Presbyopia drops have expanded quickly over the last few years, including a new FDA approval already in 2026. This week, we’re revisiting and updating our guide to presbyopia drops. What’s the latest? What’s in the pipeline? What do you need to know?
Pharmacologic treatments for presbyopia promise to give patients freedom and flexibility in the midst of busy careers and active lifestyles. They’re non-invasive, they’re adjustable, and they offer help in transitioning between near, intermediate, and distance vision. But patients miss the boat if optometrists don’t discuss it with them. Jacob Lang, OD, FAAO, called it out at CIME 2025 to Optometry Times:
Some of the barriers that patients run into with regards to pharmacologic correction and presbyopia … I think one of the biggest ones is their providers. It’s actually the doctors not knowing what options are out there with regards to pharmacologic correction and how those pharmacologic options might benefit their patients in their chairs. So furthering their education, embracing new things … I think that’s the biggest thing and the biggest barrier to patients getting access to these options.
Who are the best candidates?
Presbyopia drops tend to work best for patients who meet most of the following criteria:
- Early to moderate presbyopia, where near blur is present but not yet constant across all tasks
- Stable distance vision, whether emmetropic or well corrected with spectacles or contact lenses
- Patients seeking situational near-vision support for workdays, social events, or travel
- Post-refractive surgery patients who have good distance outcomes but are frustrated by the onset of presbyopia
Patients with significant cataracts, retinal pathology, or severe dry eye are not ideal candidates. Pupil size, while a factor, isn’t as critical as motivation and ocular health. Also at CIME 2025, Selina McGee, OD, FAAO, emphasized that it’s less about the perfect measurement and more about the patient’s willingness to try something new.
Drops can complement progressive lenses or monovision or multifocal contact lenses. And as bulleted above, they can support post-surgery patients or those seeking a temporary boost. McGee urged ODs to educate patients on combining options based on their lifestyle needs.
Here’s important context from Marc Bloomenstein, OD, FAAO, in his deep dive on presbyopia eye drops (which we recommend reading).
Presbyopia drops aim to restore near vision by targeting the size of the pupil and thus inducing an extended depth of focus. A very important and distinct feature to note is that we are not inducing accommodation; thus, there is not an enlargement of text on the page or screen, as you would experience wearing readers, for instance. When patients who have myopia look through a progressive lens or multifocal contact lens, they are magnifying the image. Presbyopia drops do not have the same magnifying effect and therefore, as with any new treatment, they have an adaptation curve. There is, and will be, an adaptive period that is needed to allow the visual system to align with these new modalities.
Available and emerging drops
Current options:
Vuity (pilocarpine 1.25%)
- The first FDA-approved presbyopia drop (2021)
- Works by inducing miosis to increase depth of field
- Uses a proprietary rapid pH-shifting mechanism (pHast™) designed to enhance absorption
- Onset: ~15 minutes, duration: up to 6 hours
- Common side effects: Headache, brow ache, eye redness, and reduced night vision due to pupil constriction
- No ocular surface lubricant in the formulation, which might contribute to stinging or burning on instillation, especially in patients with dry eye
- See Vuity prescribing information
Qlosi (pilocarpine 0.4%)
- FDA-approved in 2023
- Also induces miosis via pilocarpine
- Lower pilocarpine concentration → fewer side effects (and slower onset but greater comfort on instillation)
- Onset: ~20–30 minutes, duration: up to 6 hours
- Soothing vehicle formulation helps support the ocular surface
- Ideal for those who experienced discomfort with higher concentrations
- See Qlosi prescribing information
Another CIME 2025 attendee, Neda Shamie, MD, pointed out, “This new drop is really a two-in-one solution. It provides the visual benefits of pilocarpine while also supporting the ocular surface, which is often compromised in this demographic.”
Vizz (aceclidine ophthalmic solution) 1.44%
- FDA-approved in August 2025
- Uses aceclidine, a pupil-selective cholinergic agent, to induce miosis and increase depth of field
- Designed to limit ciliary muscle stimulation compared with pilocarpine-based drops
- Dose: Once daily using two sequential drops per eye from a single-dose vial
- Onset: ~30 minutes, duration: up to 10 hours
- See Vizz prescribing information
Yuvezzi (carbachol 2.75% / brimonidine tartrate 0.1%)
- FDA-approved in January 2026
- Fixed-dose combination of a cholinergic agonist (carbachol) and an alpha-adrenergic agonist (brimonidine)
- Designed to induce miosis and increase depth of field while moderating some miotic-related effects through combination therapy
- Dose: Once daily
- Onset: ~30 minutes, duration: 8–10 hours
- See Yuvezzi prescribing information
Recommended read: For a deeper dive into clinical implications of currently available drops, including ophthalmologist commentary, check out Options for Presbyopia Treatment Continue to Evolve, Healio
In the pipeline:
Current development in the presbyopia pipeline are focused less on expanding the field and more on refining durability, tolerability, and delivery. Here’s a few notables:
- Nyxol (phentolamine 0.75%) uses a different mechanism — alpha blockers — to modulate pupil size, with Phase III data reporting significant near-vision improvement and extended duration
- Microdosed delivery systems (such as Eyenovia’s MicroLine) are in development, using established pharmacologic agents delivered in smaller, more precise volumes
- Lens-softening agents (including LX-OPH-162) are also under investigation, although earlier in development as a non-miotic approach
A note on barriers:
Many of these newer therapies still lack long-term efficacy data. What has also become more explicit in newer clinical commentary is that the category lives or dies on patient experience. That includes headache rates, dimming complaints, redness, and night driving concerns, especially because these drops are elective, cash-pay treatments.
On the provider side, we expect some will wait to see which brands rise to the top. That, combined with a desire to wait for post-market experience, will likely be the main factors slowing widespread use.
This content is intended for educational purposes only and does not substitute for clinical judgment. Treatment decisions should be based on individual patient needs, professional guidelines, and a comprehensive clinical evaluation.
