Recent Non-Surgical Advances in Management of Presbyopia

Presbyopia is an age-related decrease in the eye’s ability to focus on near objects, affecting nearly all individuals over 40 years of age. Increasing life expectancy and greater dependence on digital devices have increased their impact on quality of life. Recent non-surgical advances include improved multifocal optical correction and pharmacological therapies, such as pilocarpine and aceclidine-based eye drops, which enhance near vision by increasing the depth of focus. Emerging lens-softening therapies aimed at restoring accommodation are currently being investigated. However, no current treatment fully restores natural accommodation with long-term safety and efficacy. Future therapies are expected to focus on personalised, restorative treatment approaches to improve vision and quality of life in patients with presbyopia.
This review focuses on contemporary non-surgical approaches to presbyopia, highlighting recent developments in pharmacological eye-drop therapy and important considerations for patient selection and treatment initiation.

Presbyopia, Loss of accommodation, Non-surgical, Pilocarpine, Contact lenses

1. Kierstan Boyd and J Kevin McKinney MD. “What is Presbyopia?” American Academy of Ophthalmology (2020) [Google Scholar] [Crossref]

2. Bourne R, Steinmetz JD, Flaxman S, Briant PS, Taylor HR, Resnikoff S, et al. Trends in the prevalence of blindness and distance and near vision impairment over 30 years:An analysis of the Global Burden of Disease Study. Lancet Glob Health. 2021;9:e130–43. doi: 10.1016/S2214-109X(20)30425-3 [Google Scholar] [Crossref]

3. Kleinstein RN. “Epidemiology of presbyopia.” In: Stark L, Obrecht G, eds. Presbyopia: recent research and reviews from the third international symposium. New York: Professional Press Books(1987):12-18 [Google Scholar] [Crossref]

4. Holden BA, Fricke TR, Ho SM, et al. Global vision impairment due to uncorrected presbyopia. Arch Ophthalmol. 2008;126(12):1731–1739. doi: 10.1001/archopht.126.12.1731 [Google Scholar] [Crossref]

5. Fricke T.R., Tahhan N., Resnikoff S., Papas E., Burnett A., Ho S.M., Naduvilath T., Naidoo K.S. Global Prevalence of Presbyopia and Vision Impairment from Uncorrected Presbyopia: A Systematic Review, Meta-analysis, and Modelling. Ophthalmology. 2018;125:1492–1499. doi: 10.1016/j.ophtha.2018.04.013. [Google Scholar] [Crossref]

6. Jain BK, Jain E, Kuyyadiyil S, Sen A, Sood D and Bajaj A (2020). High-volume and high-quality eye care : Bridging the paradox. A unique rural based approach : The Chitrakoot model. Indian J Ophthalmol. 68(2): 294–298, [Google Scholar] [Crossref]

7. Mancil G., Bailey I., Brookman K. Optometric clinical practice guideline care of the patient with presbyopia. Ref. Guide Clinicians. Am. Optom. Assoc. 2011;1:458. [Google Scholar] [Crossref]

8. Patel I and West SK (2007). Presbyopia: prevalence, impact, and interventions. Community Eye Health J. 20(63): 40–41. [Google Scholar] [Crossref]

9. Adeyemi O and Bekibele CO (2020). Prevalence, correction coverage, unmet need, and impact on the quality of life of presbyopia among market traders in Ibadan, Nigeria. Afr J Biomed Res. 23 Suppl 1: 75–79. [Google Scholar] [Crossref]

10. Government of India. National Programme for Control of Blindness and Visual Impairment. Pattern of assistance under the National Programme for Control of Blindness and Visual Impairment during 2017-2020. New Delhi [Google Scholar] [Crossref]

11. Charman W.N. Developments in the correction of presbyopia II: Surgical approaches. Ophthalmic Physiol. Opt. 2014;34:397–426. doi: 10.1111/opo.12129 [Google Scholar] [Crossref]

12. Waring G.O.I.V. Diagnosis and treatment of dysfunctional lens syndrome. Cataract. Refract. Surg. Today. 2013;13:36–38 [Google Scholar] [Crossref]

13. Wolffsohn J.S., Davies L.N. Presbyopia: Effectiveness of correction strategies. Prog. Retin. Eye Res. 2019;68:124–143. doi: 10.1016/j.preteyeres.2018.09.004 [Google Scholar] [Crossref]

14. Sánchez-Brau M, Domenech-Amigot B, Brocal-Fernández F, Quesada-Rico, JA, Seguí-Crespo M. Prevalence of Computer Vision Syndrome and Its Relationship with Ergonomic and Individual Factors in Presbyopic VDT Workers Using Progressive Addition Lenses. Int J Environ Res Public Health.2020;17(3):1003. doi:10.3390/ijerph17031003 [Google Scholar] [Crossref]

15. Chu BS, Wood JM, Collins MJ. Effect of presbyopic vision corrections on perceptions of driving difficulty. Eye ContactLens. 2009;35(3):133–143. doi:10.1097/ICL.0b013e3181a1435e [Google Scholar] [Crossref]

16. Charman W.N. Developments in the correction of presbyopia I: Spectacle and contact lenses. Ophthalmic Physiol. Opt. 2014;34:8–29. doi: 10.1111/opo.12091. [Google Scholar] [Crossref]

17. Efron N., Nichols J.J., Woods C.A., Morgan P.B. Trends in US Contact Lens Prescribing 2002 to 2014. Optom. Vis. Sci. 2015;92:758–767. doi: 10.1097/OPX.0000000000000623 [Google Scholar] [Crossref]

18. Bennett E.S. Contact lens correction of presbyopia. Clin. Exp. Optom. 2008;91:265–278. doi: 10.1111/j.1444-0938.2007.00242.x. [Google Scholar] [Crossref]

19. Remón L, Pérez-Merino P, Macedo-de-araújo RJ, Amorim-de-sousa AI, González-Méijome JM. Bifocal and MultifocalContact Lenses for Presbyopia and Myopia Control.J Ophthalmol. 2020;2020:8067657. doi:10.1155/2020/8067657 [Google Scholar] [Crossref]

20. Pérez-Prados R, Piñero DP, Pérez-Cambrodí RJ, Madrid-Costa D.Soft multifocal simultaneous image contact lenses: a review. ClinExp Optometry. 2017;100(2):107–127 [Google Scholar] [Crossref]

21. Jain S, Arora I, Azar DT. Success of monovision in presbyopes: Review of the literature and potential applications to refractive surgery. Surv Ophthalmol. 1996;40(6):491–499. doi:10.1016/S0039-6257(96)82015-7 [Google Scholar] [Crossref]

22. Kirschen DG, Hung CC, Nakano TR. Comparison of suppression,stereoacuity, and interocular differences in visual acuity in mono-vision and acuvue bifocal contact lenses. Optom Vis Sci. 1999;76(12):832–837. doi:10.1097/00006324-199912000-00018 [Google Scholar] [Crossref]

23. Rajagopalan AS, Bennett ES, Lakshminarayanan V. Visual perfor-mance of subjects wearing presbyopic contact lenses. Optom Vis Sci.2006;83(8):611–615. doi:10.1097/01.opx.0000232185.00091.45 [Google Scholar] [Crossref]

24. Collins MJ, Brown B, Bowman KJ. Contrast sensitivity withcontact lens corrections for presbyopia. Ophthalmic Physiol Opt [Google Scholar] [Crossref]

25. Abramowicz, M., Pflomm J, Shah B. Vuity - pilocarpine ophthalmic solution for presbyopia. Med Lett Drugs Ther. 2022;64:17–8 [Google Scholar] [Crossref]

26. Grzybowski A., Ruamviboonsuk V. Pharmacological Treatment in Presbyopia. J. Clin. Med. 2022;11:1385. doi: 10.3390/jcm11051385 [Google Scholar] [Crossref]

27. Waring G.O.I.V., Price FWJr Wirta D., McCabe C., Moshirfar M., Guo Q., Gore A., Liu H., Safyan E., Robinson M.R. Safety and Efficacy of AGN-190584 in Individuals With Presbyopia: The GEMINI 1 Phase 3 Randomized Clinical Trial. JAMA Ophthalmol. 2022;140:363–371. doi: 10.1001/jamaophthalmol.2022.0059. [Google Scholar] [Crossref]

28. Kannarr S., El-Harazi S.M., Moshirfar M., Lievens C., Kim J.L., Peace J.H., Safyan E., Liu H., Zheng S., Robinson M.R. Safety and Efficacy of Twice-Daily Pilocarpine HCl in Presbyopia: The Virgo Phase 3, Randomized, Double-Masked, Controlled Study. Am. J. Ophthalmol. 2023;253:189–200. doi: 10.1016/j.ajo.2023.05.008 [Google Scholar] [Crossref]

29. Orasis Pharmaceuticals Announces FDA Approval of Qlosi (Pilocarpine Hydrochloride Ophthalmic Solution) 0.4% for the Treatment of Presbyopia. [(accessed on 18 October 2023)]. [Google Scholar] [Crossref]

30. Ishikawa H., De Santis I., Patil P.N. Selectivity of muscarinic agonists including (±)-Aceclidine and Antimuscarinics on the Human Intraocular Muscles. J. Ocul. Pharmacol. Ther. 1998;14:363–373. doi: 10.1089/jop.1998.14.36 [Google Scholar] [Crossref]

31. LENZ Therapeutics Announces Positive Topline Data from Phase 3 CLARITY Presbyopia Trials. [(accessed on 3 April 2024) [Google Scholar] [Crossref]

32. Kang J. Aceclidine-Based Eye Drop Vizz Approved for Presbyopia. Optometry Advisor. [(accessed on 7 August 2025)] [Google Scholar] [Crossref]

33. Harp M.D. LENZ Therapeutics announces positive topline results from Phase 3 CLARITY study. Ophthalmology Times. Apr 9, 2024. [Google Scholar] [Crossref]

34. LENZ Therapeutics Announces US FDA Approval of VIZZ™ for the Treatment of Presbyopia. [(accessed on 31 July 2025)]. [Google Scholar] [Crossref]

35. Abdelkader A, Kaufman HE. Clinical outcomes of combinedversus separate carbachol and brimonidine drops in correctingpresbyopia. Eye Vis. 2016;3:31. doi:10.1186/s40662-016-0065-3 [Google Scholar] [Crossref]

36. Patel R., Brigell M.G., Pepose J.S., Haddad L., Coleman D. VEGA-1 Phase 2 Trial: Phentolamine Ophthalmic Solution Maintains Pupillary Light Reflex with Improved Distance-Corrected Near Vision in Presbyopes. Investig. Ophthalmol. Vis. Sci. 2023;64:2507. [Google Scholar] [Crossref]

37. ClinicalTrials.gov Safety and Efficacy of Nyxol Eye Drops as a Single Agent and With Adjunctive Low-Dose Pilocarpine Eye Drops in Subjects With Presbyopia (VEGA-2) [(accessed on 24 March 2024)] [Google Scholar] [Crossref]

38. Garner WH, Garner MH. Protein disulfide levels and lens elasticity modulation: applications for presbyopia. Invest Ophthalmol Vis Sci. 2016;57:2851–63. https://doi.org/10.1167/iovs.15-18413. [Google Scholar] [Crossref]

39. ClinicalTrials.gov. A dose-ranging study to evaluate the safety and efficacy of UNR844 in subjects with presbyopia (READER). ClinicalTrials.gov identifier NCT04806503. Updated August 30, 2023. Accessed May 31, 2024. https://clinicaltrials.gov/study/NCT04806503 [Google Scholar] [Crossref]

40. Benozzi G, Perez C, Leiro J, Facal S, Orman B. Presbyopia Treatment With Eye Drops: An Eight Year Retrospective Study. Transl Vis Sci Technol [Internet]. June 2020. [cited 2021 Apr 26]; Vol.9, 25. doi: 10.1167/tvst.9.7.25 [Google Scholar] [Crossref]

41. Kaufman S. Addressing presbyopia pharmacologically. Ophthalmology Times. 2012. [Google Scholar] [Crossref]

42. Renna A, Vejarano LF, De la Cruz E, Alió JL. Pharmacological treatment of presbyopia by novel binocularly instilled eye drops: a pilot study. Ophthalmol Ther. 2016;5(1):63–73. doi: 10.1007/s40123-016-0050-x. [Google Scholar] [Crossref]

43. Singh P, Zeppieri M, Tripathy K. Presbyopia. InStatPearls [Internet] 2025 Jun 2. StatPearls Publishing. [Google Scholar] [Crossref]

44. AbbVie New Data Presented on the Safety and Efficacy of Investigational AGN-190584 as a Potential Novel Treatment for Presbyopia, a Common and Progressive Eye Condition|AbbVie News Center. Available online: https://news.abbvie.com/news/press-releases/new-data-presented-on-safety-and-efficacy-investigational-agn-190584-as-potential-novel-treatment-for-presbyopia-common-and-progressive-eye-condition.htm (accessed on 3 December 2021 [Google Scholar] [Crossref]

45. Zhu D, THAKUR S. Presbyopia Drops: Best Practices for Success. [Google Scholar] [Crossref]

46. Westin, E., Wick, B. and Harris, R. B. (2000) Factors influencing success of monovision contact lens fitting: survey of contact lens diplomates. Optometry 71, 757–763. [Google Scholar] [Crossref]

47. Plasma Pharmacokinetics and Safety of LNZ101 and LNZ100 Ophthalmic Solutions in Healthy Adult Subjects With Presbyopia,” Clinicaltrials.gov. Accessed: March. 24, 2024. [Google Scholar] [Crossref]

48. European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition. Br J Ophthalmol. 2021;105(Suppl 1):1-169. [Google Scholar] [Crossref]

49. Waring GO 4th, Brujic M, McGee S, Micheletti JM, Zhao C, Schachter S, Liu H, Safyan E. Impact of presbyopia treatment pilocarpine hydrochloride 1.25% on night-driving performance. Clin Exp Optom. 2024 Aug;107(6):665-672. doi: 10.1080/08164622.2023.2279189. Epub 2023 Dec 3. PMID: 38044272. [Google Scholar] [Crossref]

50. Holland E., Karpecki P., Fingeret M., Schaeffer J., Gupta P., Fram N., Smits G., Ignacio T., Lindstrom R. Efficacy and Safety of CSF-1 (0.4% Pilocarpine Hydrochloride) in Presbyopia: Pooled Results of the NEAR Phase 3 Randomized, Clinical Trials. Clin. Ther. 2024;46:104–113. doi: 10.1016/j.clinthera.2023.12.005 [Google Scholar] [Crossref]

51. Wolffsohn JS, Dhallu S, Aujla M, Laughton D, Tempany K, Powell D, Gifford K, Gifford P, Wan K, Cho P, Stahl U, Woods J. International multi-centre study of potential benefits of ultraviolet radiation protection using contact lenses. Cont Lens Anterior Eye. 2022 Dec;45(6):101593. [Google Scholar] [Crossref]

52. Doki Y, Nakazawa Y, Sukegawa M, Petrova RS, Ishida Y, Endo S, Nagai N, Yamamoto N, Funakoshi-Tago M, Donaldson PJ. Piezo1 channel causes lens sclerosis via transglutaminase 2 activation. Exp Eye Res. 2023 Dec;237:109719 [Google Scholar] [Crossref]

53. Srinivasan R, Paramasivan G, Sharma A, Surya J, Sharma T, Raman R. Prevalence, risk factors and association with glycemic levels of presbyopia in South Indian population. Indian J Ophthalmol. 2021 Nov;69(11):3173-3177. [Google Scholar] [Crossref]

54. Nakazawa Y., Aoki M., Ishiwa S., et al. Oral intake of α-glucosyl-hesperidin ameliorates selenite-induced cataract formation. Molecular Medicine Reports . 2020;21(3):1258–1266. doi: 10.3892/mmr.2020.10941. [Google Scholar] [Crossref]

55. Institute of Medicine Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc . Washington, DC: National Academy Press; 2001 [Google Scholar] [Crossref]

56. Shetty L, Kamath YS, Bhasin G, Pandey AK. A protocol for management of presbyopia through ancient yogic eye purificatory method: A randomized controlled trial. Contemporary Clinical Trials Communications. 2025 Oct 18:101563. [Google Scholar] [Crossref]

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