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Presbyopia remains one of the most common and frustrating age-related vision changes, often representing the first sign of ocular aging for many patients. Traditionally, the solutions have been limited to reading glasses, progressive lenses, or multifocal contact lenses, leaving little room for flexibility. In recent years, pharmacologic options have begun to reshape the treatment landscape, offering alternatives that allow patients to reduce their dependency on corrective lenses.
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In this episode of The 4-Eyed Professor Podcast, Dr. Chris Lievens sits down with Dr. Janelle Davison to discuss Qlosi™, a pilocarpine eye drop specifically formulated for presbyopia treatment. Their conversation explores how the drop’s performance, convenience, and customization can enhance patient care while supporting the clinical and business objectives of modern optometric practices.
Understanding Qlosi’s EyeQ Formulation and Its Role in Presbyopia Management
Qlosi is a targeted pharmacologic solution that addresses near vision loss by inducing a controlled, temporary change in pupil size through its active ingredient, pilocarpine. While pilocarpine has been a mainstay in ophthalmic care for over a century, primarily in glaucoma, it was previously used in much higher concentrations. Qlosi’s formulation contains the lowest concentration of a miotic currently available for presbyopia management, at just 0.4%. This low dose is designed to provide the benefits of the miotic effect while reducing the likelihood of side effects associated with stronger solutions. For patients, this means clearer near vision without a significant compromise to distance vision. For practitioners, it represents a new opportunity to broaden their therapeutic toolkit, offering an option that can be incorporated alongside existing corrective solutions.
Performance: How Qlosi Delivers Results
The effectiveness of Qlosi lies in its ability to create the “pinhole effect,” which sharpens near vision by reducing the pupil diameter to an optimal range of two to three millimeters. At this size, the visual system benefits from increased depth of focus without introducing significant blur or distortion at distance. If the pupil becomes too small, diffraction and reduced brightness can occur, while a pupil that is too large may introduce optical aberrations. Qlosi’s carefully calibrated concentration achieves the sweet spot, providing patients with the clarity they need for near tasks while maintaining functional distance vision. This balance is particularly important for active presbyopes who move between various visual demands throughout the day, from reading a smartphone to driving.
Convenience: Integrating Qlosi into Daily Life
One of Qlosi’s most appealing qualities for patients is its dosing flexibility. While it can be taken twice daily for extended near vision support, many patients find a single morning dose sufficient to carry them a few hours into their workday. The option to customize use based on daily needs means patients can match their treatment to their lifestyle, whether they have long stretches of close work or only occasional near-vision demands. Dr. Davison herself often uses just one dose per day to manage her clinic schedule comfortably, demonstrating how providers can speak from personal experience when guiding patients. For those who require longer-lasting effects, such as individuals with demanding near-vision work in the evening, a second drop two to three hours after the first can extend the benefits.
Customization: Tailoring the Experience to the Patient
The ability to adapt Qlosi’s dosing schedule gives patients more control over their vision than ever before. Some will choose to use it daily for consistent performance, while others may reserve it for specific situations, such as social events or professional tasks that require sustained near focus. This flexibility aligns with the broader goal of reducing dependency on glasses or contact lenses without eliminating them entirely. By positioning Qlosi as an additional tool rather than a replacement, optometrists can encourage patients to see it as part of a comprehensive vision care plan. The emphasis on options and adaptability resonates strongly with presbyopes who value both visual performance and lifestyle freedom.
Identifying Ideal Candidates for Qlosi
While Qlosi is indicated for adults with presbyopia, its versatility allows it to benefit a wide range of patient types. Candidates can include low to moderate myopes, hyperopes, post-refractive surgery patients, and progressive lens wearers looking for alternatives. Contact lens users who experience gaps in their near vision can also benefit, as can those emerging into presbyopia who are not yet ready for full-time reading glasses. Dr. Davison notes that assumptions about who will be interested can be misleading; sometimes the patients you expect to be most receptive decline, while others you might not consider ideal show strong enthusiasm. Including Qlosi as an option in intake paperwork or discussing it during the case history allows more patients to self-identify as interested, streamlining the process for both patient and provider.
Setting Expectations and Addressing Side Effects
As with any presbyopia treatment, managing expectations is key. Dr. Davison advises patients to begin with two doses per day for the first week to support neuroadaptation, allowing the visual system to adjust to the altered depth of focus. Common side effects can include mild stinging upon instillation, a brief dimming of vision, or occasional headaches—each of which occurs in a small percentage of users and typically resolves quickly with continued use. Patients should also be reminded of the importance of comprehensive peripheral retinal evaluations before and during treatment. This ensures that the eye health baseline is documented and any changes that could influence treatment safety are monitored over time.
Qlosi as a Complement to Glasses and Contact Lenses
Qlosi is not designed to replace corrective lenses but rather to complement them. Many patients will continue to use their glasses or contacts for certain situations while enjoying the freedom of reduced dependency in others. This approach enhances patient satisfaction by providing choice, rather than presenting Qlosi as an all-or-nothing solution. Providers should also make it clear that Qlosi is a prescription medication that should not be shared, as candidacy should be confirmed through an eye health evaluation. This precaution protects patients and reinforces the importance of individualized care.
Building Awareness and Adoption in the Practice
Since many presbyopes are unaware of pharmacologic options, in-office education plays a critical role. Strategies such as posters in the exam room, patient engagement tools, and staff training can prompt interest and questions, creating opportunities for discussion. Dr. Davison has found that even small changes, like displaying materials on the back of the exam room door, can prompt patients to initiate the conversation. Providers who use Qlosi themselves can further build trust by sharing their personal experience, making the recommendation more relatable.
Why Now Is the Time to Offer Qlosi
For practices that want to stay at the forefront of innovation, now is the ideal time to incorporate Qlosi into the treatment conversation. The product combines measurable visual performance, daily-use flexibility, and patient-centered customization, all qualities that align with modern patient expectations. By introducing it proactively, even to patients who may not be immediate candidates, optometrists can position themselves as forward-thinking providers while expanding their service offerings.
Qlosi represents a significant step forward in presbyopia treatment, combining the proven action of pilocarpine eye drops with Qlosi’s EyeQ Formulation designed for optimal pupil control, minimal side effects, and flexibility. For patients, it offers the chance to reduce reliance on glasses or contact lenses without giving them up entirely. For providers, it’s an opportunity to deliver innovation, increase patient satisfaction, and reinforce the value of comprehensive, customized care. In an era where visual demands are more varied than ever, Qlosi’s blend of performance, convenience, and customization makes it a compelling addition to the presbyopia management toolkit.
INDICATION
QLOSI is a cholinergic agonist indicated for the treatment of presbyopia in adults.
IMPORTANT SAFETY INFORMATION
CONTRAINDICATIONS
Hypersensitivity
WARNINGS AND PRECAUTIONS
Advise patients to not drive or operate machinery if vision is not clear (e.g., blurred vision). Exercise caution in night driving and other hazardous occupations in poor illumination.
Rare cases of retinal detachment have been reported with miotics. Examination of the retina is advised in all patients prior to initiation of therapy. Advise patients to seek immediate medical care with sudden onset of flashes of lights, floaters, or vision loss.
QLOSI is not recommended to be used when iritis is present.
QLOSI should not be administered while wearing contact lenses. Remove lenses prior to the installation of QLOSI and wait 10 minutes before reinsertion.
Avoid touching the tip of the vial to the eye or any other surface.
ADVERSE REACTIONS
The most common adverse reactions (5% to 8%) are instillation site pain and headaches.
