Several studies have been conducted to determine how much each factor involved in the accommodative process contributes to it [10–14]. The few topical treatments for presbyopia currently under study claim to work on different aspects of the accommodative process: they involve monovision parasympathetic-mediated miosis and ciliary muscle stimulation or lens softening in order to restore its shape-changing ability [4–7]. Each of these approaches presents some disadvantages. Pure parasympathetic treatments result in a rather small pupil diameter and a myopic shift, compromising far distance vision, and they also cause several well-known adverse reactions due to the muscarinic stimulation of ciliary muscle and pupil sphincter [5]. Even a safe lens-softening treatment could be less effective than expected because changes in mechanical properties seem to be less important in the advent and progression of presbyopia than changes in lens geometry [12]. A monovision treatment could reduce visual performance in reduced light conditions compared to a binocular approach [14]. For this reason, the treatment used in our pilot study is instilled in both eyes. The Vejarano (patent pending) eye drops both stimulate the contraction of the ciliary body and maintain a physiological pupil diameter variation. In this context, binocular treatment avoids the worsening of visual performance in reduced light and allows physiological image merging with clear focus at near, intermediate, and distance. Pilocarpine provides both miosis and ciliary body contraction, stimulating accommodation, and may improve tear production by stimulating lacrimal gland secretion [15]. Phenylephrine, nepafenac, and pheniramine, each in different ways and amounts, stop excess pupil constriction and counteract ciliary muscle spasm, vascular congestion, and hyperemia induced by pilocarpine [6, 16–18]. Naphazoline intensifies the relaxing effect of pilocarpine on dilator pupillae while relieving its side effects, increasing acetylcholine release and reducing norepinephrine release [18]. The lubricating effect of polyethyleneglycol makes the eye drops more tolerable by stopping the burning sensation typically caused by most of the compounds present in the eye drops. The synergistic effect observed by Vejarano between these compounds permits improved near vision and preserves distance vision in all subjects. The synergism reduces symptoms of headache and hyperemia, allowing lower doses of miotics to be used. There was no evidence of tachyphylaxis in this study. No ocular complications were detected in any of the treated eyes during the entire follow-up period. The results showed that UNVA improved by about 2–3 lines in each eye and binocularly from a baseline mean of about J 3.5 to about J 1.5. No patient presented any UDVA degradation in an eye or binocularly. Whereas other drops for treating presbyopia improve near vision by causing extreme miosis or a myopic shift that can reduce far vision [5], refractive measurements performed in this study showed there was a maximum myopic shift of just 0.5 D, which progressively reduced and disappeared after 3 h. Pupil diameter was also measured and found to be mildly affected by the topical treatment, so the mechanism for near vision improvement might be due to factors other than miosis. However, we cannot clarify this issue based on the evidence provided by the present study, so a controlled study of a larger number of patients in which the dynamic changes in refraction are investigated objectively is required. Moreover, the measurements showed that the treatment seemed to mitigate significant pupil enlargement under scotopic conditions as well as significant contraction under photopic conditions. Other assessments showed that there were no clinical changes in tear film quality or quantity or in endothelial cell count, showing that the eye drops had no adverse effects on the lacrimal film, corneal epithelium, or endothelial cells. The study also showed that there was a significant decrease in intraocular pressure of almost 2 mmHg 5 h after eye drop instillation. There is clinical evidence that the trabecular meshwork stiffens with age, which leads to increased prevalence and incidence of glaucoma with age [19]. The daily movement of the scleral spur induced by the eye drops could reduce this stiffening of the trabecular meshwork, thereby suppressing the increase in glaucoma incidence with age.