Comparing Eyedrops for Presbyopia
Qlosi vs. Vuity vs. Vizz: Which Presbyopia Eye Drop Is Right for You?
A Simple Guide to Today's Prescription Eye Drops for Age-Related Blurry Near Vision
If you're over 40 and finding yourself holding your phone farther away, increasing the font size on your screen, or reaching for reading glasses more often, you are experiencing something extremely common: presbyopia.
Presbyopia is the age-related loss of the eye's natural ability to focus clearly on objects up close. It typically becomes noticeable during the 40s and gradually progresses with age.
Today, there are three FDA-approved prescription eye drops available for the treatment of presbyopia:
Qlosi
Vuity
Vizz
All three work by making the pupil smaller, which increases depth of focus and can improve near vision. However, they differ in their active ingredients, medication strength, dosing flexibility, duration of effect, and reported side-effect profiles.
Here is a closer look at how they compare.
Quick Comparison: Qlosi vs. Vuity vs. Vizz
FeatureQlosiVuityVizzActive ingredientPilocarpine 0.4%Pilocarpine 1.25%Aceclidine 1.44%FDA approved for presbyopiaYesYesYesTypical onset of effectAbout 20 minutesAbout 15 minutesAbout 30 minutesDurationUp to 8 hours with a second doseApproximately 6 hours after one dose, with a second dose permitted 3 to 6 hours laterUp to approximately 10 hoursDosingOnce daily or as needed, up to twice daily, with doses 2 to 3 hours apartOnce daily, with an optional second dose 3 to 6 hours laterOnce dailyPreservative-freeYesNoYesMost notable advantageLow-dose formulation, flexible dosing, and favorable tolerability profileLongest track record as the first FDA-approved presbyopia dropLong duration of effect and strong near-vision efficacyCommonly reported side effectsInstillation-site discomfort and headacheHeadache, eye redness, and eye irritationEye irritation, dim vision, headache, and eye redness
Qlosi vs. Vuity vs. Vizz
The three FDA-approved prescription eye drops for presbyopia differ in formulation, dosing flexibility, duration, and reported side-effect profiles.
| Feature | Qlosi | Vuity | Vizz |
|---|---|---|---|
| Active ingredient | Pilocarpine hydrochloride 0.4% | Pilocarpine hydrochloride 1.25% | Aceclidine hydrochloride 1.44% |
| FDA approved for presbyopia | Yes | Yes | Yes |
| Typical onset | About 20 minutes | About 15 minutes | About 30 minutes |
| Duration | Up to 8 hours when a second dose is used | Up to approximately 6 hours after the first dose | Up to approximately 10 hours |
| Dosing | One drop in each eye. A second dose may be used 2 to 3 hours later. | One drop in each eye. A second dose may be used 3 to 6 hours later. | One drop in each eye once daily |
| Preservative-free | Yes | No | Yes |
| Notable advantage | Low-dose formulation, flexible dosing, and a favorable reported tolerability profile | The first FDA-approved presbyopia eye drop, with the longest history of clinical and real-world use | Long duration of effect and strong near-vision improvement in clinical studies |
| Commonly reported side effects | Headache and temporary instillation-site discomfort | Headache, eye redness, and eye irritation | Eye irritation, dim vision, headache, and eye redness |
| May be especially appealing for | Patients prioritizing comfort, lower-dose pilocarpine, preservative-free treatment, and flexible dosing | Patients who prefer the most established prescription option | Patients prioritizing long-lasting benefit from a single daily dose |
Qlosi
Vuity
Vizz
Clinical-trial results for Qlosi, Vuity, and Vizz come from separate studies with different designs and patient populations. The medications have not been directly compared in a head-to-head clinical trial, so reported differences should not be interpreted as definitive proof that one treatment is superior in efficacy, safety, or tolerability.
Qlosi: A Lower-Dose, Flexible Option Designed With Tolerability in Mind
Qlosi contains pilocarpine hydrochloride 0.4%, making it a substantially lower-concentration pilocarpine formulation than Vuity, which contains pilocarpine 1.25%.
Qlosi is also preservative-free and formulated with a near-neutral pH and two lubricating agents. Its formulation was designed to improve near vision while emphasizing ocular comfort and tolerability.
One drop is placed in each eye. If additional duration is desired, a second dose may be administered 2 to 3 hours later. With two doses, improvement in near vision may last for up to 8 hours.
Qlosi also offers unusual flexibility. It may be used daily or as needed, up to twice per day, allowing patients to tailor treatment to their activities and schedule.
What About Side Effects?
This may be one of Qlosi's most important advantages.
In Qlosi clinical trials, the most commonly reported treatment-related adverse events were headache, reported in approximately 6.8% of patients, and instillation-site pain or discomfort, reported in approximately 5.8%. Most adverse events were mild and temporary, and no serious or severe adverse events were reported in the pivotal clinical studies.
There have been no direct head-to-head clinical trials proving that Qlosi causes fewer side effects than Vuity or Vizz. However, when the separately conducted clinical trials for the three medications are considered, Qlosi appears to have a particularly favorable tolerability profile and may be an attractive choice for patients who prioritize comfort and minimizing side effects.
Vuity: The Original Prescription Eye Drop for Presbyopia
Vuity was the first prescription eye drop approved by the FDA specifically for presbyopia. It contains pilocarpine hydrochloride 1.25%.
Like Qlosi, Vuity constricts the pupil to increase depth of focus and improve near vision. It may begin working within approximately 15 minutes.
Vuity is administered as one drop in each eye once daily. A second dose may be administered 3 to 6 hours after the first dose if additional benefit is desired.
Vuity has the advantage of being the most established of the three medications, with several years of clinical and real-world experience since its initial FDA approval.
The most commonly reported adverse reactions in clinical trials included headache, conjunctival hyperemia, or eye redness, and eye irritation.
Vizz: A Long-Acting Aceclidine Option
Vizz is the newest of the three FDA-approved presbyopia eye drops. Unlike Qlosi and Vuity, which contain pilocarpine, Vizz contains aceclidine 1.44%.
Aceclidine is designed to constrict the pupil and create a pinhole effect that improves depth of focus. It has relatively limited stimulation of the ciliary muscle responsible for accommodation.
Vizz is administered once daily and may improve near vision within approximately 30 minutes, with benefits lasting for up to approximately 10 hours in clinical studies.
Its principal advantage is duration. For patients who want a single morning dose that may provide improved near vision through much of the day, Vizz may be an appealing option.
However, reported adverse reactions in Vizz clinical trials were more frequent than those reported in the separate Qlosi trials. The most common adverse reactions with Vizz were instillation-site irritation in 20% of participants, dim vision in 16%, and headache in 13%. Eye redness was also reported.
Because these medications have not been directly compared in the same clinical trial, these percentages should not be interpreted as definitive proof that one medication is safer or better tolerated than another. Nevertheless, they are important considerations when choosing among available treatment options.
Which Presbyopia Eye Drop Has the Fewest Side Effects?
There is no direct head-to-head clinical trial establishing one presbyopia eye drop as definitively having the fewest side effects.
However, based on the reported results from the separate clinical trials for each medication, Qlosi appears to have a particularly favorable tolerability profile.
Qlosi uses the lowest pilocarpine concentration of the currently available pilocarpine-based presbyopia drops. It is preservative-free and contains two lubricating agents. In its pivotal clinical studies, the most commonly reported treatment-related adverse events occurred in approximately 5% to 7% of patients and were generally mild and temporary.
For patients especially concerned about headache, eye irritation, redness, dim vision, or other medication-related effects, Qlosi may therefore be an especially appealing option.
Which Presbyopia Eye Drop Is Best?
There is no single best eye drop for every patient. The right choice depends on your priorities, your eyes, your daily activities, and how you respond to treatment.
Qlosi may be especially appealing if you want a low-dose, preservative-free formulation with flexible dosing and a favorable reported tolerability profile.
Vuity may be appealing if you prefer the original FDA-approved presbyopia eye drop with the longest history of clinical and real-world use.
Vizz may be appealing if your highest priority is obtaining the longest possible duration from a single daily dose.
For many patients, the choice comes down to finding the right balance among near-vision improvement, duration, convenience, comfort, and side effects.
Important Safety Information
All three medications work by constricting the pupil and may cause temporary dim or dark vision, particularly in low-light conditions. Patients should use caution when driving at night or performing hazardous activities in poor illumination.
Temporary blurred vision may occur after instillation. Patients should not drive or operate machinery until their vision is clear.
Rare retinal complications, including retinal tears and retinal detachment, have been reported with miotic medications. Patients should seek immediate medical attention for new flashes of light, a sudden increase in floaters, loss of vision, or the appearance of a curtain or veil across part of the visual field.
A retinal examination may be advisable before starting treatment, particularly in patients with a history of retinal disease or other risk factors.
The Bottom Line
Prescription eye drops have created a new option for adults with presbyopia who want greater freedom from reading glasses.
Qlosi, Vuity, and Vizz can all improve near vision, but they are not identical.
Qlosi stands out for its low-dose 0.4% pilocarpine formulation, preservative-free design, flexible once- or twice-daily dosing, and favorable tolerability profile in clinical studies. Although no direct head-to-head studies have proven that Qlosi causes fewer side effects than its competitors, the available clinical-trial data suggest that it may be one of the most comfortable and best-tolerated options currently available for the treatment of presbyopia.
For patients seeking improved near vision while prioritizing flexibility, comfort, and a lower likelihood of bothersome side effects, Qlosi deserves strong consideration.
