After 40, small text on your phone has to be held farther and farther from your eyes, and reading often requires special glasses. Now an unusual eye drop has been approved in the US: it is instilled before bed to see better up close the next day.

On October 16, 2026, the U.S. Food and Drug Administration (FDA) approved Ryzumvi for the treatment of age-related presbyopia in adults. This was reported by the pharmaceutical company Viatris.

However, there is an important nuance: in clinical trials, a marked improvement in vision by the main criterion was achieved by approximately 23–27% of patients versus 11–12% in control groups. The drops may help some people use reading glasses less often, but they cannot completely replace them for everyone.

Why reading becomes difficult after 40

Many people notice age-related vision changes in familiar situations: you have to increase the font size on your smartphone, hold a book farther away, or find brighter lighting to make out small print.

The cause is often presbyopia—a natural age-related decline in the eye's ability to focus on near objects.

In youth, the lens is elastic enough and easily changes shape. This allows the eye to quickly shift focus between near and distant objects.

With age, the lens becomes less flexible. Gradually it becomes harder to read at a usual distance, even if distance vision remains good.

Typically the first symptoms appear after 40 and then worsen. For correction, reading glasses, progressive lenses, and other optical solutions are used.

The new eye drops offer a different approach: temporarily improve near vision without changing the lens itself.

How drops used before bedtime work

The active ingredient in Ryzumvi is phentolamine at a concentration of 0.75%. It acts on receptors in the iris muscles involved in pupil dilation.

As a result, the pupil becomes smaller and depth of focus increases.

This effect can be compared to a camera: if you reduce the aperture, objects at different distances can appear sharper.

By narrowing the pupil, it becomes easier to see fine details up close, even if the lens has already lost some ability to change focus.

At the same time, phentolamine does not directly act on the muscle that controls the shape of the lens and does not restore its elasticity.

According to the updated official label, for the treatment of presbyopia the drug is applied once daily at bedtime—one drop in each eye.

It is the evening dosing schedule that makes it unusual: the person uses the drug before sleep, and vision improvement is assessed including on the next day.

Trial results: did the drops help most patients?

Approval was based on two randomized phase III clinical trials—VEGA-2 and VEGA-3.

A total of 902 people aged 40 to 64 years participated. All had presbyopia that made near reading difficult, with fairly good corrected distance vision.

Participants were randomly assigned to groups: some received Ryzumvi, others were given control drops without active ingredient. The studies were double-masked: neither participants nor specialists evaluating results knew which treatment a particular patient had used.

The primary efficacy endpoint was an improvement in near vision of at least three lines on a reading chart, without significant loss of distance vision.

Measurements were done under good lighting at a distance of 40 centimeters—similar to reading a book or using a smartphone.

At 12 hours after evening dosing, following seven days of daily use, results were as follows:

  • In VEGA-2, the required improvement was achieved by 22.6% of patients on Ryzumvi versus 11% in the control group.
  • In VEGA-3, 27.2% versus 11.5%, respectively.

The difference was statistically significant in both studies.

In simple terms, about every fourth patient on Ryzumvi could read at least three more lines. In the control groups, this result was seen in about every ninth.

However, this does not mean that other patients noticed nothing at all. Some may have had less pronounced improvement that did not reach the threshold set by researchers.

Additional data showed that in some participants the effect lasted even beyond 20 hours after dosing. In VEGA-2, the required improvement at this time point was achieved by 24% of Ryzumvi patients versus 15% in the control group.

But such a result cannot be guaranteed for every person.

In addition, the main studies did not include patients older than 64. Therefore, available data are insufficient to evaluate exact efficacy in older people.

Side effects discovered

Despite FDA approval, Ryzumvi cannot be considered a drug without side effects.

According to the official label, the most common adverse reactions when used for presbyopia were eye redness—in 21% of patients—and instillation site irritation—in 16%.

The drug is not recommended for use in active inflammatory eye conditions, such as iritis, because in such states there is a risk of adhesions between the iris and lens.

People who wear contact lenses must remove them before using the drops. Lenses can be reinserted no earlier than 10 minutes afterwards.

Ryzumvi is supplied in single-use, preservative-free vials. After use, the opened vial should be discarded.

In the US, the drug is prescription-only. The decision to use it should be made by an ophthalmologist, because reduced near vision may be related not only to age-related changes in the lens but also to other diseases.

Will the drops replace glasses and when will they be available

Ryzumvi is not the first medication for temporary improvement of near vision. Other eye drops for presbyopia are already approved in the US.

But the new drug has an important difference: phentolamine reduces pupil diameter without directly acting on the muscle responsible for changing lens shape.

For some people, this approach may be a convenient way to see fine print better without constant use of reading glasses. However, trial results show that only a portion of patients achieve marked improvement.

In addition, the drops act temporarily. They do not restore youthful elasticity to the lens, do not stop age-related vision changes, and do not eliminate presbyopia permanently.

There is also a practical question—accessibility of the new treatment.

Ryzumvi had already been approved in the US for another purpose: reducing pupil dilation after eye examinations. The FDA decision of October 16, 2026 expanded the label to include treatment of presbyopia in adults.

However, Viatris is still considering the possibility of partnering to promote the drug for the new indication in the US market.

As of October 2026, the timing of availability specifically for presbyopia and the cost of such use have not been announced.

FDA approval also does not mean automatic permission to sell the drug in the European Union or Ukraine: separate regulatory decisions are required.

Thus, people with age-related vision decline now have another potential alternative to reading glasses. But one should not expect a universal result: the drops can temporarily improve near vision in some patients, while the underlying cause of presbyopia remains unchanged.

Sources: Viatris, official Ryzumvi prescribing information with results of VEGA-2 and VEGA-3 studies.