For example, administration of an ophthalmic formulation comprising an effective amount of a parasympathomimetic and an effective amount of an α 1 adrenergic agonist or antagonist can ameliorate symptoms of presbyopia while allowing spontaneous modulation.

In some embodiments, an ophthalmic formulation as described herein is administered to one or both eyes of a patient exhibiting symptoms of presbyopia to improve the patient's ability to focus on objects at nearby distances, including objects at the periphery of normal reading distances. In some embodiments, administration of an ocular formulation as described herein can substantially improve the near visual acuity of a patient independent of other treatment methods. For example, administration of an ocular formulation as described herein may enable a patient to focus on objects at distances around the normal reading distance without the use of corrective lenses or corrective ocular surgery. For patients in the early stages of presbyopia, administration of an ocular formulation may alleviate symptoms, including enabling near visual acuity without the use of corrective lenses or glasses.

In some embodiments, an ocular formulation as described herein is administered to a patient with symptoms of presbyopia (other than symptoms from myopia or hyperopia) to facilitate near vision acuity such that the patient may not need to rely on corrective treatments such as bifocal/multifocal lenses or monocular vision contact lenses or need to take off glasses to read with myopic eyes.

In some embodiments, an ophthalmic formulation as described herein is administered to one or both eyes of a patient to provide treatment for presbyopia as an alternative to corrective eye surgery. For example, an ophthalmic formulation as described herein may be administered to a patient with symptoms of presbyopia when the patient does not prefer or receive corrective eye surgery to treat presbyopia. An ophthalmic formulation as described herein may also be administered to myopic or hyperopic patients with symptoms of presbyopia (with or without astigmatism), but preferably receive treatment only for defects in distance vision. Alternatively, an ophthalmic formulation as described herein may be administered to a patient who continues to have symptoms of presbyopia after the patient has undergone corrective eye surgery for presbyopia. The ophthalmic formulation may be used in conjunction with corrective eye surgery for presbyopia to further alleviate symptoms of presbyopia. In some embodiments, an ophthalmic formulation as described herein is administered to one or both eyes of a patient to reduce the decline in near visual acuity after corrective eye surgery for distance vision at a lesser age.

In some embodiments, administration of an ophthalmic formulation as described herein is beneficial for ameliorating presbyopia symptoms in a patient who has reversed a previously accepted corrective eye surgery for presbyopia. For example, administration of an ophthalmic formulation to a patient may enable the reconstitution of binocularity (binoculity) following reversal or regression of previously accepted monocular laser surgery directed to the treatment of presbyopia.

In some embodiments, an ophthalmic formulation as described herein is administered to a patient to improve the patient's ability to focus on nearby objects after the patient has undergone corrective surgery (e.g., including corrective eye surgery for treating cataracts) directed to treating an eye condition other than presbyopia.

In some embodiments, an ophthalmic formulation as described herein is used in conjunction with other treatments for ocular conditions (including treatment for presbyopia symptoms). For example, an ophthalmic formulation as described herein may be administered to a patient in conjunction with the use of a monofocal intraocular lens, a multifocal intraocular lens, or an accommodating intraocular lens to improve the patient's near-focusing ability.

In some embodiments, administration of an ophthalmic formulation as described herein is suitable for alleviating symptoms of ocular hypertension. Ophthalmic formulations can be administered to the eye of a patient to ameliorate ocular hypertension symptoms by lowering intraocular pressure.

Although the present invention has been disclosed in the context of certain embodiments and examples, it will be understood by those skilled in the art that the present invention extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses of the invention and obvious modifications and equivalents thereof. In addition, while several variations of the embodiments of the present invention have been shown and described in detail, other modifications, which are within the scope of this invention, will be readily apparent to those of skill in the art based upon this disclosure. It is also contemplated that various combinations or subcombinations of the specific features and aspects of the embodiments may be made and still fall within the scope of the invention. It should be understood that various features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the disclosed embodiments of the invention. Therefore, it is intended that the scope of the invention herein disclosed should not be limited by the particular embodiments described above.

Examples

Prospective studies were conducted according to a clinical protocol approved by the clinical's Ethics Committee in Colombia (columbia clinical Ethics Committee). All subjects had signed informed consent. A group of 20 presbyopic subjects with an average age of 49.65 (between 41 and 57 years) participated in the study. Of the 20 presbyopic patients, 9 were emmetropies, 5 were post-LASIK and 6 were post-PresbV LASIK. Emmetropes are those that have perfect far vision but require glasses to correct near vision. post-LASIK subjects are those who undergo refractive surgery to correct their distance vision prior to developing presbyopia. post-PresbV LASIK subjects were those who previously underwent refractive surgery to correct presbyopia and noted a slight decrease in near vision over time.

One drop of ophthalmic formulation a was administered to each eye of each subject. Prior to administration of ophthalmic formulation a, and then, 0.5 hours, 1 hour, 2 hours, 3 hours, 4 hours, 5 hours, 1 week, and 1 month after administration to each eye, and then, binocular combination, various visual acuity measurements were performed. The vision measurements performed included uncorrected ocular visual acuity (UCVA) for the distant 20/20 format and for the near Jaeger (Jaeger), Best Corrected Visual Acuity (BCVA), distance and near diopters, pupil size, the schirmer test, endothelial cell count, intraocular pressure (IOP), corneal curvature measurements (keratetry), and Anterior Chamber Depth (ACD).

The active ingredients of the ophthalmic preparation a include: 0.247% pilocarpine and 0.78% phenylephrine. Additional ingredients include: 0.09% of polyethylene glycol as lubricant, 0.023% of nepafenac and 0.034% of pheniramine, and 0.003% of naphazoline.

UCVA measurement

Table 1: binocular UCVA results (jege form) for mean near vision of emmetropic, post LASIK, post PresbV and all subjects.

Binocular UCVA results for near vision indicate that ophthalmic formulations are effective for correcting near vision in presbyopic subjects, whether they have perfect far vision or have previously undergone refractive surgery to correct far or near vision. The same results were also obtained for measurements performed on each eye separately, indicating that ophthalmic formulation treatment was effective for treating both eyes, not monocular vision. The results show that near vision in each eye and both eyes is improved by 2-3 rows. Surprisingly, only 1 drop per eye and 1 administration, even after 1 week and 1 month (past the period of action of the ophthalmic formulation), the improvement in near vision was maintained. Although the improvement in near vision becomes a little bit weaker after the initial period of action, the potential long-term benefits of ophthalmic formulations have been demonstrated with only a 1-drop setup.

Table 2: binocular UCVA results (form 20/20) for mean distance vision in emmetropics, post LASIK subjects, post PresbV subjects, and all subjects.

UCVA remote (20/20)	The person looking straight ahead	post-LASIK procedure	Post PresbV operation	All are
					Before eye drops	20/23.61	20/24.5	20/27.5	20/25
After 0.5 hour	20/20.56	20/23	20/21.67	20/21.5
					1 hour	20/21.11	20/30	20/20	20/23
2 hours	20/20.56	20/22	20/20.83	20/21
					3 hours	20/20	20/20	20/20	20/20
4 hours	20/20	20/20	20/20	20/20
					5 hours	20/20	20/21	20/21.67	20/20.75
1 week	20/20	20/21	20/20.83	20/20.5
					1 month	20/20	20/20	20/20.83	20/20.25

Binocular UCVA results for far vision indicate that the ophthalmic formulation does not adversely affect the visual acuity for far vision in presbyopic subjects, whether they have perfect far vision or have previously undergone refractive surgery to correct far vision or near vision. The same results were also obtained for measurements performed on each eye separately. In addition, the results also show that distance vision for binocular vision improves between 1 and 2 lines, while each eye generally improves 1 line. Thus, the results of binocular UCVA can contribute to improving both eyes. Unlike other presbyopic eye drops, this also indicates that the ophthalmic formulations disclosed herein are effective for improving near vision without compromising or adversely affecting distance vision.

Refractive measurement

The refraction of the eye before and after 1 administration of the eye drop formulation was measured. The change of the sphere and cylinder was calculated from the measurement results and is shown in table 3. The ophthalmic formulation did not change cylinders, but slight changes in spheres were observed. The change in the sphere was most pronounced at 1 hour after administration of the formulation, but the change was only half of the diopter. Since there was no change in the cylinder and only a slight change was observed in the sphere, it caused only a slight myopic shift and, therefore, had no adverse effect on distance vision. In contrast, other presbyopic drops cause large near vision excursions to improve near vision, but they also reduce distance vision.

Table 3: refractive change (measured in diopters) after administration of 1 drop of the ophthalmic formulation.

	Before one	0.5h	1h	2h	3h	4h	5h	1 week	1 month
										Ball body	0	-0.39	-0.51	-0.36	-0.23	-0.11	-0.10	-0.07	-0.01
Cylinder body	0	0.02	-0.04	-0.01	-0.01	0.01	-0.03	-0.01	-0.01

Regulating capacity

The optical quality of the eyes was measured using an OQAS HD analyzer before administration of the ophthalmic formulation and at hours after administration of 1 drop 2 in each eye. The results indicate that the Objective Scattering Index (OSI) of the eye is not affected by the ophthalmic formulations disclosed herein, and that the accommodative range improves by about 0.75 diopters after administration of the ophthalmic formulations. Aberrometry (iTrace) was also used to objectively measure the ability to adjust far and near vision, and the results were consistent with those of OQAS measurements.

Size of pupil

Changes in pupil diameter were also found to be minimal when measured by OQAS, iTrace, three-dimensional anterior ocular segment analyzer (Pentacam), and autorefractometer. This further confirms that the ophthalmic formulations disclosed herein do not much affect pupil diameter.

Table 4: pupil diameter changes after administration of the ophthalmic formulation. (measured in mm)

Diameter of pupil	Before one	0.5h	1h	2h	3h	4h	5h	1 week	1 month
										Automatic refractometer	4.86	4.64	4.78	4.74	4.55	4.42	4.42	4.72	4.79
Three-dimensional anterior segment analyzer	3.12	3.67	3.77	3.47	3.21	3.13	3.07	3.14	3.09

Anterior Chamber Depth (ACD)

ACD was measured by a three-dimensional anterior segment analyzer, and the results are shown in table 5. Slight shallowing of the anterior chamber depth occurs but is not sufficient to cause problems. This is different from other presbyopic preparations as other preparations will lighten the ACD to achieve improved near vision.

Table 5: ACD of eyes at different times after administration of the ophthalmic formulation. (measured in mm)

	Before one	0.5h	1h	2h	3h	4h	5h	1 week	1 month
										ACD	3.21	3.16	3.16	3.18	3.16	3.16	3.13	3.19	3.21

Intraocular pressure (IOP)

IOP was measured by Goldmann and Pascal Tonometers (Goldmann and Pascal Tonometers), and the results are shown in table 6. IOP is important for evaluating the safety of ophthalmic formulations, as high IOP can be dangerous to the optic nerve and can cause irreversible damage over time. The results indicate that the ophthalmic formulation does not increase IOP and is therefore safe.

Table 6: IOP of the eye at different times before and after administration of the ophthalmic formulation. (measured in mmHg)

IOP	Before one	0.5h	1h	2h	3h	4h	5h	1 week	1 month
										Pascal	17.34	17.31	17.14	17.46	16.54	16.43	15.61	17.09	17.06
Goldman	14.28	14.23	13.90	14.18	13.25	13.03	12.55	13.68	14.08

Amount and quality of tears

The Schirmer (Schirmer) test measures the amount of lacrimal tears. The results indicate that the ophthalmic formulation does not have an adverse effect on the tear film and is therefore less likely to cause dry eye problems. The quality of the tear film after administration of the ophthalmic formulation was also measured using OQAS. The results show that the ophthalmic formulation also does not have an adverse effect on the quality of the tear film during long-term use.

Corneal curvature measurement

Corneal curvature at the flat axis (flat meridian) and the steep axis (steep meridian) of the cornea was measured at different time intervals before and after administration of 1 eye drop formulation. The results show that the corneal curvature is steepest half an hour and 1 hour after administration (when the ophthalmic formulation has the greatest effect and when major accommodation occurs).

Endothelial cell count

Endothelial cells are found on the cornea, and corneal endothelial cell counts can indicate the health of the cornea. Endothelial cell counts of the subjects were collected as part of the safety study of the ophthalmic formulations. The results show that endothelial cell counts did not decrease after administration of the ophthalmic formulation, indicating that the ophthalmic formulation did not have an adverse effect on the cornea and was safe for long-term use.