The End of Reading Glasses? Inside the Eye Drops Revolution for Aging Eyes

What is Presbyopia?

Presbyopia, often called “age-related farsightedness”, is a natural part of aging that is caused by the gradual loss of the eye’s ability to focus on near objects, like when reading or looking at a phone. It occurs because the crystalline lens inside the eye becomes stiffer with age, and the surrounding muscles lose some elasticity. This affects nearly everyone over 40, impacting over a billion people worldwide.

For decades, the main solutions have been reading glasses, bifocals, contact lenses, or surgical procedures that reshape the cornea or replace the lens. While effective, these methods can be inconvenient or carry risks, such as dry eye, dependence on glasses, or surgical complications.

Recently, researchers have been exploring pharmacological (drug-based) treatments, specifically, eye drops that can temporarily restore near vision without surgery or permanent alteration. These treatments have drawn significant attention because they offer a non-invasive, reversible, and convenient alternative to glasses or surgery.

How the New Eye Drops Work

Pharmacological treatments for presbyopia mainly fall into two categories: miotics and lens softeners:

Miotics are drugs that cause the pupil to constrict, producing a “pinhole effect.” This reduces the amount of unfocused light entering the eye, which enhances depth of focus, much like a small camera aperture sharpens an image. The improvement in near vision is noticeable within minutes and can last for several hours, although the effect wears off as the pupil returns to its normal size.

Lens softeners, on the other hand, were developed to address the root cause of presbyopia, which is the hardening of the lens. They aim to restore the lens’s flexibility and natural focusing ability. However, recent clinical trials of promising compounds like UNR844 (EV06) and STN1013600 (ursodeoxycholic acid) did not achieve statistically significant improvements, leading companies such as Novartis and Santen to halt their development programs.

Thus, while the concept of reversing presbyopia pharmacologically remains appealing, current progress primarily focuses on miotic eye drops, which provide temporary relief but do not reverse the aging process of the lens.

FDA-Approved Treatments

A breakthrough occurred with the U.S. FDA approvals of pilocarpine-based eye drops, the first-ever drugs specifically approved for presbyopia.

Pilocarpine 1.25% (Vuity), approved in 2021, is a cholinergic agonist that acts on the eye’s muscarinic receptors to constrict the pupil. Clinical trials demonstrated that Vuity significantly improved near vision by about three lines on a vision chart within 15 minutes, and the effect lasted for roughly 6 hours. Importantly, it did not affect distance vision in most users. However, some participants reported mild side effects, including headaches, redness, and eye pain.

In 2023, a lower-dose formulation, Pilocarpine 0.4% (Qlosi), also gained FDA approval. This version can be used twice daily, extending near vision improvement for up to 8 hours. The phase 3 NEAR-1 and NEAR-2 clinical trials confirmed its safety and efficacy, with milder side effects and better tolerability than the higher-dose version.

These approvals represent a major step forward: patients can now treat presbyopia with a simple daily or twice-daily drop rather than relying solely on reading glasses.

Safety and Risks

Although miotic eye drops have opened a new era in vision correction, there is a subject of safety monitoring, especially for individuals with existing eye conditions. Because pilocarpine stimulates the ciliary muscles and alters the shape of the lens, it can slightly move structures inside the eye, particularly the vitreous and retina.

In rare cases, this can lead to retinal tears or detachments, particularly in individuals with high myopia (nearsightedness) or lattice degeneration. While these events are uncommon, ophthalmologists are advised to examine the retina before prescribing the drops and to educate patients about warning symptoms like sudden flashes, floaters, or loss of peripheral vision.

Other mild, short-term effects include headaches, blurred vision, and light sensitivity. Chronic use might theoretically lead to inflammation or “fixed” pupils, but such outcomes have not been documented in presbyopia studies so far. Overall, pilocarpine drops are considered safe when used correctly and monitored appropriately, but long-term data are still limited.

References

1.     Grzybowski A, Kapitanovaite L, Zemaitiene R. An updated systematic review of pharmacological treatments for presbyopia. Adv Ophthalmol Pract Res. 2024;4(4):220-225. Published 2024 Sep 3. doi:10.1016/j.aopr.2024.09.001

2.     Wolffsohn JS, Davies LN. Presbyopia: Effectiveness of correction strategies. Prog Retin Eye Res. 2019;68:124-143. doi:10.1016/j.preteyeres.2018.09.004

3.     Ishikawa H, DeSantis L, Patil PN. Selectivity of muscarinic agonists including (+/-)-aceclidine and antimuscarinics on the human intraocular muscles. J Ocul Pharmacol Ther. 1998;14(4):363-373. doi:10.1089/jop.1998.14.363

4.     Mullard A. FDA grants first US approval for decades-old eye drug. Nat Rev Drug Discov. 2025;24(9):655. doi:10.1038/d41573-025-00138-3

5.     Korenfeld MS, Robertson SM, Stein JM, et al. Topical lipoic acid choline ester eye drop for improvement of near visual acuity in subjects with presbyopia: a safety and preliminary efficacy trial. Eye (Lond). 2021;35(12):3292-3301. doi:10.1038/s41433-020-01391-z

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