Flummoxing PAL fit

[ODoS_HBB]

Hi everyone, fresh optician seeking some advice.

The following patient has been wearing Hoya's ID lifestyle 2 for that past 5 years and loves it, they can do everything they need to. They recently came in with a new RX which shows minimal change (OS went from +0.25-0.75x160 to PL-0.50x160, OD the same at -0.25-0.25x130, add still +2.50).

I use Essilor not Hoya at the shop, so I fit them with Physio 3.0 keeping in mind that the patient wants to wear them all the time, but specifically for computer and reading. Since pick up they have given them an honest try (wore them for 2 weeks) and came back saying that the intermediate FoV is too small. Driving is good, as is close up reading, but for arms length work the "zone" is too small.

Increasing panto and fitting them closer to their face hasn't provided enough of a change for them to be happy. Meanwhile, when they put on the old ID Lifestyle lenses, they do not have this issue. Both frames are similar in size, within a 2mm of A and B measurements.

Is this an issue of PAL design or am I wrapped up in my own head and overlooking something?

[DanLiv]

Varilux are generally pretty lackluster at intermediate, in exchange for better distance and near. You could try the Varilux X, it is specifically intended to improve the intermediate over previous Varilux designs. Plus, in case his frame has a fairly deep B, you can get the X Design (not Fit) which is a fixed corridor length, instead of the Physio's variable. However, that's an expensive experiment and I don't know that it will solve the issue. I wear several X myself and still struggle at intermediate. Ensure the fitting height is dead on the pupil, Varilux very lazily move into add power and do not perform well with when fit 1-2mm low.

[JuliaG]

There are 2 ways I deal with this situation. Either a short design, or a Varilux X fit with a 16 mm corridor. I have noticed that many patients once they sit at a +2.50 for a bit want their + power sooner.

[drk]

Design issue.

[lensmanmd]

There are 2 ways I deal with this situation. Either a short design, or a Varilux X fit with a 16 mm corridor. I have noticed that many patients once they sit at a +2.50 for a bit want their + power sooner.

Except, short corridors do not help with intermediate vision. The OP was specific about intermediate vision.

[lensmanmd]

Hi everyone, fresh optician seeking some advice.

The following patient has been wearing Hoya's ID lifestyle 2 for that past 5 years and loves it, they can do everything they need to. They recently came in with a new RX which shows minimal change (OS went from +0.25-0.75x160 to PL-0.50x160, OD the same at -0.25-0.25x130, add still +2.50).

I use Essilor not Hoya at the shop, so I fit them with Physio 3.0 keeping in mind that the patient wants to wear them all the time, but specifically for computer and reading. Since pick up they have given them an honest try (wore them for 2 weeks) and came back saying that the intermediate FoV is too small. Driving is good, as is close up reading, but for arms length work the "zone" is too small.

Increasing panto and fitting them closer to their face hasn't provided enough of a change for them to be happy. Meanwhile, when they put on the old ID Lifestyle lenses, they do not have this issue. Both frames are similar in size, within a 2mm of A and B measurements.

Is this an issue of PAL design or am I wrapped up in my own head and overlooking something?

Design. If you have access to IOT, I would suggest the Ultimate B or Ultimate Mobile.

[ODoS_HBB]

Thank you to all who replied. I pitched the Varilux X to the them and they've decided to upgrade. I'll keep the corridor fixed and double check my measurements.

[drk]

Except, short corridors do not help with intermediate vision. The OP was specific about intermediate vision.

You're right, of course.
I think Julia's strategy is to raise the near zone and let them use that on the computer, because she wants to give them more plus than an intermediate zone would.
I don't use that approach myself.

[IIxIPariahIxII]

Without knowing which Hoya iD Lifestyle 2 lens it is (there's Clarity and Harmony for 2 and Urban, Indoor, Outdoor for 3), your best bet is either the Varilux Comfort Max or Varilux X. I would honestly say if the intermediate is more a concern, the Comfort Max may be the better option for just a design swap.

[drk]

Maybe it's just me, but I have a pair of Varilux X and it's practically unusable on a computer. The Autograph III is way better.

[CCGREEN]

My add has increased to a +2.50 over the years of course and in that time frame I have used Physio which with a lower add was a, ok, design. Eventually I worked my way to a Varilux X which when it came out was supposed to be the cream of the crop at the time. Add at the time was +2.25 or +2.50. Then the lab I was using gave me a call and asked me if I wanted to try the Comfort Max? I was like sure,
That one got my attention.....it wasn't the WOW factor but I did raise my eyebrow and I do like it much better then previous lenses I have use.
I personally feel that it gave me a wider near and intermediate was maybe improved just a bit and distance was more comfortable. For now my thumbs up for Comfort Max.
In todays world of lots of intermediate and near work at this time I feel that two pair of glasses will be best for all.

[NAICITPO]

Good to know that you like the comfort max over physio drx for intermediate, may have to give that more of a shot.

[uncut]

Hi everyone, fresh optician seeking some advice.

The following patient has been wearing Hoya's ID lifestyle 2 for that past 5 years and loves it, they can do everything they need to. They recently came in with a new RX which shows minimal change (OS went from +0.25-0.75x160 to PL-0.50x160, OD the same at -0.25-0.25x130, add still +2.50).

I use Essilor not Hoya at the shop, so I fit them with Physio 3.0 keeping in mind that the patient wants to wear them all the time, but specifically for computer and reading. Since pick up they have given them an honest try (wore them for 2 weeks) and came back saying that the intermediate FoV is too small. Driving is good, as is close up reading, but for arms length work the "zone" is too small.

Increasing panto and fitting them closer to their face hasn't provided enough of a change for them to be happy. Meanwhile, when they put on the old ID Lifestyle lenses, they do not have this issue. Both frames are similar in size, within a 2mm of A and B measurements.

Is this an issue of PAL design or am I wrapped up in my own head and overlooking something?

I believe your answer lies in your first sentence.......5 years.

The ability to accommodate, the range of accommodation has changed so the intermediate power demand has amplified. Suggest a separate lens design for those annoying tasks that require detail.

This will help them in the future.

Yes, some designs of multifocals have more intermediate, at the expense of reading and/or distance.

Just my opinion

[Kwill212]

I believe your answer lies in your first sentence.......5 years.

The ability to accommodate, the range of accommodation has changed so the intermediate power demand has amplified. Suggest a separate lens design for those annoying tasks that require detail.

This will help them in the future.

Yes, some designs of multifocals have more intermediate, at the expense of reading and/or distance.

Just my opinion

If their add was +2.50 5 years ago and is unchanged, I doubt accommodation issues are at play at all here.

[ODoS_HBB]

I really appreciate all the feedback I'm getting here.

I would love for this patient to have two pairs of specs, and their previous pair is still in good condition, but they insist on one pair for everything...

I'll keep the Comfort Max in mind going forward, not had a ton of patient feedback on it when I have dispensed it.