In part 3 of a video series focused on presbyopia, the panel reviews the evolution of FDA-approved presbyopia-correcting eye drops, from Vuity as the first approved therapy to newer options such as Qlosi and Vizz, as well as the newest available option, Yuvezzi. The panel highlights key treatment considerations and discusses lessons learned from earlier therapies and how newer formulations, particularly Yuvezzi, aim to improve tolerability and duration while minimizing ocular redness.
Nathan Lighthizer, OD, FAAO:
We’ve had readers and we’ve had contact lenses for a long time and some surgical options, but the presbyopia-correcting drops are fairly new within the last 5 years. The first FDA-approved presbyopia drop was pilocarpine 1.25%. You all know that that is as Vuity. It was FDA-approved in 2021. A couple of years later, we had pilocarpine 0.4% released by Orasis, that’s known as Qlosi. Then we had aceclidine, known as Vizz, that was FDA-approved in 2025.
Our most recent FDA-approved presbyopia drop, Yuvezzi, which is a dual-agent treatment combination of carbachol and brimonidine. All of these are working on the pupil. They’re modulating the pupil to work on that pinhole effect, enhancing depth of field and depth of focus. The FDA-approved guidelines or the endpoints they wanted to meet were improving at least 3 lines of near visual acuity without affecting that distance acuity as well.
Dr. Mah, I’m going to kick it back to you. You said you were fairly heavily involved in some of the earlier ones, Vuity and Qlosi. Give us your comments on data points that were interesting to you from each of the trials, maybe with Vuity and comment on Qlosi as well and the strengths and weaknesses of those.
Francis Mah, MD:
Yeah, I think it’s always hard for the first. In this case, Vuity was the first of its class for presbyopia. I think it was very effective. The data points that I think are important for all of them are, as you mentioned, that 3-line improvement. I think the other things that people really want, people want a long-acting agent, and these are things that we’ve learned over the past 5 years, 6 years as these drugs have launched. People want something that will be there for a long time. People want something that’s not going to affect their other types of vision, their distance vision, for example. It was wise of the FDA to have not only an improvement in your near vision, which is obviously the goal of these medications, but also not to impact the distance vision. I think those were key endpoints that, in fact, all of these medications have met.
Some of the learnings have been that we would like something that’s going to be a little bit longer-acting. Obviously, safety is going to be a huge issue with all of these drugs since this is kind of a lifestyle thing. We don’t want to trade off safety for some improved lifestyle. We want to make sure that it’s impeccably safe and it’s not going to cause any harm. I think the fact that these were kind of the real initial watershed moment where we’ve got these FDA-approved drugs was enormous. I think there’s been a lot of learning over the past several years regarding who is a good candidate, how to advise patients to use this, how patients are actually using these medications. I think these are all very important learnings that we’ve had over the past 5, 6 years.
Nathan Lighthizer, OD, FAAO:
Certainly, it’s not easy to be the first one in anything it is. You’re really trailblazing and learning and learning from successes, but also learning from failures as well. It’s never easy to be one of the first ones. Vuity certainly paved that path followed by Qlosi and Vizz as well.
Dr. McDonald, I’m going to come to you next and then we’ll come to Dr. Brujic on Yuvezzi. Your thoughts, Dr. McDonald, on Vuity, Qlosi, Vizz, things that have interested you regarding those first 3 medications that were FDA-approved. Your thoughts on those available options.
Marguerite McDonald, MD, FACS:
Well, Vuity, as we all know, is rarely prescribed now. I’m not even sure it’s available, actually. Unfortunately, it died in the marketplace because there were some very early retinal detachments. Now, I was part of a group of ophthalmologists that took a deep dive into those cases. Turned out, over half of them were prescriptions for Vuity that someone got from their dermatologist or psychiatrist or their boyfriend who was a doctor, by non-eye doctors. They hadn’t been screened. They hadn’t had a dilated retinal exam. Several of them had a history of retinal detachment, history of retinal tears that had been sealed off with a laser, the worst possible candidates. We all learned the hard way. Non-eye doctors stopped prescribing for these drops, but unfortunately Vuity paid the price for being the first one, as you say.
The others do work. They make the eyes red. A lot of people buy a bottle of Lumify at the same time, but they do work and each of them has a following in the marketplace.
I must say Yuvezzi is different in that the eyes do not become red because of the brimonidine component. With each generation comes a better and better formulation. Yuvezzi being the most recent, I would have to say, because of the combination, it gets the job done, prevents dilation of the pupil while it also constricts the pupil. It increases the amount of drug that gets into the anterior chamber. It’s longer lasting and the eyes stay white. Some very strong positive points for Yuvezzi.
Nathan Lighthizer, OD, FAAO:
Yeah, I think we have better antibiotics than we did decades and decades ago. The newer versions of anything, glaucoma medications, antibiotics, we evolve and technology evolves and these pharmaceuticals learn and get better and better as well.
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