Pharmacological Therapy for Presbyopia (Age-related Farsightedness): New Developments

  • Man with very long arms and binoculars as a humorous example of presbyopia (age-related farsightedness)

Presbyopia (age-related farsightedness) affects many people from around the age of 45: Reading becomes more difficult, arms become “too short,” and good lighting suddenly gains importance. Ophthalmological institutes, often part of large international chains, frequently advertise operations on the internet to replace the healthy—yet age-relatedly inelastic—eye lens. However, in addition to glasses, contact lenses, or surgical procedures, there are now also eye drops as a reversible, pharmacological option to improve near vision. The most important active ingredient for this is Pilocarpine.

Pilocarpine slightly constricts the pupil, thereby increasing depth of field—similar to a camera with a small aperture. What’s interesting for patients is that Pilocarpine is not a new active ingredient. It has been used for many decades in glaucoma therapy. Its side effect profile is therefore very well known. Only its application in the low dosage range for the treatment of presbyopia is new.

Approved Preparations

Two pilocarpine-containing preparations are already approved in the USA:

• Vuity (Pilocarpine 1.25%): since 2021, as the first medication specifically for presbyopia therapy.

• Qlosi (Pilocarpine 0.4%, known as CSF-1 in studies): since 2025, preservative-free and with flexible dosing.

Both improve near vision for several hours without significantly disturbing distance vision.

New Active Ingredients and Ongoing Studies

In addition to Pilocarpine, other new substances are continuously being investigated. Therefore, for those of our patients who wish to delve deeper into the subject, here is a brief overview of the new preparations currently under development:

• Aceclidine (VIZZ): approved in the USA in 2025; constricts the pupil but with less influence on the ciliary muscle, and therefore less tension in the forehead and temple area.

• Combinations such as Brimochol PF (Carbachol + Brimonidine) or Nyxol (Phentolamine) are in advanced studies and aim for longer duration of action or better tolerability.

Approval Status in Europe

In Europe, the mentioned preparations are currently not yet approved. Approval procedures are underway or have been announced. When they will be available in Austria cannot yet be said with certainty. However, a so-called “off-label prescription” is currently possible after appropriate consultation.

Conclusion for Our Patients

Pilocarpine drops can situationally replace reading glasses and are well-researched due to decades of experience in glaucoma therapy. New active ingredients will offer additional options in the near future and will again displace surgeries on the age-appropriately healthy eye lens. We are therefore currently very cautious regarding surgical procedures for the correction of presbyopia, and we advise our patients to await current developments before deciding on an irreversible surgical intervention. We would be happy to clarify whether pharmacological presbyopia therapy is suitable for you in a personal consultation.

Photo Header Image: © paul prescott, Adobe Stock