Eye drops provide convenient, temporary relief for some people with presbyopia, or age-related blurry near vision.

If you’re over age 40 and find yourself squinting to make out small print right in front of you, you’re not alone. More than 128 million Americans live with normal, age-related loss of their near vision, aka presbyopia.

Reading glasses, contact lenses, increased illumination, and, in some cases, surgery were historically the only available treatments for presbyopia, which is believed to be caused primarily by stiffening of the eye’s clear lens (although other factors, such as progressive weakening of the ciliary muscle, which changes the lens shape to enable near focusing, have also been implicated).

But another choice has now become available to treat presbyopia: The U.S. Food and Drug Administration (FDA) recently approved an eye drop, Vuity (pilocarpine HCl ophthalmic solution 1.25%), which allows certain people with presbyopia to see up close without glasses or contacts for several hours a day, according to the manufacturer.

“This is a novel option that many would find more convenient than constantly taking off reading glasses or bifocals,” says George O. Waring IV, MD, medical director of the Waring Vision Institute in Mt. Pleasant, South Carolina, and principal investigator of the Vuity FDA clinical trials.

The eye’s pupil naturally constricts in response to light. When it does, a person’s depth of field expands, allowing the eye to focus at expanded distances. The result: improved near and intermediate distance vision.

Pilocarpine, the active ingredient in Vuity, contracts the ciliary muscles that help control pupil size. Pilocarpine drops were the primary treatment for glaucoma until the 1980s and are occasionally still used today.

The once-daily drops work in 15 minutes or less, and can last up to 6 hours for near vision and 10 hours for intermediate vision (such as reading on a computer screen).

The FDA based its approval of Vuity on findings from two phase 3 clinical trials: GEMINI 1 and GEMINI 2.

These studies together comprised 750 people, ages 40 to 55, who had been diagnosed with presbyopia. In each study, half of the participants were randomly assigned to administer one drop of Vuity in each eye daily; the other half used a placebo.

In both trials, those who took the Vuity drops were significantly more likely to make out three or more additional, smaller-type-sized lines on a reading chart compared with the placebo group.

Vuity, which is being marketed by the pharmaceutical company Allergan, is available in pharmacies across the United States with a doctor’s prescription.

Presbyopia is a natural part of aging that affects nearly everyone at some point. In fact, the word “presbyopia” derives from the Greek word for “old eye.”

Symptoms usually start in the mid-forties and gradually progress until about age 65.

Typically, people with presbyopia experience blurred vision when trying to read at a normal distance of about 13.5 inches. They tend to hold reading materials farther away to make out the words. Eyestrain and headaches are common complaints.

There is some evidence that uncorrected presbyopia can negatively affect a person’s vision-related quality of life: Simple tasks that were once easy to perform become more challenging for someone who struggles to see close-up.

Dr. Waring says there’s also evidence that uncorrected or undercorrected presbyopia significantly influences daily functioning and workplace productivity.

Vuity isn’t an option for everyone. The drop works best for younger people, ages 40 to 55, who have mild to moderate symptoms. And much like reading glasses, Vuity won’t stop presbyopia from progressing.

“Patients should realize that presbyopia is dynamic and that an eye drop will not be a complete cure,” says Nandini Venkateswaran, MD, a cornea, cataract, and refractive surgeon at Massachusetts Eye and Ear and an instructor in ophthalmology at Harvard Medical School in Boston.

Nor is Vuity designed to treat other eye issues that may affect people with presbyopia, including myopia (nearsightedness), hyperopia (farsightedness), or astigmatism (conditions in which the eye’s shape prevents light from focusing directly on the retina). People with these vision issues still must wear glasses or contact lenses, even if they use Vuity drops.

Since the drops reduce pupil size, they may also make it more difficult to see in the dark. For that reason, they aren’t recommended for use when driving at night or performing hazardous work in low light, Waring says. Similarly, people with cataracts may experience decreased vision when using Vuity, as the decreased light entering the eye because of the cataract is further reduced by the drop-induced smaller pupil.

The drops shouldn’t be instilled when contact lenses are in place. A history of certain eye conditions, such as angle-closure glaucoma or iritis (uveitis), is usually considered a contraindication for pilocarpine use — or a reason not to use it.

The most common side effects of Vuity were headaches and eye redness. No serious adverse events were reported in the clinical trials. As to whether manipulating the iris and pupil over the long term can adversely affect the eye, Dr. Venkateswaran and Waring said they’ve seen only the shorter-term, clinical trial data, which, again, points to minor side effects.

“The great thing about an eye drop is it’s okay to try it and see if it’s working,” Waring says. “If it’s not an ideal treatment for you, then we can easily look at other options.”

The expense could also be a deterrent for some. The out-of-pocket cost of Vuity is about $80 for a 30-day supply. Currently, neither insurance nor Medicare covers the new treatment’s cost.

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