Presbyopia affects approximately 128 million Americans.¹ The condition impacts work, social life, self-confidence, and daily activities for most of our patients over age 40, and they are looking to us to help them find solutions. Psychologically, people tend to have a more positive perception of experiences when they control the decision-making process, so I find that giving patients options—and the flexibility to rely on more than 1 method of correction, depending on their needs—is key to making the presbyopia journey a more pleasant one.

With the introduction of new presbyopia-correcting eye drops that last most of the workday, I've become much more proactive in marketing and prescribing pharmacological treatments for presbyopia. Even within the category of presbyopia-correcting eye drops, there isn’t a one-size-fits-all answer; it is important for clinicians to be aware of the benefits, mechanisms of action, and side effect profiles of each of these eye drops. I’ve found that the dual-action carbachol 2.75%/brimonidine tartrate 0.1% eye drop (Yuvezzi; Tenpoint Pharmaceuticals) provides a great balance of durability and tolerability in a once-daily single drop.

The real-world results that I’m seeing with Yuvezzi in my practice closely mirror what was reported from clinical trials: long-lasting efficacy and mild and transient side effects.² As an early presbyope with latent hyperopia, I personally use Yuvezzi as one of several options I rely on for near vision. On clinic days, I’m able to function all day, going from greeting patients to slit lamp to tablet, without needing to think about or change my eyewear. Toward the end of the day, I start to notice some near fatigue, but then I switch to glasses for the evening. Just the other day, I saw a postrefractive patient with otherwise healthy eyes. He had LASIK 10 years ago, loved the spectacle independence, and wasn’t eager to start wearing reading glasses every day. He opted for both progressive spectacles and Yuvezzi and is happy with both. The eye drops give presbyopes another option and the flexibility to choose when to wear glasses.

For anyone who is considering prescribing presbyopia-correcting drops, or prescribing more of them, here are 7 tips that have made it easy for me to integrate this drop category into my busy primary eyecare practice:

1. Cast a wide enough net. While not everyone is a candidate for pharmacological correction of presbyopia, I would encourage colleagues to offer it broadly. If you only offer the option to niche groups like post-LASIK patients or those who have failed multifocal contact lenses, you will miss the opportunity to make a difference in many patients’ lives. Emerging presbyopes, lifelong emmetropes who have never worn glasses, and even older presbyopes can be great candidates. A 62-year-old who plays mahjong or pickleball every Saturday might be thrilled with the near vision gains from presbyopia-correcting eye drops, even if they don’t achieve 20/20 near vision.

2. Gauge interest quickly. With every presbyope, I ask a simple, open-ended question, “Are you interested in glasses, contact lenses, or eye drops to address this problem?” Some people rule out at least 1 category immediately, which saves me time. Once I gauge interest, I can provide high level recommendations and then dive deeper into options that will or will not work for the patient based on their refraction, anatomy, and visual needs. I also help patients understand that they will typically need glasses in addition to contact lenses or eye drops.

3. Pay attention to patient needs. For the patient who wants uncorrected near vision for most of the day, I like Yuvezzi as a primary option because it provides approximately 8 hours of pupil constriction and improved near/intermediate vision. For patients who only want near vision for a few hours per day or sporadically based on their activities, I recommend a shorter-acting pilocarpine eye drop such as Qlosi (Orasis Pharmaceuticals).

4. Paint the right picture. We educate patients about functional vision. Rather than saying they will “never need” glasses, or promising a specific line of visual acuity, we focus on the ability to use their phone and computer, drive, and read a menu. I explain that Yuvezzi won’t be exactly like wearing their readers or progressive spectacles and that they will still need glasses at the end of the day or for certain activities. And finally, we talk about potential side effects, like brow ache, burning and stinging, a little bit of blurry vision, or dimming. I let them know that those symptoms, if they occur, generally go away with continued use.

5. Opt for scripts over samples. Product samples are nice to have, but in my opinion, a 5-day supply really isn’t enough for the patient to determine efficacy. I want them to try a presbyopia-correcting drop daily for 7 to 14 days to fully neuroadapt before they decide how well the drug works for them. So as soon as I see there is engaged interest, I send in the prescription, give the patient a tear-off sheet with clear instructions on how it's going to be delivered to them, and then I may offer a sample just to bridge the gap until they receive the eye drops from the pharmacy. I find that is the best way to ensure a positive experience for the patient and an efficient workflow for staff.

6. Use the specialty pharmacy. Although Yuvezzi is widely available through neighborhood pharmacies, I prefer to use the PhilRx specialty pharmacy. It makes communication simple and straightforward, I can tell the patient exactly how much their prescription will cost, and the order is tracked and shipped directly to them at home. By contrast, if the patient walks into their neighborhood pharmacy, pricing varies widely and my staff may have to field multiple calls from the patient, pharmacy, or both.

7. Set up protocols. We require a comprehensive exam (including retinal exam) within the past 3 months before prescribing any pharmacological presbyopia treatment. In most cases, I’m discussing this option with a patient immediately after evaluating the retina, but if a patient were to call in and ask for a prescription, the staff know they would need to have had a recent exam to screen for risk factors. Initially, I brought all patients back after 1 to 2 weeks to see how they were doing—and I still think that’s a good way for any doctor who is new to prescribing these eye drops to understand their efficacy and side effects. However, we now have protocols for follow-up visits at 2 weeks or 1 to 3 months. I only schedule the earlier follow-up when the patient really needs to be coached through their presbyopia correction options; more commonly, I bring them back in a few months. In either case, we charge for that follow-up visit, just like we would for a contact lens visit.

Putting some thought into your office procedures and protocols around the pharmacological correction of presbyopia can help make for a smooth integration into your practice and ensure that your patients hear from you first about eye drops as part of the full range of options they have for addressing presbyopia.

References

1. American Optometric Association Health Policy Institute. New approaches to presbyopia. 2023. Accessed August 3, 2026 at: https://www.aoa.org/AOA/Documents/Advocacy/HPI/presbyopia%20brief%20HPI%20Final.pdf

2. El-Harazi S, Evans DG, Williams J, Schiffman R. Vehicle-controlled phase 3 safety and efficacy evaluation of preservative-free carbachol 2.75%/brimonidine tartrate 0.1% in presbyopia—topline results. Poster presented at: American Society of Cataract and Refractive Surgery Annual Conference; April 25-28, 2025; Los Angeles, CA.

Mark E. Schaeffer, OD is an optometrist and clinical excellence captain at MyEyeDr in Birmingham, AL, where he practices full scope primary care optometry. He is a consultant to Orasis Pharmaceuticals and Tenpoint Therapeutics. Contact him at mark@drmesconsulting.com.