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While it may not be ready yet, the presbyopia drop market is also not failing
By Kyle Klute, OD
July 31, 2026
C.S. Lewis had a name for the reflex that treats “newer” as a synonym for “better”: chronological snobbery. It’s the uncritical assumption that whatever is current must be an improvement on whatever came before it. Optometry is supposedly an evidence-based profession, immune to that kind of thinking. In practice, however, we fall for it as often as any other clinician and get caught up in the hype (or hubris) of “new.”
Presbyopia drops are a good test case because the industry has already written the story it wants prescribers to believe. Four FDA-approved options now exist where none did a decade ago, and if optometrists would just talk about these drops more, the category would take off. The science behind each drop is real, and each is effective in its own unique way, which is genuinely helpful for us to differentiate patient by patient. But that story doesn’t survive contact with the actual numbers. The more useful question is this: Is the market ready?
Where things stand
VIZZ (aceclidine 1.44%, LENZ Therapeutics) launched in October 2025. Per the company’s first quarter 2026 earnings release, it had generated roughly 46,000 cumulative paid prescriptions through Q1, $1.7 million in quarterly product revenue (up 19% over the prior quarter), and more than 10,000 prescribers, backed by a national DTC campaign fronted by Sarah Jessica Parker since January. That’s real traction for a new category. It’s also modest against a market the company sizes at 128 million presbyopes.
YUVEZZI (carbachol/brimonidine, Tenpoint Therapeutics) went broadly available at the end of March and launched its own national consumer campaign in late June. Qlosi (pilocarpine 0.4%, Orasis) has been on the market since spring 2025 and remains the conservative, best tolerated entry. Vuity (pilocarpine 1.25%, AbbVie), the category’s 2021 pioneer, still hasn’t generated enough revenue for AbbVie to break it out in their quarterly filings.
Why the sales numbers look the way they do
The convenient explanation is that optometrists are slow adopters, and we’ve been here before with myopia management and dry eye. There’s some truth to that. We, optometrists, often are the bottleneck. But it doesn’t hold up as the whole story, because the competing product isn’t another drop. It’s a $10 pair of readers from the pharmacy aisle: no prescription, no headache, no dimming, no daily compliance burden.
The cost comparison matters more than it looks on paper. Readers are a one-time purchase in a patient’s mind. A presbyopia drop is a recurring monthly expense, out of pocket, for as long as the patient wants the effect. I’ve found that distinction carries more weight with patients than the sticker price of either option alone: An ongoing monthly cost is fatiguing in a way a one-time purchase isn’t, even when the annual math might favor the drop.
Put in NNT terms, since I can’t help myself: The number needed to treat for an OTC reader or a properly prescribed progressive lens to improve near vision by three or more lines is one. That’s full efficacy, felt immediately, for almost nothing up front and no recommitment.
So, the drops aren’t failing to find a market. They’re finding their actual market: Motivated patients who want to avoid readers specifically, who tolerate mild visual side effects and who are willing to pay an ongoing cost for it. That market exists. It’s simply smaller than the proposed 128 million by these companies.
What would actually move this
Three things, in order of how much control our profession has over them.
- We need to actually know the three drops well enough to match the right one to the right patient on the first try, rather than defaulting to whichever one a rep mentioned last. Qlosi, VIZZ and YUVEZZI differ in onset, duration, pupil effect and side effect profile, and those differences should drive the recommendation. A patient handed the wrong drop, who has a bad first experience and quits, isn’t evidence the category doesn’t work. But that’s how it gets remembered, by the patient and often by the prescriber too.
- The category needs sustained consumer education, and that’s largely out of our hands. LENZ and Tenpoint spending against each other builds general awareness that the category exists, benefiting both companies and the rest of the options too. Whether that spend continues past this year, or gets pulled back the way AbbVie pulled back on Vuity, will tell us more about the market’s trajectory than any single quarter’s script counts.
- Distribution is starting to shift. LENZ recently began allowing prescribers to sell and dispense VIZZ directly out of their own practice, where state law permits it, rather than routing every prescription through specific pharmacies. Rules vary considerably by state, so this isn’t available everywhere yet. But if it spreads, it removes a step between prescribing and getting the drop into a patient’s hands, and puts the revenue back in the optometrist’s office rather than the pharmacy.
Distribution experiments
The category is running two distribution experiments in opposite directions, and both are worth watching. LENZ has expanded VIZZ access on two fronts: in-office dispensing where state law permits it, and, as of July 2026, a telehealth platform through VIZZ.com connecting patients to an independent network of contracted ECPs, with prescriptions routed to LENZ’s own epharmacy partner for home delivery. No existing relationship with an eye doctor is required.
Orasis has taken the opposite bet with Qlosi: in-office dispensing plus a no cost first fill through pharmacy partner BlinkRx, built around the patient’s own prescribing ECP rather than telehealth, and points to a 48% refill rate, roughly double what’s typical for dry eye prescriptions at retail, as evidence that anchoring the relationship to the patient’s own doctor works.
Both are solving the same problem, getting the drop into more hands, from opposite directions. One treats the eye doctor visit as a barrier to remove. The other treats it as the reason patients stay on the drug. Which philosophy wins, or whether they simply serve different patient populations, is the more interesting question right now.
The honest takeaway
The drops are real, each effective in its own particular way, and the market is smaller and slower than the launch projections assumed. That has more to do with the strength of the existing alternative, a cheap and complete fix that asks for one purchase instead of a monthly one, than with anyone’s marketing failure. New categories get built over years, not launch quarters, but that’s worth saying plainly instead of waiting for the next earnings call to say it for us.
Being clear-eyed about that isn’t pessimism. It’s what a good prescriber owes a new therapy: fair evaluation now, not the assumption that new means arrived and not the assumption that slow means dead.
Dr. Klute will explore a deeper look at each presbyopia drop in a follow-up story. Stay tuned.
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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 |
