VIZZ™ Presbyopia Drops: What San Antonio Patients Should Know (From an Ophthalmic Surgeon)

By Dr. Jake Trinidad, M.D. — Trinidad Vision Cataract & Laser Eye Center, San Antonio, TX

There’s a brand-new, FDA-approved eye drop for age-related blurry near vision (presbyopia) called VIZZ™ (aceclidine 1.44%). It’s once daily, starts working in about 30 minutes, and can last up to 10 hours. In two Phase 3 trials, 65–71% of treated patients gained ≥3 lines of near vision at 3 hours without distance vision loss, compared with 8–12% on control. Side effects were mostly mild and temporary (instillation-site irritation, dim vision, headache).

What Is Presbyopia and Why Do “Readers” Keep Getting Stronger?

Presbyopia is the gradual loss of your eye’s near-focus ability as the lens stiffens with age. It affects nearly all adults over 45 and an estimated 128 million Americans. If you’re pushing your phone farther away, or swapping to stronger readers each year, you’re living it.

Meet VIZZ™ (aceclidine 1.44%): The Newest Rx Option

VIZZ is the first and only aceclidine-based presbyopia drop approved in the U.S. It’s used once daily and designed to give a pinhole effect by gently constricting the pupil, predominantly pupil-selective with minimal ciliary muscle stimulation. 

Practically, that means sharper near focus without a myopic shift being a design goal of the drug. Duration in trials was up to 10 hours.

How You Use It

Instill one drop in each eye, wait 2 minutes, then instill a second drop in each eye, once daily, from the same single-use vial. 

Remove contacts first; you can reinsert them after 10 minutes. If you use other eye drops, separate them by ≥5 minutes.

The Clinical Data (Translated)

VIZZ was studied in three Phase 3 trials (CLARITY-1/2 for efficacy, CLARITY-3 for safety).

Primary endpoint (Day 1, Hour 3):

- CLARITY-1: 65% on VIZZ vs 12% on control achieved ≥3 lines of near vision gain without losing ≥1 line of distance vision (p < 0.01).

- CLARITY-2: 71% on VIZZ vs 8% on control (p < 0.01).

Onset was seen by 30 minutes and the effect lasted to 10 hours in measured intervals. Notably, trials included some post-LASIK and pseudophakic patients.

 What That Means

If we convert those differences into an NNT (number needed to treat):

- CLARITY-1: 53% absolute benefit → NNT ≈ 2.

- CLARITY-2: 63% absolute benefit → NNT ≈ 2.

So, roughly 2 people treated for 1 to reach that ≥3-line near-vision gain at the 3-hour mark.

Safety: The most common events were instillation-site irritation (20%), dim vision (16%), and headache (13%), typically mild and transient. The label advises caution with night driving, and like other miotics, there’s a rare risk of retinal tear/detachment.

Storage: Keep VIZZ refrigerated (2–8 °C) until use; single-dose vials may be kept at room temperature for up to 30 days after removal from the fridge. Discard the opened vial after use.

How does VIZZ compare to Vuity® and Qlosi™?

VIZZ (aceclidine 1.44%) vs Vuity (pilocarpine 1.25%) vs Qlosi (pilocarpine 0.4%)

• VIZZ: Once daily; 2 drops/eye; onset ~30 min; duration up to 10 hrs; 65–71% achieved ≥3-line gain at 3h.
• Vuity: Once daily (later BID); onset 15 min; duration 6–10 hrs; ~31% achieved ≥3-line gain at 3h.
• Qlosi: BID; onset ~15–20 min; duration up to 8 hrs; met primary endpoints in pooled trials.

Who Is a Good Candidate?

• Adults with age-related near-vision blur who prefer a non-surgical, reversible option (or want to reduce dependence on readers).
• Many with prior LASIK/PRK or pseudophakia were included in VIZZ trials.

Who Should Be Cautious

Anyone with retinal disease or risk factors, a history of iritis, or activities requiring reliable night driving.

My Take as an Eye Surgeon

I like that VIZZ aims for pupil-selective miosis with minimal ciliary stimulation, targeting the pinhole effect while limiting accommodative spasm. The once-daily regimen and the ≥3-line gains seen in a majority of treated patients at the 3-hour mark are clinically meaningful. As with any miotic, we’ll counsel you about temporary dim vision and screen your retina before you start.

Frequently Asked Questions

How quickly will I notice a difference?

Within ~30 minutes, lasting up to 10 hours.

Will I still need readers?

Possibly less. Many patients reduce dependence; some still prefer readers for fine print/low light.

Can I drive at night on VIZZ?

Use caution. Temporary dim vision may occur

Is it safe if I’ve had LASIK or cataract surgery?

Yes—those groups were included in trials.

How does it differ from Vuity/Qlosi?

VIZZ uses aceclidine (not pilocarpine), is used once daily, and showed higher proportions of ≥3-line near-vision gains at 3 hours vs control than pilocarpine 1.25% in GEMINI-1.

Ready to Try a Presbyopia Drop in San Antonio?

At Trinidad Vision we’ll evaluate your refraction, pupils, ocular surface, and retina, discuss work/lifestyle needs, and map out the best plan. Book your presbyopia consultation by calling or scheduling online. Ask for the 'VIZZ evaluation.'