Welcome to question of the day #387

Eyetools question of the day #387

Some of my patients who are new to varifocals tell me that there are times when they don’t get the vision they need from them, especially for near and intermediate vision. Do you have any advice on how I can help them?

Some people love to wear varifocals. They get on with them and use them to enhance their quality of life. Other people hate varifocals. They tried them once, didn’t get on with them, and shared their negative experience whenever given the opportunity. There are many reasons for not getting on with varifocals and I’ll deal with those elsewhere.

I want to focus here on those people that do get on with varifocals.

We know that varifocals work best when the eye and the middle of the lens line up reasonably well with a distant object of regard. We also know that they work well for near vision tasks when the person gazes down through the lower portion of the lens such as when reading a book that is on a table or resting on the lap. There is also a portion of the lens between the distance sweet spot and the near sweet spot that the manufacturers tell us and we tell our patients can be used for vision tasks that are at an intermediate distance. I don’t recall many patients telling me that they love their varifocals because they get great intermediate vision.

All is fine so far. But what if the person has a near-vision task that requires looking straight ahead and not down? People often tell me they like to read in bed when lying down. They end up looking through the distance portion of their varifocals and cannot see to read or when they are working at an intermediate distance and have to look straight ahead such as when carrying out home maintenance. Other people tell me they have very intricate tasks such as when building models and need a larger reading portion than they can get through their varifocals. Using a computer can be difficult with standard varifocals.

The main point I’m making here is that there are many people who would benefit from single-vision intermediate or near-vision glasses of computer varifocals for specific visual tasks as well as having a pair of varifocals for everyday visual tasks.

It’s worth asking each patient who has varifocals or bifocals if they can think of anything they do, such as reading in bed or intricate near tasks or computer work, and describe to them the advantages of having a pair of near or intermediate vision or computer varifocals. They may decline your suggestion but remember it when they notice the limitations of general varifocals or bifocals in their everyday life and come back for a second pair of glasses that help overcome the limitations of standard varifocals and bifocals.

 Varifocals are often described as the one-stop solution for all visual requirements. Sometimes they are often they aren’t.