Qlosli (0.4% pilocarpine solution) meets all KPIs in Presbyopia Pathway Implementation Pilot

According to a poster presented at the 2026 Optometry’s Meeting of the American Optometric Association, held from June 17-20, in Phoenix, Arizona, a structured implementation of 0.4% pilocarpine HCl ophthalmic solution (Qlosli; Orasis Pharmaceuticals) within routine comprehensive optometric care met or exceeded established corporate baselines across all 4 key performance indicators (KPIs) evaluated, including a 16.4 percentage-point increase in ultra-widefield (UWF) imaging utilization.¹

These data from the Presbyopia Pathway Implementation Pilot (PPIP) provide real-world, practice-level evidence for pharmacologic presbyopia management outside the controlled conditions of a clinical trial setting. They were presented by Harmin Chima, OD, FAAO, the vice president of Professional Services at West Point Optical Group, and colleagues.

Qlosli is approved by the FDA for the treatment of presbyopia in adults and represents an expanding category of topical miotic pharmacotherapy for primary eye care.¹ As adoption of pharmacologic presbyopia management grows across optometric practices, practice-level implementation data—including effects on new patient acquisition, diagnostic yield, optical revenue, and ancillary testing—are increasingly relevant to ODs considering structured presbyopia pathways.

PPIP study design and key performance indicator results across 8 optometric sites

The PPIP was a prospective, multicenter, single-arm, open-label pilot study conducted across 8 West Point Optical sites in the United States.¹ Candidates were identified opportunistically during scheduled office visits; eligibility required a presbyopia diagnosis, desire to pursue miotic pharmacotherapy, and absence of recognized contraindications, excluding patients with high myopia, vitreoretinal pathology, or a history of iritis. All 111 enrolled subjects received a Qlosli Clear Start Kit containing 10 single-use vials of 0.4% pilocarpine HCl, written dosing and safety instructions, a written prescription, and a mandatory 1-week neuroadaptation period, with follow-up conducted in person or via telecommunication.¹

Four KPIs were tracked against established corporate baselines: new patients, new medical diagnoses, new optical purchases, and UWF imaging utilization. UWF imaging was the highest-performing KPI, utilized in 85.6% of subjects (95 of 111) versus a corporate baseline of 69.2%, a difference of 16.4 percentage points (P = .0003).¹ New medical diagnoses were identified in 24.5% of subjects (27 of 110), representing a 6.2 percentage-point increase over the 18.3% baseline, though this KPI demonstrated the greatest degree of intersite variability (χ² = 27.93; P <.0001).

New optical purchases were recorded in 71.6% of subjects (78 of 109), exceeding the 68.8% corporate baseline. New patients represented 34% of enrolled subjects, a 4.0 percentage-point increase over baseline, with no significant inter-site variation (χ² = 9.60; P = .142).¹

Patient satisfaction, goal attainment, and practice implications of pilocarpine presbyopia therapy

Among subjects with follow-up data (n = 50), mean patient satisfaction was 7.32 out of 10 (median 8 out of 10), with 70% reporting a satisfaction rating of 7 or higher.¹ Satisfaction did not differ significantly by site, patient status (new vs established), optical purchase behavior, or new diagnosis status, confirming outcomes were largely independent of one another rather than driven by any single patient or practice variable. Goal attainment was reported by 72.7% of subjects with available follow-up data (n = 55).¹

The PPIP authors identified appropriate patient selection and proactive expectation-setting as prerequisites for optimizing both goal attainment and patient satisfaction, noting patients who achieved their stated goals were significantly more satisfied, with direct implications for retention and referral.¹ All four KPIs exceeded corporate baselines, and the authors concluded pharmacologic presbyopia management, when implemented deliberately within a structured clinical pathway, operates in a complementary fashion to traditional optical revenue rather than cannibalizing it.

Optical purchase rates remained robust at 71.6%, exceeding the corporate baseline of 68.8% and directly refuting the concern presbyopia pharmacotherapy would reduce frame and lens revenue.

For ODs evaluating whether to implement a structured presbyopia pharmacotherapy pathway, the PPIP data support a model centered on structured introduction during routine comprehensive exams, a mandatory neuroadaptation period, and defined follow-up—with UWF imaging as both a clinical and practice efficiency driver. Future controlled studies with larger and more diverse patient populations and longer follow-up are warranted to confirm and extend these preliminary observations.

References

1. Chima HJ, Womack J, Campbell K, et al. The Presbyopia Pathway Implementation Pilot: assessing key performance indicators relative to 0.4% pilocarpine eye drops across a large, multicenter optometric practice. Poster presented at: AOA Annual Meeting; June 17–20, 2026; Phoenix, AZ. Poster #79.

2. Waring GO IV, Price FW Jr, Wirta D, et al. Safety and efficacy of AGN-190584 ophthalmic solution 0.4% in participants with presbyopia: the GEMINI 1 phase 3 randomized clinical trial. JAMA Ophthalmol. 2023;141(1):7-14. doi:10.1001/jamaophthalmol.2022.4739