Patient guide
Presbyopia: why reading gets harder after forty, and what helps
Presbyopia comes on slowly, over years. Sudden blurred or lost vision, a shadow or curtain across your vision, or new flashes or floaters is something else: call (609) 246-0236 the same day. If you use a presbyopia eye drop and notice flashes, floaters or a loss of vision, get care immediately.
Sometime in your forties, small print starts to need better light and the phone drifts farther away. This is presbyopia. It happens to everyone, including people who have never needed glasses.
There are more ways to deal with it than there used to be, and since 2021 they include prescription eye drops such as Vizz. This page explains what is happening, what each option does, and what to know before trying the drops.
What is happening
To focus up close, the lens inside the eye changes shape. With age the lens gets harder and less flexible, and close focus slowly goes. It is a normal part of aging, not a disease.
- It starts in the forties. Most people begin to notice it shortly after 40.
- The first signs are small. Holding things farther away to read them, needing more light, and tired eyes or a headache after close work.
- It keeps changing for years. Near focus goes on getting harder and usually stops changing after about 65. That is why the reading power in your glasses goes up over time.
Early on, brighter light and larger text on your phone and computer may be all you need.
An eye exam at this age is about more than reading glasses. It checks the health of the eye at the same visit, and some eye diseases, glaucoma among them, cause no symptoms until vision has already been lost.
Glasses
- Reading glasses. If close work is your only problem, a pair of readers may be all you need. Drugstore readers are all right for many people, when both eyes need about the same power and there is little astigmatism. The right power is best settled at an exam.
- Bifocals and trifocals. Two or three areas in one lens: far and near, or far, mid-range and near.
- Progressive lenses. The power changes gradually from the top of the lens to the bottom, with no dividing line. A first pair takes one to two weeks to get used to for most people.
- A computer pair. For long hours at a computer, a pair set for that distance can be more comfortable than all-purpose lenses.
Which suits you depends on your work, your hobbies and your distance prescription.
Contact lenses
- Multifocal lenses. Near and distance vision in the same lens. They suit most people who want them, with a short adaptation. Vision can be a little less sharp than with a single-power lens.
- Monovision. One eye is corrected for distance and the other for close work. Some people find it harder to judge distance or speed this way.
Multifocal fittings are routine in this office. Trial lenses are placed on the eye and assessed at the fitting, so you find out how they work for you before anything is ordered. What a contact lens fitting involves.
Eye drops: Vizz and the others
The FDA has approved five prescription eye drops for presbyopia in adults. All of them work by making the pupil smaller. A small pupil acts like a pinhole, which deepens the range that is in focus.
The drops wear off, and presbyopia is still there when they do. They are something to use alongside glasses or contact lenses, on the days you choose, and they need an eye exam first.
Vizz (aceclidine 1.44%)
Vizz was approved in 2025 and is used once a day: one drop in each eye, then a second drop in each eye two minutes later, from the same single-use vial.
- How long it lasts. In the trials it began working within 30 minutes and the effect lasted 10 hours.
- How well it worked. Three hours after the drops, 65 and 71 percent of people in the two trials could read at least three lines smaller on the near chart without losing distance vision. With the comparison drops it was 12 and 8 percent.
- Who was in the trials. People aged 45 to 75, with prescriptions from −4.00 to +1.00 and up to 2.00 of astigmatism, including people who had had laser vision correction or cataract surgery.
- Side effects. Irritation as the drops go in (20 percent), dim vision (16 percent), headache (13 percent) and red eyes (7 to 8 percent). Most were mild and passed on their own.
- Storage. Keep it in the refrigerator. Once out, it can stay at room temperature for up to 30 days. Each vial is used once and thrown away; it contains no preservative.
The other four
- Pilocarpine 1.25%. The first of these drops, sold as Vuity from 2021 and now also made as a generic. One drop in each eye once a day. Headache and red eyes were the most common side effects.
- Qlosi (pilocarpine 0.4%). One drop in each eye, repeated two to three hours later if wanted, for an effect of up to 8 hours. It can be used every day or only when needed. Stinging as the drop goes in and headache were the most common side effects.
- Yuvezzi (carbachol 2.75% and brimonidine 0.1%). Approved in January 2026, with two medicines in one drop. One drop in each eye once a day; the trials measured its effect from 30 minutes to 8 hours. Its label adds cautions for people with depression, Raynaud's, poor circulation to the heart or brain, or blood pressure that falls on standing, and for people taking blood pressure medicines, sedatives or certain antidepressants.
- Ryzumvi (phentolamine 0.75%). Approved for presbyopia in October 2026. It works on a different muscle: it relaxes the one that widens the pupil. One drop in each eye at night, with an effect lasting at least 24 hours. Red eyes (21 percent) and irritation as the drop goes in (16 percent) were the most common side effects.
The trials of each drop were run differently, so their results cannot be compared side by side.
Before starting a drop
Vizz, both strengths of pilocarpine and Yuvezzi carry the same set of cautions on their labels.
- The retina is examined first. Rare cases of retinal tears and detachment have been reported with drops that constrict the pupil, in susceptible people and in people with existing retinal disease. The labels advise an examination of the retina in everyone before starting. If you are in a higher-risk group for retinal detachment, say so.
- Flashes, floaters or loss of vision. Get care immediately. Flashes and floaters explains why.
- Dim vision and night driving. Vision can be dim or dark for a while after the drops. Take care driving at night and in poor light, and do not drive or use machinery if your vision is not clear.
- A history of iritis. Tell us. Constricting the pupil can make the after-effects of inflammation inside the eye worse.
- Contact lenses. Take them out before the drops and wait 10 minutes before putting them back in.
- Other eye drops. Leave at least five minutes between different drops.
Ryzumvi's label is different. It is not recommended while there is active inflammation in the eye, and it carries the same advice about contact lenses and other drops.
Ask the pharmacy for the price, and whether your plan covers it, before you fill the prescription.
Dilated examination of the retina is done in this office. If you would like to try a drop, say so when you book, so that it can be part of the same visit.
Surgery
- Monovision laser surgery. A laser reshapes the cornea so that one eye is clear for distance and the other for close work. Trying monovision with contact lenses first shows whether you would be comfortable with it.
- Lens replacement. The natural lens is replaced with a lens implant, an operation called refractive lens exchange.
- At cataract surgery. Multifocal and extended-range lens implants aim to reduce dependence on glasses at more than one distance. They trade a little contrast and some halos at night for that convenience. Cataracts and choosing the lens.
These procedures are performed by an ophthalmic surgeon. Whether laser correction suits you depends on your prescription, corneal shape and tear film, all measured here.
Common questions
Will wearing reading glasses make my eyes worse?
No. Glasses focus the light; they do not change the eye. Presbyopia gets worse over time with or without them, and usually stops changing after about 65.
I have never needed glasses. Why now?
Presbyopia comes from the lens inside the eye stiffening with age, which happens to everyone, including people who have always seen well.
Are drugstore reading glasses all right?
For many people, yes, when both eyes need about the same power and there is little astigmatism. They are not right for everyone, and they do not replace an exam, which also checks the health of the eye.
Can I use Vizz with contact lenses?
Yes. Take the lenses out before the drops, and wait 10 minutes before putting them back in. The same applies to the other presbyopia drops.
Can I use a drop only on the days I want it?
Qlosi is labeled for use every day or as needed. Vizz, pilocarpine 1.25% and Yuvezzi are labeled for once a day, and Ryzumvi for once a day at night. Ask at your visit how that applies to you.
I have had LASIK or cataract surgery. Can I still use the drops?
The trials of Vizz and of Yuvezzi included people who had had laser vision correction or cataract surgery. Whether a drop suits your eyes is decided at the exam.
Does this go through my vision plan or my medical insurance?
A routine exam for glasses or contact lenses usually goes through a vision plan. If you are coming in about a symptom or a condition, it is a medical visit and goes through your medical insurance. Vision plan or medical insurance explains the difference.
Book an eye exam
A routine exam checks your prescription and the health of each eye at the same visit. If you want to talk about multifocal contact lenses or a presbyopia drop, mention it when you book.
Book an exam Call (609) 246-0236
Khoury Eye Care, Hamilton Mall, 4403 Black Horse Pike, Mays Landing.
Sources
The figures and recommendations on this page come from the following. Ask at your visit if you would like a copy of any of them.
- National Eye Institute. Presbyopia. Updated December 2024.
- American Academy of Ophthalmology. What is presbyopia? Reviewed May 2026.
- VIZZ (aceclidine ophthalmic solution) 1.44%. Prescribing information. LENZ Therapeutics. Revised January 2026.
- QLOSI (pilocarpine hydrochloride ophthalmic solution) 0.4%. Prescribing information. Orasis Pharmaceuticals.
- Pilocarpine hydrochloride ophthalmic solution 1.25%. Prescribing information. Amneal Pharmaceuticals.
- YUVEZZI (carbachol and brimonidine tartrate ophthalmic solution) 2.75%/0.1%. Prescribing information. Visus Therapeutics. 2026.
- RYZUMVI (phentolamine ophthalmic solution) 0.75%. Prescribing information. Revised October 2026.