Truth or Myth:
Fitting soft multifocal contact lenses
takes too much chair time?
Answer: MYTH
Marc Schulze, PhD, Dipl. Ing. (AO), FAAO, Meredith Bishop OD, MS, FAAO
Introduction:
According to 2022 population data from the
United Nations, the median age of those in the
world’s developed regions is 41.4 years.1
Similarly, the number of presbyopic patients
needing vision correction is increasing, with an
estimated 2.1 billion presbyopes globally in 2030.2
Presbyopic patients have multiple options for vision
correction, including single vision reading
spectacles, bifocal or progressive addition glasses,
and various contact lens (CL) options. According to
Sivardeen et al., who reviewed the correction
modalities for 529 presbyopic patients in 2020, only
11.8% of the surveyed sample wore CLs (2.8%
monovision, 2.8% multifocal (MF) CLs, 6.2%
distance CLs).3 Thus, if we consider the 88% of the
presbyopic population wearing a spectacle
correction or no correction at all, plus the 6.2%
using presbyopic distance CLs with over-readers, it
is clear that the numbers of people using CLs to
address their presbyopia are very small (<6%).
Similar findings have been reported by
other groups.4,5
In their most recent annual survey on contact lens
use, Morgan et al. reported that 49% of presbyopic
Figure 1. Results showing extent of agreement or disagreement with the statement “I usually do not
offer soft multifocal contact lenses as fitting them takes too much communication and chair time.”
Data is from 2022 for all markets except Russia which is from 2021.
Statement Agreement by Country (% ECPs):
Strongly disagree 1 2
USA (n=284) UK (n=143) Russia (n=151)
48% 28% 63% 22% 21% 50%
patients fitted with CLs received MF lenses (ranging
from 12% in Singapore to 95% in Hungary), while
11% were fitted with monovision. This suggests that
the remaining 40% of presbyopes were fit with
distance vision CLs with over-readers. While 49%
may appear to be a high number for MF CL fits, this
number only refers to the presbyopic sub-cohort of
all the soft lens fits in the survey, and the proportion
of presbyopic patients who wear contact lenses is
very small.3 So why are so few presbyopes fit with
MF CLs?
Professional Belief Survey Results:
Historically, MF CLs were perceived by many
practitioners as requiring more chair time due to the
complexity of the fitting process. This often resulted
in them being considered a “specialty” area that did
not have a high enough success rate relative to the
time required for multiple fitting attempts.5,6 A recent
survey of 1028 Eye Care Professionals (ECPs)
conducted in 2021 in Russia and in 2022 for the
other markets, assessed their prescribing beliefs in
all six countries.7 This survey reported that 40% of
ECPs strongly agreed that multifocal CL fitting takes
too much chair time. Agreement ranged from just
15% of ECPs in South Korea to 76% in China
(Figure 1).
3 4 5 Strongly agree
China (n=150) Japan (n=150) South Korea
(n=150)
3% 76% 9% 69% 31% 15%
© Johnson & Johnson Vision Care, Inc. 2023
What the Evidence Shows:
A study by Woods et al. showed that when following
the manufacturer’s guide, fitting MF CLs took more
attempts than single vision or monovision
modalities, but not by very much.8 The average
number of attempts were 1.5 for MF CLs compared
to 1.3 attempts for single vision or monovision
lenses,8 a difference that is probably irrelevant when
it comes to chair time in clinical practice.8 More
recently, Luensmann et al. also reported that fitting
success for a silicone hydrogel MF CL, when
closely following the manufacturer’s fitting guide,
was 83% with the initial trial lens pair and 100%
after the second fitting attempt.9
In addition to providing guides to facilitate
MF CL fittings, contact lens manufacturers have
also introduced online fitting tools that allow
practitioners to determine ideal initial trial lens
parameters based on easily available factors such
as subjective refraction, near work parameters and
ocular dominance.10,11 These provide high success
rates compared to practitioner determined lens
selection.12
Dr Marc Schulze is a Senior Clinical Scientist at
the Centre for Ocular Research & Education,
School of Optometry & Vision Science,
University of Waterloo. Dr Meredith Bishop is
Senior Manager, Global Professional Education
and Development at Johnson & Johnson Vision
Care, Inc.

Conclusion:
A closer look at the contact lens fitting trends across 20 countries over the past 21 years suggests a change
in practitioner perception and a greater willingness to fit MF lenses.4 These improvements can likely be
attributed to the increasing availability of MF CL lens types, expanded lens parameters, as well as more
advanced designs. Clinically, closely following the recommended fitting guides and using online tools help to
make fitting MF CLs a relatively routine procedure.10,11 Thus, it is safe to say that increased chair time is not
a factor that should dissuade practitioners from fitting MF CLs.

References:
1. United Nations, Department of Economic and Social Affairs, Population Division (2022). World Population Prospects: The 2022 Revision.
https://population.un.org/wpp/. Accessed: Aug 16, 2022.
2. Fricke TR, Tahhan N, Resnikoff S, et al. Global Prevalence of Presbyopia and Vision Impairment from Uncorrected Presbyopia: Systematic
Review, Meta-Analysis, and Modelling. Ophthalmology 2018;125:1492-9.
3. Sivardeen A, McAlinden C, Wolffsohn JS. Presbyopic Correction Use and Its Impact on Quality of Vision Symptoms. Journal of Optometry
2020;13:29-34.
4. Morgan PB, Efron N. Global Contact Lens Prescribing 2000-2020. Clinical and Experimental Optometry 2022;105:298-312.
5. Walsh K, Jones L, Moody K. Addressing Common Myths and Misconceptions in Soft Contact Lens Practice. Clinical and Experimental
Optometry 2022;105:459-73.
6. Bennett ES. Contact Lens Correction of Presbyopia. Clinical and Experimental Optometry 2008;91:265-78.
7. Johnson & Johnson Vision Care. Online survey of 1028 Eye Care Professionals across United States, United Kingdom, Russia, China, Japan
and South Korea. JJV data on file.; 2021 (Russia) and 2022 (other markets)..
8. Woods J, Woods C, Fonn D. Visual Performance of a Multifocal Contact Lens Versus Monovision in Established Presbyopes. Optometry Vision
Sci 2015;92:175-82.
9. Luensmann D, Schulze M, Woods J, et al. Fitting Success with Stenfilcon A Daily Disposable Multifocal Lenses. BCLA Virtual Clinical
Conference & Exhibition 2021.
10. Coopervision. Optiexpert™ Contact Lens Calculator. https://coopervision.com/practitioner/tools-and-calculators/optiexpert. Accessed: July 19,
2022.
11. Johnson & Johnson Vision. ACUVUE® Multifocal Fitting Calculator. https://www.jnjvisionpro.ca/calculators-tools/fitting-calculator. Accessed: July
19, 2022.
12. Orsborn G, Woods J, Varikooty J, Bogers A. Validation of the Online Fitting App Optiexpert™ for a Reusable Multifocal Soft Contact Lens.
Contact Lens and Anterior Eye 2021;44:20-1.

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© Johnson & Johnson Vision Care, Inc. 2023