Here is a transcript from our advanced refraction course offered by our lead techs. The skills needed to work in an ophthalmology office is much different than those of other fields. The hardest step to master is learning to refract and prescribe the correct glasses prescription.
Refraction: “The sum of steps performed in arriving at a decision as to what lenses (if any) will most benefit the patient or “determination of an eye’s refractive error and the best corrective lenses to be prescribed.”
Refractometry: “The measurement of refractive error” or “objective testing to determine the combination of sphere and cylinder that will optically correct an eye without determining what prescription a patient will accept subjectively.” (retinoscopy or autorefraction)
Cycloplegic Refraction: “test performed without using cycloplegic eye drops.”
However it is defined, refracting the clinical patient is one of the most important duties we ophthalmic technicians perform for the doctors. There are many different ways and techniques to achieve a good refraction and EVERYONE will eventually devise their own uniquely refined method, but there are some basic rules that must be followed …
1. The least amount of change for the best improvement in vision. Accurately recording initial vision is VERY important (distance, AND near - if of presbyopic age), because that is what you will base your refraction changes on. There must be a relationship between how poorly the patient sees and the amount of power (or change) given to improve the patient’s vision, and to what level the patient CAN be improved. Not every patient has the potential to see 20/20, depending on the patient’s eye history and pathology present. A diopter of change is a lot! If you DO give a diopter of change, the patient needs to see 3-4 lines further on the chart. If they don’t we must recognize that it may be too much change - try giving half of what they are asking for and see what they can read with that (note to the doctor that the patient wanted more change, but saw no better with the additional change, if that is correct).
2. Change the sphere power most, the cylinder power occasionally and the axis rarely (axis “adjustment” in moderation is allowed - but keep in mind the more cylinder the patient has, the more sensitive to axis changes they will be). Round the axis to five degrees.
3. Pushing plus in the distance portion of the refraction is encouraged, thereby avoiding over-minusing.
4. Pay attention to the patient’s comments and answers to your questions during your initial patient chief complaint and “history of present illness” elaboration (HPI). “Listen to the patient. They’re trying to tell you what’s wrong.”
5. Base the add that you give on the patient’s age and their desired reading distance - avoid over-plusing the add, especially if it’s the patient’s first reading correction.
6. ALWAYS write comments to the doctors as to whether the patient appreciates the changes you have made (this is Not the same as making them see further down on the chart). Remember, the doctor isn’t in the room during the refraction, and he needs your input as to whether he will recommend that the patient spend money on new glasses.
7. Refract as if YOUR name was going on the prescription - when you write it, would you be confident enough to fill it?
8. Remember, if it doesn’t make sense to you, it won’t make sense to the doctor, either. Don’t be afraid to go to the doctor with your questions about your results - communication with the doctor is vital.
