Refer this article as: Borish, A., Varilux 2 in USA, Points de Vue, International Review of Ophthalmic Optics, N62, Spring 2010
Varilux 2 in USA
In the early sixties through a group of old friends: Dr Irv Bennett and Dr Brad Wild, I had been exposed to the very first generation of Varilux lenses.
In March 1977 a young French man, who sounded more English than French, was trying to meet with me. I was still at the time teaching in Bloomington, Indiana. Not able to meet with me there, he finally found out that I was visiting my wife’s brother in Pittsburgh. He phoned me and asked whether I would be prepared to receive him in Pittsburgh, I agreed.
Marc Alexandre was full of enthusiasm and explained to me that the US professionals were quite happy to find out that the lens worked very well in Europe but they always ended the conversation by asking” OK, but does it work in the States?“.Marc Alexandre and I considered the concerns faced in attempting to introduce the Varilux 2 concept to the United States, I noted three aspects which might need to be answered. It had been emphasized that the Varilux 2 was so widely readily accepted through out Europe because the obvious absence of a typical bifocal line. In America, this attitude was not nearly indicative - many major movie stars and others in positions in which physical presence was essential, talked openly about their continued aptitudes despite increasing age in frequent publications and appearances. If this attitude played a significant role in the Varilux 2 acceptance in Europe, it could not be assuredly counted on to do so in the United States. Secondly, the optics of the Varilux automatically derived aberrated areas in the peripheral visual field. American optometrists had been emphatically indoctrinated with the deficiency of quality indicated by an aberration. Third, without regard to these first two, Essilor, a totally unknown entity in the United States at the time was making its move just at the time that American Optical Co.,then the dominant prescription optical company in the United States was itself introducing its own version of the so-called progressive design. This last might actually mitigate some of the negative assumptions mentioned in prior sentences, since A. O. Co.’s acceptance of the idea could help palliate the original concerns of practitioners accustomed to A. O. Co.’s validity.
Thus Marc Alexandre was faced with two major problems. Would the optical performance of the progressive design be of a quality that would compensate for the possible disturbances of peripheral distortions, and even if so, would the comparative merits of the Varilux 2 compete favourably versus the A. O. Co. version? Optical factors which bolstered acceptance of the progressive design were the elimination of image displacement, so-called “jump” between the distant and near images, scotoma about the segment due to abrupt magnification from far to near optics, and the lack of an intermediate field, all accompanying difficulties of habitual bifocal design. I considered that the initial problem was that of the competitiveness of the two manufactures. If the Varilux were not superior or at least as effective a design as the A. O. lens, the question of whether progressive design had a place in the United States was not the problem facing Varilux 2. Thus I proposed that if Essilor would finance the cost of materials of frames and lenses, We would conduct a double-blind study of both progressive designs upon a number of patients divided into three groups, - those who were reaching the earliest stage of Presbyopia, those who were confirmed habitual presbyope experienced with standard bifocals and last those at the fullest stages of Presbyopia in the trifocal need. The study would make no attempt to convince the patient that either of the lenses had to be selected, providing a third offer of a standard bifocal ( such as they may have been accustomed to wearing) if they found neither progressive acceptable. Performed at Indiana University where Borish was stationed, only one individual, who never faced a patient, would keep a record of which lenses a given patient wore at a given time, and the designs were fitted in equal numbers in order of first or second wear so experience would not affect selection. In addition, tests were performed on each for awareness of distortion and the influence of aberrations. The study resulted in an overwhelming preference for the Varilux and was published in the Journal of the American Optometric Association. It served to introduce Essilor and the Varilux 2 lenses to American practitioners.
We conducted several follow-up studies to confirm the validity of this initial indication. Two years after, I recalled those subjects who had been habitual standard bifocal wearers but selected the progressive lenses and offered them the option, after having worn them for that period; of remaining with them or returning to the habitual style of bifocal they had worn prior to the first experiment. Only one such subject chose to return to a habitual style. Several years later, in a study which I was conducting while I was at the University of Houston, a similar happenstance occurred in which an individual returned after a short period and requested that the progressive lenses which were part of the experiment be replaced by the initial habitual style to which the patient had been accustomed. After this was done, the patient then returned within two weeks, requesting that the rejected progressives be again inserted in place of the habitual bifocals!
In the earlier years, one of the first assumptions was that whatever optical interferences the progressive lenses produced the vanity component of the absence of an identifying segment border or line was sufficient to influence patients to select such lenses. We conducted a further study in which patients were fitted with both Varilux lenses and several forms of bifocals which were optically standard in design but had had the dividing lines between “distance “and” near” polished to invisibility. These produced a blurred ring around the segments, but were undetectable as bifocals when worn. No patient found them acceptable compared to the Varilux 2 lens.
Varilux lenses continued to flourish ever after…