Hi folks,
I was paid a visit this morning by a fellow who picked up his glasses a couple of weeks ago. This is what he received:

OD -0.75 +1.00 x005
OS -1.50 +1.75 x163
+1.50 add OU
Varilux Comfort W2+, 23 seg height on 35 B measurement.

This guy prefers to wear his glasses a little bit further down his nose; his comment was "if I wear my glasses up at the top of my nose, I feel claustrophobic." When he first picked up his glasses, I encouraged him to try wearing them closer to his eyes, and explained that wearing them further away narrows the window of clear vision through his glasses (especially for anything arm's length away and closer), and doesn't provide the level of correction that he needs. Nonetheless, he has continued wearing his glasses further down on his nose.
Today, his complaint was that the waviness of the peripheral blur area in his lenses was bothersome when at his desk at work. He noticed that if he placed the glasses even further down his nose, it wasn't as problematic. I marked the lenses up and asked him to position them at that spot, and the fitting cross was 6 mm below his pupils--lower than his eyelid. I told him that because all progressive lenses have at least some element of that peripheral blur, it would be difficult to avoid that issue with any lens we tried, so he needed to turn his head a little more to avoid that distorted area. Not satisfied, he asked if I could remake the lenses "with the bifocal area lowered," and I said that I could, but if we lowered the fitting height enough to where he preferred it, that he would have trouble seeing at arm's length. He didn't seem bothered by that.

I am reluctant to do what this patient is asking me to do, mostly because I think he still won't be happy with the results. The arm's length focal area will be totally useless, and the area of full reading power will shrink. His insurance lab will only remake lenses once for an issue like this, so I need to feel sure that I'm doing the right thing. I've thought about switching him to another progressive lens in the category, but not all of the lenses offered by the insurance are in my price book or billing software. Ideally, I would've fit him in the Lifestyle 2 Clarity to begin with, but he was not a fan of the $100 difference in price. He's also not interested in two pairs, or he'd be wearing iD screen lenses, too.
The other lenses in the category that I can offer:
Definity
Comfort Enhanced
Physio Enhanced
Summit iQ

Others on the list:
Accolade Freedom
Ideal/Short/Advanced
Supercede
Autograph II
element
Kodak Unique
Compact Ultra HD
Sola HDV
SolaOne HD
Precision Pure
Synchrony

I would prefer not to fit this patient in a lens that we can't price out for him in the future, but I could be convinced to if y'all can assure me that the results will be noticeably different. I've thought about switching him to the Shamir Duo, because of how much more peripheral clarity it has. In comparing the end product, I have a feeling that the Duo will likely have the same amount of useful intermediate area as a Comfort W2+ with the seg dropped 6mm. (Read: none.) For most patients with a low add like this, they often don't miss (or even use) that focal distance anyway, and I often fit them in short corridor lenses to ease their access to the full add. I really do not want to fit a PAL incorrectly for this patient, because he'll only run into bigger problems as his add power increases if he becomes accustomed to wearing them this way.

Now that I've written a novel, does anyone have any suggestions for me, given the patient's non-compliance with my recommendations?

Thanks!