Presbyopia is a progressive, age-related condition that reduces the eye’s ability to focus on near objects. If uncorrected or undercorrected, presbyopia can negatively impact people’s daily activities and quality of life. Until recently, standard treatments comprised corrective glasses or contact lenses and surgical procedures, all of which fail to restore natural accommodation of the lens and are associated with inconvenience and/or potential ocular complications. Pilocarpine hydrochloride (HCl) ophthalmic solution 1.25% (Vuity™; Allergan, an AbbVie Company, North Chicago, IL, USA) is the first and, at the time of writing, only topical agent approved by the United States Food and Drug Administration to treat presbyopia. Pilocarpine HCl ophthalmic solution 1.25% is formulated in a proprietary vehicle using pHast™ technology, which allows rapid equilibration to the physiological pH of the tear film to enhance bioavailability and reduce side effects such as ocular discomfort and vision blur. Clinical trials in individuals with presbyopia have demonstrated that pilocarpine HCl 1.25% is well tolerated and leads to rapid improvements in near and intermediate vision, without impacting distance vision. In this article, we discuss the mechanism of action of pilocarpine HCl 1.25%, preclinical and clinical evidence supporting its use in presbyopia, and its value in providing a non-invasive, reversible, glasses-free alternative for managing presbyopia.