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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 Donnenfeld5 1The Midwest Center for Sight, Des Plaines, IL, USA; 2Kentucky Eye Institute, Lexington, KY, USA; 3Favoris AG, Basel, Switzerland; 4Novartis Pharma AG, Basel, Switzerland; 5Ophthalmic Consultants of Long Island, Garden City, NY, USACorrespondence: Eric DonnenfeldOphthalmic Consultants of Long Island, 711 Stewart Avenue, Suite 160, Garden City, NY, 11530, USAEmail ericdonnenfeld@gmail.comAbstract: 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 significantly impact patients’ quality of life. Presbyopia represents an area of considerable 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 field and impaired depth perception, which have been linked to an increased risk of falls in the elderly. Contact lens options can be difficult 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 significant 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

Laura M Periman,1 Francis S Mah,2 Paul M Karpecki3 1Periman Eye Institute, Seattle, WA, USA; 2Scripps Health, La Jolla, CA, USA; 3Kentucky Eye Institute, Lexington, KY, USACorrespondence: Laura M PerimanPeriman Eye Institute, Seattle, WA, USAEmail dryeyemaster@gmail.comAbstract: Dry eye disease (DED) is a multifactorial disease of the ocular surface and tear film that has gained awareness as a public health problem. Characteristics of DED include tear film instability, hyperosmolarity, and ocular surface inflammation, which can occur independently or may be a sequela of numerous ocular diseases, ocular surgery or contact lens wear. Much has been learned about the impact of the disease to help affected individuals who report symptoms of poor vision, pain, and tearing. Recently, new research highlights the importance of the role of ocular surface inflammation and damage in DED—leading to a vicious cycle of inflammation as well as loss of tear film homeostasis. DED immunopathophysiology is characterized by four stages: initiation, amplification, recruitment, and re-initiation. Cyclosporine is proven to be a valuable ophthalmic therapeutic for DED through its immunomodulatory actions and regulation of the adaptive immune response. Cyclosporine mechanism of action is well described in the published literature and the myriad of benefits in all four stages lend a broad-based immunomodulatory function particularly suitable for addressing DED. Furthermore, cyclosporine has unique goblet cell density improvement capabilities as well as anti-apoptotic properties. Topical formulations of cyclosporine are centered around addressing the highly lipophilic nature of the molecule. The poor aqueous solubility of cyclosporine traditionally presented technical challenges in drug delivery to the ocular surface. Newer formulations such as cationic emulsions and nanomicellar aqueous solutions address formulation, tissue concentration, and drug delivery challenges.Keywords: dry eye disease, cyclosporine A, emulsion, OTX-101, keratoconjunctivitis sicca