Phentolamine Mesylate Ophthalmic Solution Provides Lasting Pupil Modulation and Improves Near Visual Acuity in Presbyopic Glaucoma Patients in a Randomized Phase 2b Clinical Trial

Jay S Pepose; Paul J Hartman; Harvey B DuBiner; Marc A Abrams; Robert J Smyth-Medina; Sayoko E Moroi; Alan R Meyer; Mina P Sooch; Reda M Jaber; Konstantinos Charizanis; Seth A Klapman; Arin T Amin; Jonah E Yousif; Eliot S Lazar; Paul M Karpecki; Charles B Slonim; Marguerite B McDonald

doi:10.2147/OPTH.S278169

Phentolamine Mesylate Ophthalmic Solution Provides Lasting Pupil Modulation and Improves Near Visual Acuity in Presbyopic Glaucoma Patients in a Randomized Phase 2b Clinical Trial

Clin Ophthalmol. 2021 Jan 8:15:79-91. doi: 10.2147/OPTH.S278169. eCollection 2021.

Authors

Jay S Pepose^{1

2}, Paul J Hartman³, Harvey B DuBiner⁴, Marc A Abrams⁵, Robert J Smyth-Medina⁶, Sayoko E Moroi⁷, Alan R Meyer⁸, Mina P Sooch⁸, Reda M Jaber⁸, Konstantinos Charizanis⁸, Seth A Klapman⁸, Arin T Amin⁸, Jonah E Yousif⁸, Eliot S Lazar⁹, Paul M Karpecki¹⁰, Charles B Slonim¹¹, Marguerite B McDonald¹²

Affiliations

¹ Pepose Vision Institute, St. Louis, MO, USA.
² Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA.
³ Department of Ophthalmology, University of Rochester, Rochester, NY, USA.
⁴ Clayton Eye Center, Morrow, GA, USA.
⁵ Case Western Reserve University, Cleveland, OH, USA.
⁶ North Valley Eye Medical Group, Mission Hills, CA, USA.
⁷ The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁸ Ocuphire Pharma Inc, Farmington Hills, MI, USA.
⁹ elCON Medical, Buffalo, NY, USA.
¹⁰ Kentucky College of Optometry, University of Pikeville, Pikeville, KY, USA.
¹¹ Oculos Development Services, LLC, Tampa, FL, USA.
¹² Department of Ophthalmology, New York University Langone Medical Center, New York, NY, USA.

Abstract

Purpose: Phentolamine mesylate ophthalmic solution (PMOS), applied to the eye topically, was shown previously to have beneficial effects in patients with dim light vision disturbances (DLD), including decreased pupil diameter (PD), improved best-corrected distance visual acuity (BCDVA), as well as lower intraocular pressure (IOP). The ORION-1 trial evaluated the long-term safety and efficacy of PMOS in a glaucomatous, presbyopic population.

Patients and methods: In this randomized, double-masked, multi-center, placebo-controlled, multiple-dose Phase 2b trial, 39 patients with elevated IOP were randomized to receive one evening dose of study medication or placebo for 14 days. The primary outcome measure was mean change in diurnal IOP, and the key secondary outcome measures included changes in PD, distance-corrected near visual acuity (DCNVA), and conjunctival hyperemia.

Results: Use of 1% PMOS did not lead to a statistically significant decrease in diurnal IOP compared to placebo (P = 0.89) but trended toward a greater decrease in patients with lower IOP baselines. PMOS produced a statistically significant mean 20% PD reduction under both photopic and mesopic conditions that was sustained for 36 hours post-dosing. A statistically significant number of patients with PMOS compared to placebo demonstrated ≥1 line of improvement in photopic DCNVA at day 8 (P = 0.0018), day 15 (P = 0.0072), and day 16 (P = 0.0163), with a trend for 2- and 3-line improvements at all time points. There was no statistical difference in conjunctival hyperemia compared to placebo.

Conclusion: Although mean IOP was not lowered significantly, daily evening dosing of 1% PMOS was found to be well tolerated with no daytime conjunctival redness and demonstrated improvement in DCNVA with sustained PD reduction in a glaucomatous and presbyopic population. Smaller pupil size can have beneficial effects in improving symptoms of presbyopia and DLD, which will be the focus of further studies.

Keywords: IOP; ORION-1; dim light vision disturbances; night vision disturbances; presbyopia; pupil diameter.