Study evaluates pilocarpine 1.25% for presbyopia management

Pilocarpine 1.25% eye drops significantly improve near and intermediate vision in presbyopic patients, but concerns remain regarding side effects, including headaches and rare retinal complications, according to a study. More extensive and long-term studies are needed to confirm its safety and effectiveness in broader patient populations.

Data from 3 randomized controlled trials (RCTs) involving 980 participants aged 40-55 years were included, with 489 patients receiving pilocarpine and 491 in the control group. The Gemini 1 and 2 trials used the drops once daily, while the Virgo trial administered them twice daily. Results showed a significant improvement in near and intermediate vision in the pilocarpine group compared to controls (P < 0.01). However, headaches were the most frequently reported adverse event (13.49%). Severe complications were also documented in 3 cases, including vitreomacular traction and retinal detachment.

Reference
Singh M, Sinha BP, Dutta S, et al. A Systematic Review and Meta-Analysis on the Efficacy and Safety of Topical Pilocarpine 1.25% in Presbyopia Treatment. J Curr Ophthalmol. 2025;36(2):111-121. doi: 10.4103/joco.joco_262_23. PMID: 40012805; PMCID: PMC11856121.