Refractions should be based on the following:
1. Patient visual complaints … make them be specific! How is their distance vision AND near vision with their current correction? (or without any correction, if that is how they view distance/drive/watch TV or read). Is it blurry? Cloudy? Slanted? One eye, both eyes or can they tell? Is it better WITHOUT the glasses? … if so, record the vision uncorreced so they can prove it! remember, we are gathering information to “solve the mystery.”
2. Level of vision on the eye chart - distance AND near. Remember, it’s important to encourage blinking.
3. Eye history - Any eye surgery? Possible amblyopia? Any eye injuries? When did the patient start wearing glasses? Any pathology present? (One of the hardest thing to accept in refracting is that not everyone CAN be corrected to 20/20)
4. Current glasses neutralization … If we don’t record the glasses correctly and start in the right place, we will not end in the right place. Be especially aware of reading progressive glasses correctly - the least plus in the distance and the most plus in the reading. Always look for prism showing on the screen or printout - if any shows on the screen or printout, take the glasses to optical to verify whether any prism is present and what amount.
5. If the patient has never had glasses, use the autorefractor (and autokeratometer or manual K) readings as a starting point. (Sometimes these AR readings can be misleading, so the only way to know if they ARE a good starting point is to check the patient’s distance acuity with them).
6. When the patient is wearing contacts, you need to know if the patient is wearing monovision, single vision, “modified” monovision, etc and record the vision accordinglt: check the “near eye” for near (and overrefract for near, prn) and the “distance eye” for distance (and overrefract for distance, prn). Multifocal contacts: check for both near and distance in the eye wearing the multifocal CL (overrefractions on multifocal CL are harder to make sense of, so check with your physician as to how he wants these handled).
7. Premium IOLs and sp refractive surgery patients: remember, they have a large incentive to be spectacle-free, so checking these patient’s uncorrected vision for distance, intermediate (as indicated), and near is important.
