Pilocarpine shows promise for presbyopia but linked to mild side effects

A new systematic review and meta-analysis of randomized clinical trials suggests that pilocarpine, an FDA-approved eye drop for presbyopia, can significantly improve near vision, though it carries a higher risk of mild, transient side effects.

The review included 4 trials with 1,531 participants and compared pilocarpine with a vehicle solution. Results showed that 33% of patients using pilocarpine gained ≥3 lines in binocular distance-corrected near visual acuity versus 12% in the control group. Similarly, 63% of pilocarpine users gained ≥2 lines compared to 36% in controls.

However, pilocarpine was associated with increased rates of headache, blurred vision, and eye pain, alongside a reduction in pupil size. Most adverse events were reported as mild and temporary.

Researchers concluded that pilocarpine provides short-term improvements in near vision but emphasized the need for larger, longer-term studies to confirm its safety and optimize dosing strategies.