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A closer look at the options in the presbyopia drop market and practical prescribing advice
By Kyle Klute, OD
August 31, 2026
Is the market ready for presbyopia drops? Are we, optometrists, the real bottleneck in this seemingly vast and untapped market of presbyopes?
I attempted to answer those questions last month in my column Is the Presbyopia Drop Market Ready?
This month, I’d like to move from philosophical to practical and evaluate the claims of each new drop on the market and help us, as clinicians, apply the current evidence on those drops to clinical practice. Essentially, if we have a patient in the chair who is a good fit and eager to try a non-surgical, non-optical product to improve their near vision, how should we arrive at the right decision for our patients?
Whenever I create a clinical protocol for my practice or teach other doctors on various topics in disease detection and management, I think in terms of building habits (two of my favorite books on the subject are “Atomic Habits” by James Clear and “The Power of Habit” by Charles Duhigg).
Essentially, a habit begins with a trigger or cue, which leads to a routine, followed by a reward. We can apply this insight to our prescribing behavior in clinical practice. Let’s apply it to the presbyopia drops.
Before we get into cues, here’s how the three stack up, side by side.
| Qlosi® | Vizz® | Yuvezzi™ | |
| Active drug | Pilocarpine 0.4% | Aceclidine 1.44% | Carbachol 2.75% / brimonidine 0.1% |
| Dosing | 1 drop, may repeat at 2-3 hours; daily or PRN | 2 drops, 2 minutes apart, once daily | 1 drop, once daily |
| Onset / duration | ~20 min onset; up to 8 hrs with second dose | ~30 min onset; effect through 10 hrs | ~30 min onset; effect through 8 hrs |
| Pupil effect | Moderate, ~2.3-2.5mm | Most aggressive, sub 2.0mm | Moderate, ~2.0-2.5mm |
| Most common side effects | Instillation pain/headache 5-8%; blurred vision 2-5% | Instillation irritation 20%; dim vision 16%; headache 13% | Headache/irritation 10-16%; notably less redness than carbachol alone |
Cue
What cues am I looking for? What do I need to see or hear from my patient that will trigger my recommendation?
VIZZ®: longer lasting, higher SE profile, greatest effectiveness = patient attempting a full replacement and complete avoidance of spectacle correction for near. May be used in conjunction with SV correction, whether glasses or contact lenses. In CLARITY-2, 71% of patients gained three or more lines of near vision at three hours, dropping to 40% by ten hours, alongside the highest reported rates of dimming (16%) and irritation (20%) in the category.
YUVEZZI™: moderate duration, moderate SE profile, moderate effectiveness = patient who wants most of a full workday without VIZZ’s degree of dimming, especially one who cares about how their eyes look day to day. Brimonidine in the formulation meaningfully cuts the ocular redness carbachol causes on its own, 2.8% versus 10.7% with carbachol alone in BRIO II. Reasonable landing spot for a patient who backs off VIZZ once dimming and irritation rates come up.
QLOSI®: shortest duration per dose, best tolerated SE profile, most flexible dosing = patient who’s curious but hesitant, wants an occasional option rather than an everyday commitment or simply wants to test whether they like the effect before going further. PRN or twice daily dosing lets them use it for a dinner out or a heavy screen afternoon rather than committing to daily use. The tradeoff is a shorter window, up to 8 hours, and only with the second dose.
Routine
Once the cue is recognized, a communication routine should start. I like the five-step sales formula from Donald Miller and his book, “How to Grow Your Small Business“:
- Name and empathize with the patient’s problem
- Position your product as the solution
- Explain a clear path to that solution
- Note what happens if they don’t choose it
- Call them to action
It could go something like this: “Mr. Smith, you are not alone in your frustration with worsening close up vision. It happens to everyone, and like you, many people find it difficult to adapt to multifocal lenses or carry readers everywhere they go. Good news: We now have several drops, yes, drops, that help you see better up close without affecting your distance vision. All you have to do is get a prescription, put the drops in 20 to 30 minutes before you think you’ll need them, and go several hours without reaching for your readers. This will likely keep getting worse, and you’ll only become more dependent on reading glasses over time. If you’re struggling with your near vision, this is worth trying. Would you like to give it a shot today?”
Reward
The reward is the “yes,” but the real payoff comes later: the follow-up call or the next visit where a patient tells you, unprompted, that they went a full day without hunting for their readers. That’s the moment the loop closes, and it’s what makes you reach for this same pitch with the next patient who fits the pattern.
If the answer is no, treat it as information rather than a dead end. It usually means the cue was misread or the routine undersold the tradeoffs. Adjust one or the other before running the same pitch on the next patient. Each drop calls for a slightly different profile and approach, and the habit loop only works if you’re matching the right one to the right person.
As I concluded last month, I don’t believe optometrists are the bottleneck in the slow uptake of these drops. But we could become one, and the stakes for getting the cue, routine and reward right are higher than they first appear. This isn’t just a communication exercise. It’s what determines whether a legitimate, well-differentiated option actually reaches the patient sitting in front of us. If we skip it, the companies that made these drops won’t be the ones who feel it. The patient who never heard there was an option beyond glasses, contacts and reading glasses will be.
Read more from The Aging Eye here.
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Kyle Klute, OD, is the owner of Good Life Eyecare, a multi-location full-scope practice with locations in Nebraska and Iowa. He is also the founder of Optometry Simplified, a weekly newsletter delivering no-hype, practical and tactical resources to help optometrists run stronger practices. To contact him: kyle.klute@practiceperformancepartners.com |
