During the subjective refraction part of the eye examination, my patients sometimes interrupt me to say that they can’t see anything on the letter chart. They often seem anxious about the eye examination and I get the feeling that they think I have made a mistake. How can I avoid this?

Patients can get anxious during an eye examination. They worry that they will say the wrong thing and get the wrong power in their lenses. They sometimes also worry that the eye care specialist has done something wrong and they will get the wrong power in their lenses.

Some patients expect to see clearly throughout the eye examination and become anxious if they can’t see the letters on the chart. They may experience blurred vision when lenses are changed during the examination. For example, if a patient is looking through +3.00 lens and accepts a further +0.25 then when the +3.00 lens is removed to be replaced by a +3.25 lens for a few seconds before the +3.25 lens is in place, they will have blurred vision. This will occur for lens powers above plus/minus 1.00.

My technique is to tell the patient that when I remove a lens things will go blurred for a few seconds before becoming clear again. This gives them extra confidence in my skills because I’m predicting what they will see before they see it. By predicting what they will see they realise that I am in control of the lenses and of the eye examination. This gives them confidence in my skills.

Furthermore, when a patient needs an add, I always tell them that ‘these lenses will make the letters across the room blurred because these are for close-up vision. Again predicting what they can see and when boosts their confidence in me.

Finally when I’m using the Jackson cross-cyl. during the subjective refraction and I’m asking the patient to choose between lens 1 and lens 2 for the axis and lens 3 and lens 4 for the cylinder power I let them know that the sharpness of the target I’m using may be better without either of the lens options, ask them to choose the lens which gives the sharpest/darkest view by saying ‘This is a strange test. Choose the best between 1 and 2. I know it might be clearer without either but choose the best one. Thanks.’

Try to avoid surprising the patient with periods of very blurred vision during an examination. It takes a few seconds to let the patient know that they will have a short period of blurred vision and that their vision will become sharp again in a moment. A fully informed patient is a good patient.