POAG Patients on Glaucoma Meds Have Earlier Presbyopia Onset

Glaucoma patients treated with prostaglandin agonists may experience earlier presbyopia progression, possibly due to the drug's influence on contracting the ciliary muscle, which leads to a continuous limitation of accommodative mobility. A second possibility is that open-angle glaucoma results from a more pronounced progression of presbyopia, as a previous study proposed. This graph from the study shows near add powers of glaucoma patients and controls by age group. Photo: Ayaki M et al. Transl Vis Sci Technol. 2025;14(5):25. Click image to enlarge. A team of researchers based in Tokyo recently hypothesized that “presbyopia in glaucoma patients treated with prostaglandin F (FP) receptor agonists may be altered because the long-term use of FP receptor agonists may induce certain changes in the ciliary muscle.” To test this theory, they performed a cross-sectional study comparing the near add power and other ocular parameters between glaucoma patients and healthy controls aged 40 to 79. They found that the former group experienced earlier progression of presbyopia, especially in those aged 40 to 64.The study involved a large sample size of 2,724 participants, consisting of 1,615 controls and 1,109 patients diagnosed with primary open-angle glaucoma. Participants were classified into eight age groups ranging from 40 to 79 years. In all or most age groups studied, researchers noted significant differences in the following parameters between glaucoma patients and controls: spherical equivalent, intraocular pressure, cup/disc ratio, ganglion cell complex thickness, peripapillary RNFL thickness and use of eye drops for dry eye.Glaucoma patients required higher near add power than controls from ages 40 to 74, but most notably from ages 40 to 64. Specifically, the near add power of glaucoma patients was comparable to that of the controls of the immediately older age group, suggesting an advancement of near add power requirements by approximately five years for glaucoma patients.In the discussion portion of their paper, which was published recently in Translational Vision Science & Technology, the researchers revisited their hypothesis for why glaucoma patients taking this medication experience sooner presbyopia progression: “FP receptor agonists contract the ciliary muscle, leading to a continuously forced restriction of mobility for accommodation,” they explained. “The ciliary muscle is one of the major components for accommodation, and a decline in its function may result in an increase of near add power in glaucoma patients treated with FP receptor agonists.” However, since this study didn’t analyze patients’ ciliary muscle function or accommodation ability prior to glaucoma treatment, this theory could neither be confirmed nor disproved.The authors also presented a second possible explanation for why glaucoma patients taking FP receptor agonists have increased near add power: “The Kaufman group’s studies suggest that open-angle glaucoma may be a result of a more pronounced progression of presbyopia, especially because the near add power requirement is higher in glaucomatous eyes as demonstrated in the present study,” they wrote. This prior research also suggested that “during accommodation, there may be pressure and tension spikes on the optic nerve in the normal young eye.”The early onset of presbyopia in glaucoma patients treated with prostaglandin F receptor agonists suggests a need for tailored management strategies, the study authors concluded. Optometrists should be aware of the need for increased near add power when managing these patients.Click here for the journal source. Ayaki M, Hanyuda A, Negishi K. Presbyopia progression from the age of 40 to 79 years in glaucoma patients treated with prostaglandin F receptor agonists. Transl Vis Sci Technol. 2025;14(5):25.