Can a patient who has undergone Laser-Assisted In Situ Keratomileusis (LASIK) use Vuity (pilocarpine) eye drops?

Can a Patient Who Had LASIK Use Vuity Eye Drops?

Yes, patients with a history of LASIK can safely and effectively use Vuity (pilocarpine HCl 1.25%) eye drops for presbyopia treatment. 1

Evidence Supporting Use After LASIK

The most definitive evidence comes from a pooled analysis of the GEMINI 1 and 2 phase 3 randomized trials, which specifically evaluated pilocarpine HCl 1.25% in patients with prior laser vision correction 1:

• 39 patients with LASIK/PRK history were treated with pilocarpine 1.25% once daily for 30 days 1
• Responder rates (≥3-line improvement in distance-corrected near visual acuity) on day 30 were significantly higher with pilocarpine compared to vehicle at multiple time points:
  • Hour 0.25: 16.7% vs 0.0% (p=0.0087) 1
  • Hour 0.5: 38.9% vs 2.6% (p=0.0001) 1
  • Hour 1: 41.7% vs 10.5% (p=0.0022) 1
  • Hour 3: 37.8% vs 5.1% (p=0.0005) 1

Critically, there were no significant differences in responder rates between pilocarpine-treated participants with and without LASIK/PRK history, demonstrating equivalent efficacy regardless of prior refractive surgery 1.

Safety Considerations

While the evidence supports use, clinicians should be aware of specific LASIK-related considerations:

Post-LASIK Anatomic Changes

• LASIK creates permanent corneal structural changes including a flap and altered stromal bed 2
• Artifactual IOP reduction occurs after LASIK due to altered corneal biomechanics, which could theoretically affect interpretation of pilocarpine's miotic effects 2
• Post-LASIK patients commonly experience dry eye symptoms and neurotrophic changes that may persist for months to years 2

Potential Pilocarpine-Related Concerns in Post-LASIK Eyes

• Pilocarpine causes pupillary constriction, which could theoretically exacerbate night vision symptoms (halos, glare) that some LASIK patients already experience, particularly those with smaller optical zones 2
• The medication's mechanism involves ciliary muscle contraction, which does not interact with the corneal flap structure 1

Clinical Algorithm for Prescribing

Proceed with pilocarpine 1.25% in post-LASIK patients if:

1. LASIK was performed at least 3-6 months prior to allow for refractive stability and resolution of acute post-surgical changes 2
2. Patient has stable refraction without evidence of corneal ectasia or progressive irregular astigmatism 2
3. No active flap complications (striae, epithelial ingrowth, diffuse lamellar keratitis) 2
4. Patient is counseled about potential for enhanced night vision symptoms given pre-existing LASIK-related optical aberrations 2

Exercise additional caution if:

• Patient has significant residual dry eye from LASIK, as this may affect drop tolerance 2
• Patient already experiences bothersome night vision symptoms (halos, starbursts), as miosis may worsen these 2
• Patient has high myopic correction or smaller treatment zones, which increase baseline optical aberrations 2

Practical Prescribing

• Dosing: Once daily pilocarpine HCl 1.25% as studied in clinical trials 1
• Onset: Peak effect occurs 0.5-1 hour after instillation 1
• Duration: Therapeutic effect maintained for approximately 3-6 hours 1
• Monitoring: Assess near vision improvement and any worsening of distance vision or night vision symptoms 1

The 2024 pooled analysis provides Level 1 evidence that prior LASIK is not a contraindication to pilocarpine use for presbyopia, with equivalent efficacy and no additional safety signals compared to patients without refractive surgery history 1.