A typical situation: pt Rx- od +1.25 -1.50 x45 os- +.50 -2.25 x 100, near add of +2.25; total near power of od- +3.50-1.50 x 45, os- +2.75-2.25 x 100, pd- 63/59. First of all, pt complains that near are of the multifocal lens is 'not as sharp as in the exam', if they go back to the dr's office, they'll likely be told that the glasses aren't right, don't read the right power in the seg, 'because it's a 'no-line'. As I see the problem, if the pt wants to see like they did in the exam, the 'only' way they're going to do that is in a single vision lens. It's actually pretty simple to explain to pts. In the refraction, the pt looks through a very small sphere power (+.50 on the os); directly in line with it is the small cylinder lens(-2.25) rotated to the desired axis(100); now these two lenses combined give the best acuity at 20' to infinity. Now also 'in line' with theses two lenses is now placed the 'add power' lens(+2.25), which now provide the best 'near point' vision. now, the refractionist has arrived at the best combination of lens powers, in SINGLE VISION lenses. This is where 'Opticianry" comes in, as opposed to 'order taking'. I think it is an unrealistic expectation to think that the pt will see as weel in 'any' multifocal lens design. they NEED single vision reading glasses. Consider that the near power add is now on the front of the lenses and anywhere from 7 to 20 mm below the distance oc's. while the cylinder power is rotating on the back surface, therefore the power through the multifocal near area can 'never' be emulated in the exam, not even in a 'trial frame' with 'trial lenses'. So, why to we constantly affirm to the pt that they 'should see' in their multifocals, like they do in the refracting lane, and if they don't, the glasses must not be made properly? Must be the 'base curves' or the p.d. or the index, or 'poly', mustn't it? This is also one of the reasons that a pt may not like a .25 add change in the phoropter, but loves it in the glasses; and also, many pts have a different refractive axis at near rotation than they do looking straight forward, which could account for further dissatisfaction. Al.