ESCRS 2026: Real-world aceclidine data guide candidate selection

Maria Soledad Romero, MD, founder and chief medical officer of Precision Eye Care in Baltimore, said real-world data serve a different purpose than the controlled conditions of a clinical trial. Speaking at ESCRS 2026 about her real-world outcomes study of aceclidine ophthalmic solution 1.44% (VIZZ; LENZ Therapeutics) for presbyopia, Romero said trials establish safety, tolerability, and efficacy. Real-world practice reveals when a treatment works, and when it doesn't, in ways a controlled setting cannot. She said feedback from everyday use can help identify good candidates, refine patient education, and inform manufacturers as they evolve the treatment.

>>> Watch Romero’s interview on the study design and results here!

How should physicians set patient expectations?

Romero emphasized that use of the drops is task-specific rather than a continuous solution. She described patients using the drops selectively, such as before going to the gym or a social event, rather than expecting all-day coverage. She cautioned that the effect is reversible and temporary, does not restore true accommodation, and is not a permanent alternative to reading glasses. Because the drops reduce vision in dim light, Romero said patients who drive at night or work night shifts, such as rideshare or truck drivers, may not be good candidates.

What identifies a good candidate?

Romero said patients with darker irises tended to tolerate treatment better than those with lighter irises, who experience more pronounced pupil constriction and associated redness. She also pointed to contrast sensitivity reserve, the eye's tolerance for reduced light following pupil constriction, as a key factor, noting that some patients simply do not adapt well to the visual effect. Romero proposed that an in-office test, such as pinhole glasses, could help predict which patients would respond well before starting treatment, drawing a comparison to how VR-based simulation is used to counsel patients ahead of cataract surgery.

Why did so few patients continue treatment?

Romero also addressed the study's 3-month treatment persistence rate, in which only 9 of 61 patients (14.8%) remained on aceclidine. She attributed the drop-off primarily to cost and insufficient patient education, noting that some patients did not understand the treatment was temporary and mistakenly expected it to fully replace their reading glasses. Romero said greater public awareness and marketing, along with clearer expectation-setting at the time of prescribing, may improve long-term adherence as the drug class becomes more established.

Reference
1. Romero MS, Han D, Setton M, Tasser I, Lerma M. A real-world outcomes study for aceclidine 1.44% eye drops to manage presbyopia. Presented at: 44th Congress of the European Society of Cataract and Refractive Surgeons; September 11-15, 2026; London, United Kingdom.