Pilocarpine is a cholinergic muscarinic agonist that has been repurposed in low concentrations for the treatment of presbyopia, the age-related loss of the eye’s ability to focus on near objects. The FDA has approved pilocarpine eye drop formulations under the brand names Vuity and Qlosi for this use.
How It Works
Pilocarpine works by:
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Constricting the pupil (miosis), which increases depth of field and improves near vision.
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Slightly stimulating the ciliary muscle, which can enhance accommodation (focusing power).
This pharmacological “pinhole effect” allows presbyopic patients to see better up close, without affecting distance vision much in good lighting conditions.
Key Facts
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Dosage: Typically one drop per eye, once or twice daily.
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Onset: Begins working in about 15-20 minutes.
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Duration: Lasts for about 6-8 hours, though this varies by person.
Benefits
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Non-invasive, non-surgical option.
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Can reduce dependence on reading glasses for mild-to-moderate presbyopia.
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Fast-acting.
Limitations & Side Effects
- Works best in early presbyopia (typically 40s to early 50s).
- Common side effects: headache, eye redness, eye discomfort, blurred vision (especially in dim lighting).
- Can cause difficulty seeing in low light due to smaller pupil size.
- Retinal detachment risk: Rare cases have been reported with miotic agents. Many LASIK patients have thinner retinas from prior myopia
- Iritis: Use is not recommended in the presence of active inflammation.
- Contact lens wearers: Should remove lenses before use and wait 10 minutes before reinsertion.
- Not a cure — it temporarily improves symptoms.
Considerations
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Not ideal for patients with cataracts, retinal disease, or narrow angles, as pilocarpine can worsen angle closure glaucoma risk.
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Effects may diminish over time as presbyopia progresses.
Availability and Cost
They are available through select pharmacies, with options for home delivery. As of June 2025, the cost is approximately $79-$89 for a 30 day supply, though prices may vary.
A Good Candidate
A healthy, early presbyopic patient in their 40s or early 50s who wants to avoid reading glasses and has no contraindicating eye disease is the ideal candidate.
✅ Meets These Criteria:
Age 40–55 Early to moderate presbyopia responds best; younger presbyopes still have some accommodative ability left to benefit from pilocarpine-induced miosis.
Good Distance Vision Without Glasses For those with excellent uncorrected distance vision
Mild-to-Moderate Presbyopia Patients who struggle with reading small print but don’t yet require strong reading glasses.
Healthy Eyes No significant cataracts, glaucoma (especially narrow-angle), uveitis, or retinal conditions that could be worsened by pupil constriction.
⚠️ Not Ideal For:
Advanced Presbyopes (typically age 60+), as accommodative loss is often too great for meaningful benefit.
Patients with Significant Cataracts – can increase visual disturbances.
People Who Need Excellent Night Vision – miosis (pinhole) reduces light entry and can cause trouble in dim lighting.
Patients with Narrow Anterior Chamber Angles – risk of angle-closure glaucoma.
History of Retinal Detachment – miotics can theoretically increase risk.
Contact Lens Wearers – may use with caution; drops can interact with lenses. Not for myopic patients with a prescription of more than -4.00.
Please call or text Towne Lake Eye Associates at 770.926.2858 with any questions!