title: Clinical outcomes of combined versus separate carbachol and brimonidine drops in correcting presbyopia.
abstract: BACKGROUND
  To test and compare in a masked fashion the efficacy of using a parasympathomimetic drug (3% carbachol) and an alpha-2 agonist (0.2% brimonidine) in both combined and separate forms to create optically beneficial miosis to pharmacologically improve vision in presbyopia.
  
  
  METHODS
  A prospective, double-masked, randomized, controlled clinical trial was conducted. Ten naturally emmetropic and presbyopic subjects between 42 and 58 years old with uncorrected distance visual acuity of at least 20/20 in both eyes without additional ocular pathology were eligible for inclusion. All subjects received 3% carbachol and 0.2% brimonidine in both combined and separate forms, 3% carbachol alone and 0.2% brimonidine (control) alone in their non-dominant eye in a crossover manner with one week washout between tests. The subjects' pupil sizes and both near and distance visual acuities will be evaluated pre- and post-treatment at 1, 2, 4, and 8 h, by a masked examiner at the same room illumination.
  
  
  RESULTS
  Statistically significant improvement in mean near visual acuity (NVA) was achieved in all subjects who received combined 3% carbachol and 0.2% brimonidine in the same formula compared with those who received separate forms or carbachol alone or brimonidine alone (P< 0.0001).
  
  
  CONCLUSIONS
  Based on the data, the combined solution demonstrated greater efficacy than the other solutions that were tested. Improving the depth of focus by making the pupil small caused statistically significant improvement in near visual acuity, with no change in binocular distance vision.
  
  
  BACKGROUND
  ACTRN12616001565437. Registered 11 November 2016.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
authors.forename: Almamoun
authors.initials: A
authors.lastname: Abdelkader
authors.affiliation: Department of Ophthalmology, Louisiana State University Eye Center, LSU Medical School, New Orleans, LA USA.
authors.forename: Herbert E
authors.initials: HE
authors.lastname: Kaufman
keywords: Brimonidine; Carbachol; Depth of focus; Miosis; Presbyopia