The Future of Presbyopia Drops

An update on the expanding category of topical drugs to treat presbyopia.

By
Jennifer Ponte Canning, Managing Editor
April 1, 2025
8 min

Ophthalmology Management

Overview

Since the FDA approval of Vuity in 2021, the presbyopia eye drop category has expanded with new agents like Qlosi gaining approval and others in late-stage development. These drops improve near vision by pupil constriction with varying mechanisms and safety profiles, offering promising non-surgical options for presbyopia management.

Background

Presbyopia, an age-related decline in near vision, traditionally requires corrective lenses or surgery. The approval of Vuity (pilocarpine hydrochloride 1.25%) introduced the first pharmacologic treatment, stimulating iris sphincter contraction to improve near and intermediate vision. Subsequent agents such as Qlosi and novel formulations like LNZ100 and Brimochol PF are advancing through clinical trials, aiming to enhance efficacy, duration, and tolerability. These developments reflect a growing pipeline targeting different mechanisms to address presbyopia in diverse patient populations.

Data Highlights

Drug	Active Ingredient	FDA Approval	Mechanism	Onset	Duration	Key Trial Results
Vuity	Pilocarpine HCl 1.25%	2021	Cholinergic muscarinic agonist; pupil constriction	~15 minutes	6-8 hours	≥3 lines DCNVA gain without >1 line CDVA loss at day 30 (GEMINI 1 & 2)
Qlosi	Pilocarpine HCl 0.4%	2023	Cholinergic agonist; pupil constriction	15-20 minutes	Up to 8 hours	≥3 lines DCNVA gain without >1 line CDVA loss (NEAR 1 & 2)
LNZ100	Aceclidine 1.75%	NDA accepted 2024	Pupil-selective miotic; miosis <2 mm without myopic shift	30 minutes	Up to 10 hours	71% achieved ≥3 lines improvement at 30 min; 40% maintained at 10 hr (CLARITY)
Brimochol PF	Carbachol 2.75% + Brimonidine 0.1%	NDA planned 2026	Miotic + alpha-2 agonist; pupil constriction with reduced side effects	Not specified	Up to 8 hours	Statistically significant near vision improvement vs vehicle (BRIO-I & II)
Ryzumvi	Phentolamine 0.75%	Approved 2023 (for mydriasis reversal)	Nonselective alpha-1/2 antagonist; reduces pupil size	Under investigation	Under investigation	Phase 3 VEGA-3 ongoing for presbyopia

Key Findings

Vuity, the first FDA-approved presbyopia drop, improves near vision within 15 minutes lasting 6-8 hours, with a favorable safety profile but limited to patients under 55 with early presbyopia.
Qlosi, approved in 2023 but not yet marketed, offers similar efficacy at a lower pilocarpine dose and uses preservative-free single-use vials to reduce ocular surface toxicity.
LNZ100 shows promise as a pupil-selective miotic that avoids myopic shift, with prolonged efficacy up to 10 hours and NDA submission accepted by FDA.
Brimochol PF combines carbachol and brimonidine to enhance near vision while potentially reducing miotic-related side effects like headache, targeting patients over 55.
Ryzumvi, originally approved for mydriasis reversal, is under phase 3 investigation for presbyopia treatment by selectively reducing pupil size without affecting accommodation.
Side effects across agents commonly include headaches, blurred vision, and eye irritation; rare but serious risks like retinal detachment have been reported with pilocarpine drops.

Clinical Implications

Presbyopia eye drops represent a non-invasive alternative to glasses or surgery, particularly beneficial for early presbyopes with minimal refractive error. Clinicians should consider patient age, presbyopia severity, and ocular history when selecting therapy, monitoring for side effects such as accommodative spasm and retinal complications. Emerging agents with improved tolerability and longer duration may expand treatment options for older patients and those with advanced presbyopia.

Conclusion

The presbyopia drop landscape is rapidly evolving, with multiple FDA-approved and investigational agents offering tailored mechanisms to improve near vision safely and effectively. These pharmacologic therapies have the potential to transform presbyopia management by providing convenient, reversible, and preservative-free options.