Vuity Use After Prior LASIK Surgery
Yes, Vuity (pilocarpine 1.25%) is safe and effective to use in individuals with a history of LASIK surgery, with clinical trial data demonstrating comparable efficacy and safety to patients without prior refractive surgery. 1
Evidence Supporting Use in Post-LASIK Patients
The most definitive evidence comes from a 2024 pooled analysis of the GEMINI 1 and 2 phase 3 trials, which specifically evaluated Vuity in patients with prior laser vision correction (LASIK or PRK). 1
Efficacy in Post-LASIK Patients
Responder rates for ≥3-line improvement in near vision were significantly higher with Vuity compared to vehicle at multiple time points on day 30: 1
- Hour 0.25: 16.7% vs 0.0% (p=0.0087)
- Hour 0.5: 38.9% vs 2.6% (p=0.0001)
- Hour 1: 41.7% vs 10.5% (p=0.0022)
- Hour 3: 37.8% vs 5.1% (p=0.0005)
Critically, there were no significant differences in responder rates between Vuity-treated patients with and without LASIK/PRK history, demonstrating that prior refractive surgery does not diminish the drug's effectiveness. 1
Safety Considerations
The American Academy of Ophthalmology mandates dilated fundus examination in all patients prior to initiating Vuity therapy to screen for retinal holes, tears, or breaks, as retinal detachment and retinal tear have been reported with miotics including pilocarpine. 2
Individuals with pre-existing retinal disease are at increased risk for these complications. 2
This screening requirement applies to all presbyopic patients considering Vuity, regardless of LASIK history. 2
Clinical Context: LASIK Does Not Create Additional Contraindications
LASIK surgery itself does not create specific contraindications to pilocarpine use beyond the standard retinal screening requirements. 1
LASIK has excellent long-term safety profiles, with 5-year data showing stable outcomes and no serious vision-threatening complications when inclusion/exclusion criteria are respected. 3
The primary concern with miotics relates to retinal complications through pupillary constriction and vitreoretinal traction, not corneal or refractive surgery history. 2
Important Caveats
Prior LASIK may affect IOP measurement accuracy, which is relevant if the patient has concurrent glaucoma concerns, though this does not contraindicate Vuity use itself. 2
Post-LASIK corneas may lead to underestimation of true IOP with applanation tonometry. 2
This is a monitoring consideration rather than a contraindication to pilocarpine therapy. 2
The mandatory pre-treatment dilated fundus examination cannot be overemphasized - this is the critical safety step that determines candidacy for Vuity, not the LASIK history. 2