It’s fashionable in some circles these days to write off the concept of pharmaceutical treatment of presbyopia in light of the rocky start the category has seen. Allergan’s 2021 launch of Vuity was met with initial enthusiasm, but then its limitations became manifest. Now, a slate of new options are on their way, hoping to remedy the issues that have stalled the concept. Will they face similar stumbles?

Probably. But I’m reminded of how the established players in the smartphone market reacted to Apple’s 2007 launch of the iPhone. The most infamous blown call came from the CEO of Palm, maker of (at the time) several popular smartphones back when they were still called personal digital assistants. “We’ve learned and struggled for a few years here figuring out how to make a decent phone. PC guys are not going to just figure this out. They’re not going to just walk in,” Palm CEO Ed Colligan said, condescendingly, about the prospect of competing with Apple’s entry into the market. 

Three years later, the iPhone was a phenomenon and Palm was out of business. Even Blackberry, the original behemoth in smartphones, failed to adapt to the threat and eventually went out of business in 2016.

None of this is to suggest presbyopia drops will follow the same course—corrective lenses ain’t going anywhere. In fact, it would be overstating matters greatly to expect iPhone-like impact for any new product. But the lesson of the iPhone is: patience.

The first-generation iPhone was primitive by today’s standards: its internet connectivity was painfully slow, third-party apps didn’t exist yet, the camera was terrible, copy/paste for text hadn’t been developed yet, and so on. But the device showed us an ideal for the future, and that vision guided the developers of successive products, both inside and outside of Apple. The company and others iterated on the smartphone year in and year out, device by device, with better technology and new features at each launch. Nowadays, smartphones are pretty much essential devices for billions of people worldwide.

Medical therapy for presbyopia feels very much like a first-gen iPhone right now, but the drug developers have a clear set of known shortcomings to chip away at with each next iteration on the concept. This month’s annual pharmaceuticals issue includes an interesting article on the state of the presbyopia eye drop category and where it’s headed. Rather than dwelling on today’s deficiencies, it’s helpful to think a few years out about where we’ll be at the end of the decade. Even in a more advanced form, this isn’t a product that will suit everyone, that’s for sure. But it’s usually a bad idea to bet against something that aims to satisfy the aesthetic anxieties of people in their mid-40s. The drops will find a suitable place in your practice.

Beyond that look at presbyopia drugs, this pharmaceutical-themed issue is packed with discussions of recent and upcoming progress in dry eye therapy, proper use of oral steroids, newly identified side effects of cancer drugs and a wide-ranging feature on how to fight insurance denials for new meds. Enjoy!