I’m a recently qualified eye care specialist and work in community practice. I want to make sure I am accurate with my refraction and provide each patient with the best prescription. Do you have any tips?

It’s important to remember that most prescriptions are determined through a partnership between the eye care specialist and the patient. The eye care specialist provides the tools and techniques and asks the patient questions about how letters look with lenses. The patient is the observer and comments on which lens makes the letters clearest. This is why this type of refraction is often called ‘subjective’ because it takes place with the help of the ‘subject’ of the refraction.

Of course, there are times when this partnership cannot happen. For example, with some children and adults who are unable to communicate. This is sometimes referred to as objective refraction.

During subjective refraction, the eye specialist and the patient work together towards a shared goal of clearest vision. This interaction between the eye specialist and the patient requires, like all forms of communication, that the eye specialist has competence in verbal communication and as a guide towards finding the best lenses.

This aspect of eye care has taken something of a back seat in recent years and sometimes quality eye care is associated with the latest technology. Technology can be useful but, to me, good communication is king or queen. And of course, technology is not available in all areas.

My advice, is during subjective refraction, to:

Speak clearly, and pronounce every word you use. Remember the patient may be hard of hearing and may not be able to see your mouth move when wearing a trial frame.

Don’t use technical words when asking the patient to compare lenses.

Use words that the patient uses. So, if you ask which lens makes the letters sharpest and the person says lens one makes the letters clearest then use the word clearest for subsequent lens comparisons.

Give the patient time to make a decision on which lens is best. If they delay it may be because the difference in letter appearance is slight.

If a patient seems unsure repeat your question.

If the patient seems unsure reassure them that some differences are very small and difficult to notice.

Encourage the patient by occasionally saying something like ‘You’re doing really well with this.’

Never be grumpy if the patient contradicts which lens is clearest from one choice to the next.

Undergoing subjective refraction can be difficult for many patients and cause them some anxiety. A caring and understanding approach will help keep any anxiety to a minimum.

At the end show the patient the clarity of the letters with their old and new prescription, or with and without the new prescription if they are new to glasses, and ask them to confirm an improvement in clarity with the new prescription.

Treat your patients as equal partners in the quest for the best prescription and you will become an excellent eye care specialist.


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