Eye drops for close-up vision

Eye drops for age-related loss of close-up focus shrink the pupil, which deepens focus like a pinhole. Pilocarpine gives about one extra user in four or five a useful gain for a few hours, and aceclidine reports bigger, longer responses in company trials not yet published in a journal; all of them dim vision in poor light, and every efficacy figure comes from the makers. Pilocarpine carries a small retinal-detachment signal, and the one drug that tried to soften the lens failed.

Treat these drops as an occasional convenience, not a replacement for reading glasses. Have a dilated retinal exam before starting, especially if you are short-sighted, and don't rely on them for night driving.

How they work, and what "response" means

Presbyopia, the age-related loss of close-up focus, comes from the lens stiffening; see Vision decline with age. None of the approved drops changes the lens. They contract the pupil, so the eye gains depth of focus at the cost of letting in less light. Trials count a "responder" as someone who reads at least three more lines (15 letters) on a near chart without losing a line at distance.

Pilocarpine (Qlosi, formerly Vuity): a few hours, for a minority

Vuity (pilocarpine 1.25%, once daily), the first approved drop, was discontinued in the US in March 2026,^[1] but its trials remain the main evidence for pilocarpine. In a company-run randomised trial of 323 people aged 40–55, 30.7% were responders three hours after the drop on day 30, against 8.1% on a dummy drop. By six hours the figures were 18.4% against 8.8%, and by eight hours the difference was too small to rule out chance. It started working within 15 minutes. Five authors were employees of the maker, AbbVie.^[2] Pooling both of its main trials, responders fell from 39% at one hour to 10.5% at ten hours.^[3] A second daily dose extends the effect, with more headache (8.8% against 3.4%).^[4]
Qlosi (pilocarpine 0.4%, twice daily). In two pooled company-run trials of 613 people aged 45–64, 40.1% responded one hour after the drop against 19.1% on the dummy drop, but the trials lasted only two weeks.^[5]
Pooled analyses agree. A meta-analysis of four trials and 1,531 people found 33% responders against 12%, with headache about 7 percentage points more common, and more blurred vision and eye pain.^[6] A second meta-analysis rated the short-term benefit moderate certainty and found it fading from about four times the dummy-drop response rate at three hours to under twice at eight; its authors declare no competing interests.^[7]

Aceclidine (Vizz): larger responses, unpublished trials

Aceclidine 1.44% was approved in the US in July 2025. In its two six-week trials of 466 people aged 45–75, 71% responded three hours after the first dose against 8% on the dummy drop, and 65% against 12% on brimonidine, another eye drop used as the comparison; the label shows an effect lasting about ten hours. Side effects were common: eye irritation in about one in five, dim vision in 10–20% and headache in 10–12%.^[8] Pooled across five trials and 883 people, responders were about six times as frequent as on placebo, with about twice as many side effects but no more serious ones.^[9] As of October 2026 there is still no peer-reviewed report of the main trials.

Carbachol plus brimonidine (Yuvezzi): label data only

This combination was approved in the US in January 2026. Its figures are public only in the US label, not in a journal. After a single dose, 38.2% responded at one hour against 3.7% on the dummy drop, falling to 13.8% against 2.8% at six hours and 10.2% against 3.2% at eight. At eight hours the combination did no better than either ingredient alone. Eye irritation and headache affected more than one in ten. Its trials measured near vision without distance glasses, unlike the Vuity (pilocarpine 1.25%) and Vizz trials, so the numbers do not compare cleanly across drugs.^[10]

Drops that tried to change the lens

UNR844 (lipoic acid choline ester) aimed to soften the lens itself. An early trial of 75 people, funded by the developer, found 53.1% gaining at least ten letters against 21.7% on placebo, apparently lasting months after stopping.^[11] The larger follow-up trial in 234 people found no dose better than placebo, and the sponsor ended it in 2022.^[12]
Pirenoxine slowed the loss of focusing range in people in their 40s in a non-blinded pilot of nine treated and nine control participants aged 44–54: controls lost a little focusing power over six months and the treated group showed no detectable change. The inventors hold the patent, and the paper carries a 2020 erratum. It is not evidence that onset can be delayed.^[13]

Safety: retinal detachment and night driving

Retinal detachment is the serious concern. Case reports describe detachments within about five weeks of starting Vuity (pilocarpine 1.25%), including three eyes in two men aged 46 and 47.^[14] In US health records, 0.78% of people using pilocarpine had a detachment within a year, against 0.33% of matched people with presbyopia using artificial tears, about 2.3 times the risk. Short sight, male sex and thinning patches in the retina (lattice degeneration) were also risk factors. This is observational and the pilocarpine group was not limited to the near-vision product.^[15] The Qlosi, Vizz and Yuvezzi labels all advise a retinal examination before starting, and immediate medical care for sudden flashes of light, floaters or vision loss.^[16]^[17]^[18] Other urgent eye symptoms are listed in when to get same-day care.

Dim vision in poor light follows from a smaller pupil. Labels warn of "temporary dim or dark vision" and possible focusing spasm, and advise care with night driving and hazardous work in poor light.^[19] This matters for a midlife eye that already gets less light; see night driving.

Who might suit them

Someone in their 40s or early 50s who wants to read a menu or a phone for a few hours without glasses, mostly in good light, and who has had a dilated retinal exam. They are a poorer fit for anyone who is short-sighted, has known retinal thinning or drives a lot at night. No trial has compared drops with reading glasses, and none has efficacy data beyond six to twelve months.

US cash prices, 2026: Qlosi about US$79–109 per 30 single-use vials;^[20] Vizz US$79 for a monthly 25-pack at its 2025 launch;^[21] Yuvezzi US$79 for 30 single-use vials.^[22]