I have a patient, let's call him Stan. He's presented me with a poser.

Here's his old RX from May 2009:
-1.75 -0.75 x082 +2.50
-2.00 -0.75 x099 +2.50
Varilux Comfort, Poly, Transitions Grey, Crizal Avance. Vertical alignment is perfect, OS OC is just a touch wide, but well within tolerance.

Here's his new RX from December 2011:
-1.25 -0.75 x073 +2.50
-1.50 -0.75 x097 +2.50
Varilux Comfort 2DRx, Poly, Transitions Grey, Crizal Avance.Vertical and horizontal alignment are spot-on.

So my excellent doctor pulled his distance RX back a bit and I put him in a progressive with a wider reading and intermediate area. But Stan is having problems. He is complaining that his distance is clear, his reading is clear, but his intermediate is too hard to find the focus in. He's coming in today for a new refraction. The only substantial change from the old lenses to the new is that sphere power change, but I have a hard time imagining that that would affect his intermediate and not his distance or near.

I have to admit to being a bit stumped. He's worn a nearly-identical PAL design for years, so I can't think that's the problem. His add hasn't changed, nor has his cylinder changed appreciably. I wanted to throw the problem out to my OB homeys today. He comes in at 420 this afternoon (EST). Any thoughts?