Methods: Twenty presbyopic subjects participated in this study using two methods to select on-eye MCLs from 4 manufacturers: (1) using the first step of the fitting guide, according to the patient’s addition need, to provide the MCLs recommended by the manufacturer and, (2) using SimVis Gekko simulations to obtain MCLs providing better 3D-VA, between the first and the first-alternative step of the fitting guides. Clinical measurements and metric calculations (3D-VA, perceptual score module, and direct preference) were conducted to compare the visual performance of the on-eye MCLsselected by both methods when differences existed.

Results: SimVis Gekko selected the same combination of MCLs as the fitting guides in 59 % of the cases. In 28 %, SimVis Gekko chose the alternative step with differences greater than 0.05 in 3D-VA. In these latter cases, the 3D-VAsobtained with the on-eye MCLs indicated that SimVis Gekko selections were better in 62 % of cases, equal in 14 %, and worse in 24 %. The perceptual score module showed that SimVis Gekko selections were better in 62 % of cases, equal in 9 %, and worse in 29 %. The direct preference indicated that SimVis Gekko selections were better in 61 % of cases. Clinical measurements revealed that MCLsselected by SimVis Gekko had better Near Activity Visual Questionnaire scoresthan the fitting guide selection acrossall manufacturers (p = 0.02), indicating greater comfort and independence for near activities.

Conclusions: SimVis Gekko can effectively replicate fitting guide steps and, in combinationwith the3D-VA metric, has the potential to become a tool that helps practitioners enhance MCL wearer satisfaction. This approach could improve the adoption and visual performance of MCLs among the presbyopic population,streamlining the fitting process.