Features

Truth or myth: Fitting soft multifocal CLs takes too much chair time?

Contact Lenses Practice
In the first of a monthly series looking at common myths concerning contact lenses, Dr Marc Schulze and Dr Meredith Bishop show how soft multifocal lens fitting is not chair-time heavy

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 varifocal 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 is 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 al6 reported that 53% of presbyopic patients fitted with CLs received MF lenses (ranging from 18% in Argentina to 80% in Greece), while 7% were fitted with monovision. This suggests that the remaining 36% of presbyopes were fit with distance vision CLs with over-readers.  

While 53% 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, 7  

A survey of 1,028 eye care professionals (ECPs) conducted in Russia in 2021 and all other markets in 2022, assessed their prescribing beliefs in six countries.8 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). 

  

Figure 1: Results showing extent of agreement (shown in blue) or disagreement (shown in red) 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

 

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.9 The average number of attempts were 1.5 for MF CLs compared to 1.3 attempts for single vision or monovision lenses,9 a difference that is probably irrelevant when it comes to chair time in clinical practice.9  

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.10  

In addition to providing guides to facilitate MF CL fittings, contact lens manufacturers have introduced online fitting tools that allow practitioners to determine ideal initial trial lens parameters based on data such as subjective refraction, near work parameters and ocular dominance.11, 12 These provide high success rates compared to practitioner determined lens selection.13  

  

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.11, 12 Thus, it is safe to say that increased chair time is not a factor that should dissuade practitioners from fitting MF CLs.  

  • 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 of Global Professional Education and Development at Johnson & Johnson Vision Care, Inc.  

  

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. Morgan PB, Woods CA, Tranoudis IG, et al. International contact lens prescribing in 2022. Contact Lens Spectrum. 2023; 38: 28-35.  
  7. Bennett ES. Contact Lens Correction of Presbyopia. Clinical and Experimental Optometry 2008;91:265-78. 
  8. 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). 
  9. 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. 
  10. Luensmann D, Schulze M, Woods J, et al. Fitting Success with Stenfilcon A Daily Disposable Multifocal Lenses. BCLA Virtual Clinical Conference & Exhibition 2021. 
  11. Coopervision. Optiexpert Contact Lens Calculator. https://coopervision.com/practitioner/tools-and-calculators/optiexpert. Accessed: July 19, 2022. 
  12. Johnson & Johnson Vision. Acuvue Multifocal Fitting Calculator. https://www.jnjvisionpro.ca/calculators-tools/fitting-calculator. Accessed: July 19, 2022. 
  13. 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. 
  • Important Safety Information: Acuvue Contact Lenses are indicated for vision correction. As with any contact lens, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. Contact lenses should not be used in case of eye infections or any other eye conditions, or in case of a systemic disease that may affect the eye. For complete information, including contraindications, precautions and adverse reactions, please consult the Instructions for Use or visit our website www.jnjvisionpro.co.uk.