Welcome to Optometry Simplified.
In this weekly newsletter, I've curated the best resources to help you grow personally and professionally.
My mission is to find what's best for my patients and my practice.
Here's what I've found...
Links I Liked
Cataract surgery as an intervention for dementia?
A recent meta-analysis of over 240,000 patients found that cataract surgery reduced dementia risk by 25% compared to leaving cataracts untreated. The working theory: untreated vision loss chronically drains cognitive resources and may accelerate neurodegeneration through the brain's "use it or lose it" wiring. This is observational data, not an RCT, but the signal is hard to ignore. Peter Attia MD
Most patients who stop wearing contacts still want to come back.
A patient tells you they quit contacts because they were uncomfortable. Most of us hear that and move on. This paper suggests we shouldn't. Andrew Pucker, OD, PhD, et al. (2026) took 61 former lens wearers who dropped out due to dryness or discomfort and refitted them. 98.4% were still wearing at 1 month. 65.6% at 6 months. Ophthalmic and Physiological Optics
Research I'm Reading
Smoking increases the risk of every vision-threatening condition we manage.
A new study analyzed 12 million ophthalmology patients comparing smokers to non-smokers. Smokers have a significantly elevated 10-year risk for every major vision-threatening condition we manage. Not one or two. All of them: cataract, glaucoma, AMD, diabetic retinopathy, retinal vascular occlusion, uveitis, and ischemic optic neuropathy. Clinical Ophthalmology
Deep Thoughts
Newness is no virtue, and oldness is no vice.
That principle is worth holding onto as we enter what the industry is calling a new era in presbyopia care.
Four FDA-approved pharmacologic options now exist where none did a decade ago. The science is real, the clinical profiles are meaningfully differentiated, and the enthusiasm from pharmaceutical companies is considerable.
But the sales data tells a more measured story, and understanding why requires us to evaluate these drops on their actual clinical merits, not on the fact that they are new.
Vizz™ (aceclidine 1.44%, Lenz Therapeutics) launched in October 2025 and generated approximately $1.6 million in net revenue in its first quarter on the market, roughly 20,000 filled prescriptions.
Yuvezzi™ (carbachol 2.75% / brimonidine 0.1%, Tenpoint Therapeutics) received FDA approval in January 2026 and is now available.
Qlosi™ (pilocarpine 0.4%, Orasis) has been available since early 2025.
Vuity® (pilocarpine 1.25%, AbbVie) has been around since 2021, and AbbVie quietly reduced its sales and marketing investment in 2022 after the launch failed to meet expectations.
The industry narrative is predictable: prescribers aren't talking about these drops enough.
Well, maybe. I think the fuller picture is more interesting than that.
The three current options, Qlosi, Vizz, and Yuvezzi, represent meaningfully different clinical profiles, and patient selection matters. In other words, they aren't interchangeable.
It's worth noting upfront that no head-to-head trials comparing these drops directly have been completed. The profiles described here come from separate trials with different study populations and endpoints, so cross-product comparisons are inferential rather than definitive.
Qlosi is the most conservative option. Low-dose pilocarpine (0.4%) with a lubricated vehicle, dosed typically twice daily. Onset around 20 minutes, with a duration of up to 8 hours with both doses. Pupils settle around 2.3–2.5mm. The tolerability profile is the best of the group, with fewer headaches than Vuity and less dimming than the alternatives. For a patient who wants to try this category with minimal side effect risk, this is where to start.
Vizz takes a different approach. Aceclidine is a pupil-selective miotic not previously approved in the US, though it has been used for glaucoma in Europe for decades. Once daily: two drops, two minutes apart; onset around 30 minutes; duration up to 10 hours. In the CLARITY 2 trial, 71% of participants achieved a three-line or greater improvement in near visual acuity at both 30 minutes and three hours, dropping to 40% at ten hours. Pupils constrict to sub-2.0mm, which drives the efficacy but also produces the highest rate of visual dimming in the category. Headache is also reported. For the highly motivated patient who wants maximum near vision and is willing to tolerate the trade-offs, Vizz has the strongest efficacy argument.
Yuvezzi sits between them. Carbachol 2.75% combined with brimonidine 0.1%, once daily, preservative-free. The brimonidine component inhibits pupil dilation rather than directly driving constriction. Pupils land around 2.0–2.5mm, duration 8–10 hours, with three-line or greater near vision gains sustained over eight hours in the BRIO II trial. Eye irritation upon instillation and headache were the most commonly reported adverse events, affecting roughly 10–16% of participants, the majority mild, transient, and self-resolving. Eye redness was low: 2.8% in the Yuvezzi group versus 10.7% with carbachol alone in BRIO II. That's a meaningful practical advantage for patients who care about cosmesis.
All three are preservative-free. That matters for long-term ocular surface health, particularly in the presbyopic age group where dry eye prevalence is already elevated.
So why do the modest sales numbers look the way they do?
Some will point to prescribers. Optometrists have been slow adopters of new pharmacologic categories before (see myopia management and dry eye...), and presbyopia drops have not been immune to that pattern.
But what about the consumer? Do they have a hand in the results?
Well, reading glasses work. They cost three dollars at a gas station, require no prescription, cause no headaches, and do not produce visual dimming. The patient who reaches for Vizz instead of a reader must be motivated, clinically well selected, and willing to pay out of pocket for a daily drop that makes their vision somewhat dimmer and occasionally causes a headache.
For my fellow nerds, the NNT for an appropriately prescribed progressive lens or an OTC reader to improve a patient's near vision by 3 or more lines is 1. That's 100% efficacy that both optometrists and patients feel. So I don't think provider apathy tells the whole story of the modest patient uptake.
The drops are finding their actual market, but that market, it turns out, is smaller than the theoretical 128 million presbyopes in the US would suggest.
So what's the takeaway?
The most useful thing an optometrist can do right now is know the three options well enough to match them to the right patient, present them without hype, and set expectations honestly.
The drops are real. The clinical profiles are differentiated. The competition is a pair of readers for two dollars from the checkout line.
That context isn't pessimism. It's just what good prescribing looks like.
Practice Performance Partners Pick
If you've ever watched an uninsured patient walk out the door because they couldn't justify the cost of care, this one's worth your time.
Chris Wolfe, OD, and the team at Vision HQ break down how in-office membership plans can replace the confusion of managed vision care with simple, tiered pricing that patients actually understand.
Can you do me a favor? If you found any of these resources helpful, share this newsletter with one of our colleagues!
See you next week!
--Kyle Klute, OD, FAAO