Opinions on Comfort Max by Essilor?

[threeblindmice]

Essilor recently launched a new PAL, the Comfort Max.
Our Essilor rep told me that this is an upgraded version of the Comfort DS, with wider intermediate zones and smoother transitions between powers. What I've found so far is that young/new progressive wearers have no issues adapting to this lens, but that long time PAL wearers (including those who wore the Comfort DS) are having a horrible time with swim in this design. I've had myopes and hyperopes struggle with this lens.
I'm also finding that some patients need the optical center moved below their pupil. What they're describing almost sounds like someone with a bifocal that's placed too high...
At this point working with this lens feels like a wild card- I know what it's supposed to be like, but the experience of wearers is inconsistent. I am not yet a presbyope so can't try for myself.

Does anyone have opinions/thoughts/info on this lens?

Thanks!

[NAICITPO]

I've only fit people upgrading from a more basic progressive lens to the comfort Max and haven't had any issues with it so far. We fit most of our patients in the Varilux X lens and that seems to work. I am definitely following this thread, I too am curious to see what people think.

[PRECISIONLAB]

Kudos to the marketing department on this one. Not a total redesign probably just a rebrand in an attempt to refresh and reposition the comfort brand in my opinion. Terms like "max" seems to suggest all areas of lens will allow for patient to see @ all 495 postures. As if position of wear is now a secondary consideration. This sounds like a "My Pillow" sales pitch. So now posture equals wear ability? What defines a posture? According to Essilor it is a 1 degree shift in gaze using a Plano/2.00 ADD lens.

Additional branding of "Flex Optim" Again more marketing fluff. Why not call it Comfort 5G?

https://www.bing.com/videos/search?q=comfort+max&docid=608012986927876856&mid=F8D846A48C5064949B49F8D846A48C5064949B49&view=detail&FORM=VIRE

[Kujiradesu]

Ive been led to believe that the Vx Comfort Max is a updated version of the Comfort W2+. Ive only fit a few since the lens became available. The one major fitting issue Ive had was a patient who needed her fitting point raised. On Vx lens designs that are not the X Design I have a tendency to fit 1mm below pupil center, but fitting the lens there meant she was having difficulty accessing her reading. Raised the FP 2mm and she was pleased as punch. Im not going so far as to say to fit these lenses high, but it may be a phenomenon to be aware of for clients coming from another lens design.

[Alex Camblor]

I fit one patient when the lens first came out who was a plano/2.00 add and didnt get any complaints but it did seem to have a lot of swim when I was inspecting it. Essilor rep called last week and said the max is an update of the comf w2+ but couldnt really add anything of substance regarding the lens design. I think there are better designs at a similar price point.

[drk]

Reminds me of the SolaMax...

It would make sense for Essilor to have the hard-180/teeny umbilicus/smallish near zone/low astigmatism design (i.e. "the single-vision experience") that is the Physio/X/whatever else and a polar opposite. Maybe the Comfort Max is a welcome addition?

[DanLiv]

Essilor is doing a free Comfort Max promo, so I'm looking forward to getting mine in the next few weeks. So far I'm solely a Varilux S/X wearer so I'll be very interested to see if I notice compromises. If I do not I'm going to have a hard time paying for Xs going forward.

My understanding after 2 webinars on the Max is it's basically a VERY soft design, distributing cyl all over the lens including the central vision areas to produce larger "20/happy" areas, while never delivering the crisp precision you get out of the narrow centers of other designs. I've fit 6 with no complaints, but I've been strategic and targeted only high adds and those who aren't corrected 20/20. I figure they don't get the crisp clarity benefits of high-end designs anyway, so maybe they'll get some advantage from the more forgiving near zones. It's a fine design concept, that many people prefer smoother more gradual transitions from clear central zone to blurred periphery and will comfortably trade sharp precision in the central corridor for that "comfort".

Marketing-wise they are positioning it as a broad replacement for traditional Comfort and Physio, both DRxs, and Comfort W2+.

[PRECISIONLAB]

CE Credit now available on this topic

https://www.2020mag.com/ce/delivering-postural-flexibility-for-the

[NAICITPO]

"The Varilux Comfort Max lens is a new design approach that focuses on managing visioninstead of optics. The useful vision zone is the area of the lens in which you can see clearly.It is also referred to as 20/Happy. The useful vision zone is unique to each wearer and iscalculated to maximize the wearer's range of horizontal and vertical gaze directions.20/Happy is a concept known to nearly all practitioners. It happens when the brainperceives an image as clear. By focusing on achieving 20/Happy vision, the lens designemphasizes a larger area of usable vision for the wearer rather than a small area of perfectvision. Supported by Flex Optim™ technology for expanded individualization, this newlens design provides PAL users with a stretched useful vision zone with a broader range ofhead movements. Head posture has to be variable and flexible to avoid musculoskeletaldisorders."

From the pdf, Dan was spot on with his explanation.

[Pete Hanlin]

(Disclaimer- Essilor employee) Apologies for the length of what follows, but I've been working with the communication of Varilux Comfort Max for almost two years, and the design represents a true advancement in performance (i.e., it's a bit more than an "updated version" of previous designs). If you want to know what Varilux Comfort Max is, put on a pot of coffee and enjoy the following novel :^).

As Dan mentioned, Varilux Comfort Max is the product of a design approach that maximizes the perception of clear vision (practitioners sometimes call this "20/Happy" vision). This area of clear vision is called the "Useful Vision Zone," and it is defined as the collection of points in the lens where the brain perceives vision to be clear (useable). This approach came from a growing realization among the R&D team that "20/20" is a measure of resolution only, and resolution is only part of what goes into the perception of clear vision. For the brain to deem an image as satisfactory, there are minimum thresholds of resolution, contrast sensitivity, binocularity, and the ability to perform saccade and pursuit movements without disruption. In other words, you have to manage all of the elements that go into good vision if you want to maximize the useable area of the lens. Practitioners instinctively know this (although it is sometimes mystifying), because we sometimes have patients who technically see 20/20- but they are not "happy" with their vision (i.e., their brain is telling them an image is not completely clear even though the resolution of that image is 20/20). Conversely, we sometimes have patients who we know do not see 20/20- but they are delighted with their vision (this often happens with bifocal soft contact lens wearers- technically, the wearer doesn't see 20/20 at either distance or near, but the brain is completely happy with the image it is receiving). Once R&D decided to make the attempt to manage all aspects of vision, they set out to try and create an avatar that could represent human vision (i.e., a computer model that would accurately balance all the components of vision and reliably predict what combination leads to the largest area of useable vision). They quickly discovered you cannot build a single model (again, practitioners instinctively realize this- a design that makes one patient happy may not work with another patient). They discovered at least two major factors you have to account for when building a reliable avatar of human vision.

First, the eye's shape plays a role in how you need to balance the various components of vision:

• Myopes by definition have longer eyes with larger retinas.  They are less sensitive to power changes across the lens, but the longer axis means their eyes scan a larger area of the lens when looking away from the center of the lens.
• Hyperopes have smaller eyes with slightly smaller retinal area. They are more sensitive to power changes, but tend to use less lens area.
• Emmetropes who wear progressives are a challenge, because they will not tolerate decreases in contrast or resolution (otherwise, they will return to your practice and observe that they "see better without their glasses").

The second major factor is the wearer's residual ability to accommodate.

• Presbyopes who still have considerable accommodation remaining (think +1.00 ADD) prefer a design that provides ADD power in the near without a lot of progression through the intermediate (after all, they don't need much/any assistance to see a computer screen, but they hold their smartphone 13" from the eye and need to be able to see it from a large number of angles).
• More advanced presbyopes (such as myself) need a design that provides some ADD power very quickly- to bring arms length objects back into focus.

When you take these and other factors into account, you end up with a requirement for 15 different avatars if you want to accurately predict what design components will provide the largest area of useable vision in a progressive design. In other words, Varilux Comfort Max isn't a design- it is a collection of numerous designs built around the goal of providing the largest area of the lens each wearer will perceive as clear- regardless of what ametropia and ADD they have. Varilux lenses are designed using a process called LiveOptics. This is an iterative process where a problem is identified (in this case the issue that most progressive lenses restrict the wearer to relatively small areas of the lens), a design is calculated, prototypes are made, and then clinical study is performed to measure performance. I say iterative, because the early rounds of clinical study reveal where the desired performance is not being met- which results in adjustments to the design, new prototypes, and additional rounds of clinical study. This process is repeated until the performance goals have been met. By the time a Varilux product is launched, it has been tested on 1,000s of wearers.

The measure of how well Varilux Comfort Max lenses achieved the goal was accomplished by directly measuring the Useful Vision Zone. Wearers were given a series of controlled tasks during which their eye and head positions were tracked. This allows the examiner to track precisely which spot on the lens is being used. The Useful Vision Zone of Varilux Comfort Max was significantly larger than other designs which have been created to manage optics and resolution only.

I realize it is tempting to look at new product claims and label them as "marketing fluff." After all, we work in a very "fluffy" market. However, Essilor spends a quarter billion dollars a year into R&D around human vision and optics (its a matter of public record- because we're a publicly traded company). Take every other lens manufacturer, combine their R&D spend, double it- and Essilor is still spending more. All this to say there is substance behind the fluff. The design technology described above was given the name Flex Optim because it gives progressive wearers more flexibility in their head and eye postures. Most progressive lenses limit the wearer to a relatively small area of the lens for intermediate and near vision. This means the wearer doesn't tend to move their head very much when performing a task like viewing a smartphone. When you are unable to change the position of your head, your neck and shoulder muscles feel strain (studies show this strain begins to be felt after just 8 minutes of static posture- it's why every airplane seat feels comfortable for the first 5 minutes, but becomes tortuous after a few hours). Varilux Comfort Max provides far greater ability to change postures while performing intermediate and near tasks- which results in greater wearer comfort throughout the day.

Varilux X Series features Xtend Technology, which includes the concepts of Flex Optim but adds the component of simultaneous vision. In other words, a Varilux X Series progressive wearer can literally focus on a range of distances through each position in the lens (more like what a single vision wearer can do- the SV wearer can do it because they are still completely able to accommodate, the Varilux X Series wearer can do so because the lens provides a range of focus at each point in the design).

Final comment (and if you are still reading, again my apologies)... A lot of research goes into designing Varilux lenses- but that research is based on the assumption that the fitting cross is being placed directly in front of the pupil. The optician plays a crucial role in how any progressive design performs, and getting that fitting reference point in front of the pupil is just vital.

[AngeHamm]

Pete, are you saying that the Comfort Max is using different PAL designs for myopes, hyperopes, and emmetropes? Not just variable corridor lengths, but different channels entirely?

[Pete Hanlin]

Yes. Way over-simplifying, but myopes tend to prefer a somewhat harder design and hyperopes tend to prefer a softer design. Also the amount of ADD power requires different progressive profiles (the basic idea being the higher the ADD the more the profile needs to be weighted towards the top of the progression). There are all sorts of other changes that are dictated by Rx (e.g., small changes to near inset and progression length due to the prismatic properties of minus vs. plus lenses), but a -4.00 with a +1.00 ADD patient will receive a very different design than a +4.00 with a +2.00 ADD.

[DanLiv]

Just got my Max today. I have Varilux X in 3 pairs, very satisfied in two of them but in one I seemed to never get the PDs perfect so I always struggled with that one. Replaced the X's in that pair with the Max today, and so far quite happy. It does seem to have a slightly more generous near zone, I certainly don't have to hunt for it. I've not noticed and visual compromises yet, but I'm in a well-lit indoor environment. I'll test them in low light driving home tonight. I have always been very impressed with the sharpness of DV in low light with the X's. And I don't get any more noticeable swim and sway than my X's, though I think I'm probably not a very picky progressive wearer. I'll update as my experience deepens.

For reference:
-1.50 -1.75 x010 +1.75
-3.25 -0.75 x168 +1.75

Poly Comfort Max with Sapphire.

[drk]

OK Pete, thanks. :)

What are the downsides?

[Jason H]

yikes