What medications are used to treat visions?

Medications for Vision Problems

The question "visions medication" is unclear, but I'll address the primary medication-based treatments for common vision conditions based on the available evidence.

Myopia Control in Children

For school-age children with progressive myopia, low-dose atropine is the primary pharmacological intervention recommended. 1

• Low-dose atropine should be considered for myopia prevention in young children at risk 1
• Antimuscarinic agents (including atropine) are recommended for myopia control in school-age children alongside multifocal spectacles, contact lenses, or orthokeratology 1

Amblyopia (Lazy Eye) Treatment

Atropine 1% ophthalmic solution applied to the nonamblyopic (good) eye is equally effective as patching for treating amblyopia in children aged 3-15 years. 1, 2

Atropine Dosing for Amblyopia:

• Daily dosing: Atropine 1% once daily to the fellow (good) eye produces similar visual improvement as 2-6 hours of daily patching 1
• Weekend dosing: Atropine 1% on two consecutive days per week is as effective as daily atropine for moderate amblyopia 1
• Visual acuity improved by approximately 3.6-3.7 lines in both atropine and patching groups over 2 years 1
• 74% of children treated with atropine achieved visual acuity ≥20/30 or improved by ≥3 lines 1

When to Use Atropine:

• Moderate amblyopia (20/40 to 20/80) in children 3-15 years old 1, 2
• When patching compliance is poor 1, 2
• Presence of latent nystagmus 1, 2
• For maintenance treatment after initial improvement 1, 2

Mechanism and Considerations:

• Atropine works by causing cycloplegia (paralysis of focusing) in the good eye, forcing the amblyopic eye to work 1, 2
• Works best when the nonamblyopic eye is hyperopic (farsighted) 1
• Side effects include photosensitivity, blurred vision in the treated eye, and transient visual acuity reduction 2

Presbyopia (Age-Related Near Vision Loss)

Topical pharmacological agents for presbyopia represent an emerging treatment field. 1

• The 2023 American Academy of Ophthalmology guidelines recommend considering emerging topical agents for presbyopia 1
• Specific agents and protocols are still being established in clinical practice 1

Diabetic Retinopathy and Macular Edema

Anti-VEGF (vascular endothelial growth factor) intravitreal injections are the primary medication-based treatment for vision-threatening diabetic macular edema. 1, 3

Anti-VEGF Treatment Protocol:

• Initial phase: 4-6 consecutive monthly injections of ranibizumab 0.3 mg, bevacizumab 1.25 mg, or aflibercept 2 mg 3
• All patients require at least 4 injections at 4-week intervals before treatment modifications 3
• Continue monthly injections as long as vision or central macular thickness improves 3

Drug Selection:

• For vision 20/50 or worse: Aflibercept provides superior outcomes (18.3 letter gain vs 13.3 for bevacizumab, 16.1 for ranibizumab at 1 year) 3
• For vision 20/40 or better: All three drugs provide similar outcomes 3

Corticosteroids:

• Intravitreal corticosteroids can be used locally for vision-threatening diabetic retinopathy and macular edema 1

Acute Angle-Closure Glaucoma

For acute angle-closure glaucoma, immediate medical treatment includes pilocarpine eye drops, acetazolamide, and mannitol. 4

• Pilocarpine eye drops to constrict the pupil 4
• Oral or intravenous acetazolamide to reduce intraocular pressure 4
• Intravenous mannitol for additional pressure reduction 4

Important Caveats

• Refractive errors (nearsightedness, farsightedness, astigmatism) are primarily corrected with eyeglasses, contact lenses, or surgery—not medications 1
• Cataracts require surgical intervention, not medication 5
• Retinal detachment requires surgical repair 4
• Giant cell arteritis causing vision loss requires immediate high-dose steroids to prevent vision loss in the unaffected eye 4