I have a patient wearing Varilux Physio Enhanced who states that it doesn't meet her needs for computer. Reading and and distance is fine. She states that her older pair, also Varilux Physio Enhanced but smaller frame with nosepads, is better. Rx has not changed significantly. Reviewing last year's exam, my notes stated her older pair wasn't meeting her computer needs and I had recommended a 2nd pair NVF last year. Despite my best efforts explaining lens expectations and recommending a 2nd pair NVF yet again, she insists on a single pair of glasses that is optimized for her computer and reading but still has good distance for driving and doesn't understand why her older pair is now better. She states that she has to tilt her head back to get better computer vision. She is on computer 10+ hours/day.

I've considered the following options.
1) Add nosepads to frame to move intermediate up. Pt declined because of additional cost.
2) Remain with Varilux Physio Enhance, and adjust Rx more towards intermediate. Some distance Rx will be lost.
3) Change to NVF with decent distance.

Here is Rx and measurements
Rx
OD -3.25 -0.25 x 100 30.5/29.0
OS -3.50 -0.50 x 060 31.0/29.5
ADD +2.25

Mono PD (Dist/Near)
OD 30.5/29.0
OS 31.0/29.5

Seg height: 22mm
Vertical B height: 32mm
Working distance: 52cm

Thanks in advance for any advice!