Revolution in Presbyopia Treatment? Clear Vision Up Close in 30 Minutes? The Truth Behind the New Drug That Uses the "Pinhole Effect" for Near Vision

A New Everyday Medication to Fill the "Gap" of Reading Glasses

"Menus are hard to read," "Smartphones are moving away." Presbyopia, unavoidable after the age of 40, is a physiological phenomenon where the lens loses elasticity, making it difficult to focus on nearby objects. A new "third option" has emerged for this everyday inconvenience, requiring neither surgery nor lasers. The topic of aceclidine eye drops, reported by Germany's RP ONLINE, has spread through German-speaking news aggregators and specialist media, stirring mixed reactions on social media. stolpen-lokal.deDer Spiegel

What's "New": FDA Approves VIZZ

On July 31, 2025, LENZ Therapeutics' VIZZ (Aceclidine 1.44%) received FDA approval in the U.S. for improving near vision in presbyopia. The manufacturer explains it as "once a day, with effects lasting up to 10 hours," planning sample distribution in the U.S. in October, with full-scale shipments by the end of the year. Medical media in German and English-speaking regions have also reported on this, making the era of drug treatment following reading glasses and multifocal lenses seem more realistic. LENZ Therapeutics, Inc.Eyes On EyecareInvesting.com Deutsch

Mechanism: Slightly Constricting the Pupil to Increase Depth of Field

Aceclidine is a muscarinic receptor agonist. It works on the sphincter muscle of the iris to **slightly constrict the pupil (miosis), similar to increasing the aperture (F-stop) in a camera, thereby widening the depth of field (range of focus). This "pinhole effect" makes nearby objects appear sharper. Meanwhile, it is designed to minimize the impact on the ciliary muscle (focusing muscle)**, which some traditional eye drops have strongly stimulated. Ophthalmology Timesingenieur.deWikipedia

Data: Takes Effect in 30 Minutes, Lasts Up to 10 Hours

In the CLARITY Phase 3 trials that supported the approval, the aceclidine group showed a primary endpoint achievement rate of 65% in CLARITY-1 and **71% in CLARITY-2**, significantly surpassing the control group (such as brimonidine). The design, with an onset of about 30 minutes and a duration of up to 10 hours, covers "work during the day to before returning home," meeting the needs of those who dislike the "on and off stress" of reading glasses. Optometry Advisorepocrates.com

Side Effects and Precautions: Dim Vision, Headaches, and "Night"

Summaries of clinical trials and approval information list common side effects such as a sensation of irritation immediately after application, dim vision or difficulty seeing in low light, and headaches. The decrease in dim vision directly affects safety during night driving or in dimly lit areas, so it is recommended to avoid driving or operating machinery until vision stabilizes. There is also a rare risk of retinal tears or detachment reported with miotic agents, and it is advised to seek immediate medical attention if there is a sudden increase in floaters or photopsia. reviewofoptometry.comDrugs.com

Status in Europe and Japan: Awaiting Approval

German-speaking media report that it is not yet approved in Europe and convey lifestyle precautions for daily use. Pharmacy trade journals also mention practical considerations such as intervals between applications and contact lens use when prescribing. The introduction timing in Japan is undecided, but real-world use in the U.S. will likely serve as a reality check. pharmazeutische-zeitung.demorgenpost.de

The "Atmosphere" on Social Media

• Medical Accounts' Breaking Posts: Many summaries like "FDA approves VIZZ, introducing once-a-day eye drops for near vision improvement" were posted. Posts mentioning clinical data achievement rates and 10-hour duration were prominent. X (formerly Twitter)

• Explanation of the Mechanism: Threads explaining "slightly constricting the pupil to sharpen near vision with the pinhole effect, reducing the burden on the ciliary muscle" spread widely. X (formerly Twitter)

• Expectations from a Consumer Perspective: Positive reactions from those who want to use it only during the day, with comments like "Is the 'no need for reading glasses' era really coming?" and investment-related jokes ("How to invest in VIZZ?"). X (formerly Twitter)

• Voices of Caution: On German-speaking forums, comments delve into the premise of daily use, diminishing effects over time, and caution with night driving, discussing practical usability. Reddit

Differences from Existing Options

As an eye drop for presbyopia, pilocarpine (U.S. brand name Vuity) was introduced earlier in 2021. Both use the strategy of "constricting the pupil," but aceclidine is accumulating knowledge in the direction of enhancing pupil selectivity and reducing stimulation to the ciliary muscle. Which is better depends on occupation, lifestyle, and exposure to dark environments. pharmazeutische-zeitung.deOphthalmology Times

When and Who Will Benefit?

• People who find it difficult to see PC work, meeting materials, and in-store menus during the day

• People who are often in strong sunlight outdoors or bright indoor environments

  and have little activity in dark places

• People who find it burdensome to put on and take off contacts or glasses
  —for such people, it may fit as a "daytime near vision boost." Conversely, people who frequently drive at dusk to night, those with a history of retinal disease, or those with migraines should consult with a doctor.

Practical Checklist

1. Start during a weekend day: Experience changes in vision and side effects, and confirm the safety range.

2. Avoid before nighttime events: There is a possibility of reduced visibility in dim places.

3. Lens Combination Rules: Contact lens wearers should follow the instructions of doctors and pharmacists to ensure the interval before and after wearing.

4. Seek medical attention in case of abnormalities: If you experience flashes of light, an increase in floaters, or sudden vision loss, visit an ophthalmologist immediately. Drugs.com

Price and Availability Outlook

In the U.S., widespread supply is expected in Q4 2025. The expansion in Europe and Japan is undecided, but as more real-world data (effectiveness, safety, continuation rates) accumulates in the U.S., discussions on entry will likely become more realistic. ##HTML_TAG_496