New findings from a prospective study are offering real-world insights into the clinical performance of Newton’s Sequel progressive addition lenses (PAL) and lens technology for digital eye strain (DES).
The patient-reported outcomes were recently published in a clinical white paper.
First up: a look at Sequel.
What it is: First launched in September 2025 (and available through VSP), this is a single-vision, anti-fatigue lens designed to address both accommodation and convergence among progressive lens wearers with digital-heavy lifestyles.
Four lens variations are available, each featuring no-glare coating and blue-light filtering:
- Sequel 0 (ideal for patients aged 4 to 24)
- Includes a minor basin prism to help with convergence; no power boost
- Sequel 38 (for patients aged 25 to 34)
- Power boost: 0.38D ADD
- Sequel 67 (for patients aged 35 to 44)
- Power boost: 0.67D ADD
- Sequel PAL (for patients aged 40+)
- Progressive power: 0.75+ ADD
And what lens technology is embedded in the lenses?
That would be Newton’s patented Convergence Boost Lens Technology, designed to deliver (in the company’s words) "unparalleled visual comfort and clarity both on screen and off.”
How it does this: By considering and factoring in an eye’s daily visual demands—all while enabling the eyes themselves to remain in their most natural position (using patients’ current prescriptions).
Alrighty, now to this new research.
This 6-week prospective study was conducted at six clinical sites across the United States with one main purpose: to measure the clinical impact of Sequel PAL with Convergence Boost technology on DES.
- The participants: 30 enrolled patients (aged 40+)
- Experienced progressive lens wearers with a minimum of 4 hours of daily digital device use
- Prescription criteria:
- Spherical power between +4.00D and –8.00D
- Cylinder power no greater than – 3.00D
- Addition power between +0.50D AND +3.00D
- < 0.75D spherical equivalent (SE) difference and < 0.50D addition power difference between habitual and updated spectacle prescriptions
- The setup: Patients underwent a baseline assessment and were then fitted with Sequel lenses
- Coating and refractive indexes were matched to each participant’s existing lenses to maintain consistency.
- The duration: All patients were followed for 6 weeks.
How was DES assessed during the study period?
Investigators utilized the Computer Vision Syndrome Questionnaire (CVS-Q) to assess DES symptom severity at two timepoints: baseline and the 6-week follow-up visit.
Also: Net promoter score (NPS) was systematically applied to individual questions across all comfort and clarity domains, with rating based on a 1-5-point scale.
- The intent behind this: To enable a consistent, domain-level view of wearer experience instead of a single aggregate score
Do we know which comfort and clarity domains were evaluated?
We do.
- Reading up close
- Mobile device usage
- Computer usage
- Dashboard (while driving) usage
- Television viewing
- Windshield viewing
- End-of-day (EOD) fatigue
And what were the main outcomes measured?
- Primary: Change from baseline in CVS-Q scores at week 6
- Secondary: Visual comfort and clarity NPS at week 6 (assessed across all evaluated task domains)
Now before we get to the final data … what were patients’ baseline numbers?
The following are based on average totals* of the 29 patients (average age of 58.3; 62% female) who completed the study:
- CVS-Q score: 6.83 (±3.46)
- SE OD (D): –0.56 (±2.18)
- SE OS (D): –0.46 (±2.11)
- Near add power (D): 2.24 (±0.33)
*Clinical data presented as mean (±) standard division.
Noted. At last: the findings.
We’ll start with DES symptom reduction: The study determined that Sequel PAL delivered a “statistically significant and clinically meaningful reduction” in symptoms.
- Specifically: When comparing CVS-1 scores (baseline to week 6), a statistically significant improvement was noted (p<0.05).
In other words: The study met its primary objective with statistical significance.
Some numbers:
- Patients experienced a 71% average reduction in DES
- 76% of patients reported no EOD fatigue (a common sign of DES)
Talk about visual comfort.
At week 6: The NPS exceeded 40 across all six evaluated domains, with patients’ overall satisfaction translating a meaningful acceptance within a relatively short period of wear time.
- In fact: The “highest NPS scores within the comfort domain were observed for viewing the dashboard while driving,” the white paper noted.
Numbers, please.
Three key stats to be aware of:
- 83% of patients reported being very comfortable in completing everyday routines while wearing Sequel PAL
- 76% indicated comfort with the field of view Sequel PAL provided
- 66% reported comfort in performing longer hours of computer-based tasks
How about from a visual clarity perspective?
We’ll stick with NPS for this as well. In regards to visual clarity, NPS exceeded 60 across all the evaluated domains at week 6—demonstrating an even “stronger result” when stacked up against the aforementioned visual comfort domains.
As for the highest NPS: These were reported for viewing the dashboard (while driving) and watching television.
Any specific data points for this?
Indeed. Other clarity and performance data obtained at week 6 included:
- 86% of patients reporting no “swaying sensation”
- 76% reporting no EOD eye fatigue
- 72% reporting clear vision when switching viewing zones (distance to near)
- +65% reporting no distortion or blurring
Can we talk about the CVS-Q score reduction as well?
To refresh, the median baseline CVS-Q score was around 7 (just under), indicating the study population was “just above the validated symptomatic threshold” (which was 6).
But after 6 weeks of Sequel PAL wear: That median score dropped to 2 (a 71% reduction).
- Translation: It fell below the symptomatic threshold—making it a clinically meaningful shift from the median patient being classified as symptomatic to non-symptomatic by the study's end.
- See page 9 of the white paper for a visual of this.
And any study limitations to consider?
One main drawback was the study’s small sample size (just 29 patients). As the paper noted: “Larger trials would strengthen the generalizability" of the findings.
So what are the key takeaways for clinicians?
First: The target candidates for Sequel PAL are, generally speaking, established progressive lens wearers with DES-related complaints (EOD fatigue, visual discomfort linked to digital device usage).
In the context of this study: “The findings suggest that individuals with higher baseline CVS-Q scores, particularly those with significant screen use, may be more likely to experience meaningful, measurable symptom improvement within six weeks,” the paper concluded.
As such: The paper frames Sequel PAL as a transition lens—with vergence support—for these established progressive lens wearers.