Refraction

A refraction is a measurement of a patient’s refractive error at one or more distances. There are two primary refractions that occur during a full exam.

The first refraction is the autorefraction which is an objective measurement of a patient’s refractive error taken with the Autorefractor (see initial testing module)

The second refraction (generally called refraction) is a subjective measurement of refractive error completed by the doctor using the phoropter.

Here is an example of the different steps the doctor will go through when performing the refraction.

When finished the doctor will read out the refractive error for each eye as well as the best corrected visual acuity to be entered into the patient’s record. Just like the autorefraction, this measurement is recorded on the workup tab in the Refraction/Visual Analysis table.

Be sure to check the “2 Years” box in the bottom right hand corner for the finalized prescription. This prefills several of the dropdown boxes and checks the “Make Available for Optical” box. The “Make Available for Optical” box must be checked on all finalized prescriptions, otherwise the eyewear stylist will not be able to use this prexcription to order the patient’s glasses. !!!!Again, this box should only be checked for finalized prescriptions, otherwise the eyewear stylist may be confused which prescription to use and put an incorrect prescription in the patients glasses!!!!!

Once all the information is entered, click save in the upper right corner and the prescription will be added to the table.

There are also two other recordings that can be listed in the Workup tab: retinoscopy (an objective measurement of refractive error, similar to an autorefraction except performed by the doctor using a retinoscope)

and a BVA (this is employed when the doctor does not wish to make a subjective refraction available to be filled as a glasses prescription)

Note that the “Make Available for Optical” box is not checked on either the retinoscapy or BVA entry.

Entering Rx in Phoropter

Most doctors will begin the refraction using a starting point. This starting point will be either the autorefraction findings or the patient’s last Final glasses Rx. The OA should enter whichever of these the doctor prefers into the phoropter during the workup. Here is a video on how to enter the sphere, cylinder, and axis for each eye into the manual phoropter.

To upload the autorefraction to the digital phoropter in Westerville, create an autorefraction entry (see initial testing module) and press the Xmit button on the toolbar to upload it. If the doctor prefers the last final, forward the last final and change the “Type” box to say autorefaction, then press the Xmit button to upload.

Accommodation Testing

Accommodation is what allows the eyes to focus unaided through a distance prescription to read clearly at near. Please review the following video.

The doctor will test the patient's ability to accommodate at the end of the refraction (after determining their distance prescription). This process varies between doctors, but there are several terms and numbers to listen for: NRA (negative relative accomodation), PRA (positive relative accomodation), and BCC (binocular cross cylinder). These are recorded on the binocularity tab

Record the numbers into their labeled boxes on the Binocular tab once the doctor has called them out. The doctor will use the accommodation findings to determine if the patient would benefit from an ADD power in their eyeglass prescription, which would end up being made into a lined or no-line bifocal. Record any ADD power the doctor prescribes on the Final Rx in the ADD boxes.

Please watch the following video that illustrates how to chart Refraction findings.

Please complete the Checkpoint Quiz