A Refraction Patients Can Trust

Andrew KarpBetter or worse? These words are familiar to anyone who’s ever had a refraction or given a refraction. Yet having my vision tested fills me with anxiety. Perhaps because it is a test that I can’t study for and in fact, often fail.

I get a sinking feeling in my stomach as I read down through the Snellen chart, and each successive line gets more blurry. Is that an “n” or an “m”? An “o” or a “2”? At some point, I find myself guessing.

As I peer at the chart, I usually get too close to the photopter and fog up the lens with my breath. “Sorry,” I tell my doc. “That’s OK,” he reassures me while wiping the lens clean. “That happens to everyone.” Somehow I doubt it.

But getting back to the question of better or worse. Sometimes I just can’t decide between A or B. They seem about the same. Yet one is supposed to let me see more clearly, isn’t it? The fact that I often can’t see the difference makes me doubt myself. It also makes me distrust the test. What if A is really better than B, but I chose B? Now I’ll have a prescription based on that choice, and lenses that I’ll have to live with for a while. And that makes me anxious too.

When it’s all over, my doctor hands me my prescription, and I can see in black and white what I already knew: My vision is a little worse than it was a year ago. It’s not good news, but I have to accept it.

I suspect many people have similar feelings about getting their vision tested, but few discuss those feelings with their doctor, either out of politeness or because they believe it won’t matter. And I suspect that for some ODs, refractions have become so routinized that they aren’t thinking about how their patient might feel.

Maybe it’s time for optical professionals to find a way to make the refraction a better experience for the patient, one that the patient can feel good about and ultimately believe in.

— Andrew Karp, Group Editor, Lenses and Technology

About James Spina
20/20 Editor-in-Chief

5 Responses to A Refraction Patients Can Trust

  1. Barry Santini says:


    I’m not sure if your post here is a set-up for me or not, but you’ve clearly described what has become my greatest pet peeve about the traditional refraction process: The examiner never, *ever* tells the testee that the end of the selection process is when “they cannot tell the difference!” The insecurity, indecision and overall decrease in trust and confidence that results routinely spills over into the rest of the patient’s experience that follows, including frame, lens and treatment selection, as well as subsequent follow-up visits that feature latent questions about visual comfort, utility and acuity. And if this current exam room paradigm doesn’t change soon, it will be even harder for our industry to understand why the public will want to welcome with open arms both solo eye-testing on their phone – EyeNetra – and perhaps moving the eyewear purchase to the convenience, warmth and comfort of their own home, via online.

    For your information, it is when you can’t tell the difference between “1 and 2” that the examiner has placed lenses of equal blur straddling the target prescription of best vision. This *is* the endpoint of the majority of the subjective process. Additionally, new technology such as Dyops, was created by a layperson just to overcome the type of imprecision inherent when using 150 year old Snellen optotypes.

    SOS will just not cut it anymore, gentlemen. Better embrace change before it embraces something you’re not an integral part of.


  2. CHI Canada says:

    Good post, i will share with my friends.

  3. Ilse Sloane says:

    You are so right! How many times when a patient walks in, they say…”dentists chair”, likening it to a “painful?” experience.
    if a patient expresses that view, I reassure them that I will go slow and that there is no right or wrong answer, just to be honest and tell me if they see a difference or not. I explain what to look out for, demonstrate the difference, and do various check tests to check on the pt’s answers, and then I put the final Rx up in a trial frame and ask the pt to note if there is a difference, for better or worse between the old specs and new….although I am sure that this is standard for all optoms?
    However, there are some impatient optoms (and especially ophthalmologists who don’t have the time to take the time to carefully refract a pt)
    I assign an hour to every pt exam….we don’t have techs or scribes in South Africa or EHS systems (yet) All tests done personally by optom and all notes written by hand.
    My pt’s especially the older and anxious leave very happy…my secret is to take the time it takes to test them – slowly and carefully with breaks if needed.

  4. Barry Santini says:

    Andy –
    Upon re-reading your post, the following paragraph seems worth commenting upon:

    “When it’s all over, my doctor hands me my prescription, and I can see in black and white what I already knew: My vision is a little worse than it was a year ago. It’s not good news, but I have to accept it.”

    The whole concept of “my vision got worse and that’s bad” invites discussion. In one way it did get worse. But from another viewpoint, it really did not, since eyewear can bring it back to as good as new. I think this points up how all of us take our vision – and eyeglasses – for granted. That satisfying “thunk” sound when you get into your Mercedes/BMW/whatever every morning acts to remind you the wisdom you demonstrated in making that purchase. Unlike our cars, we look past our glasses, and become less appreciative of the valuable benefit they silently provide every day.

    It is interesting to note that when my clients confide in me that “if I told my friends that I spent $1000 on glasses, they’d think I’m nuts!” I respond thusly:

    “We take our eyes and vision for granted. Why? Think about it: If any other part of your health or senses were as impaired as your uncorrected vision, and I told you that I could restore it to as good as new for $1000…you’d tell me that’s a bargain!”

    Never, ever take your vision for granted. Just ask any senior who finds out later in life that their old trusted and magical friend – eyeglasses – cannot always simply “be made stronger” and miraculously make them again see as they did in their youth.


  5. I read your article, “A Refraction Patient’s Can Trust.” I enjoyed your article very much. I am sure many of my patients feel as you have described your personal feelings of anxiety and mistrust. I find I explain the purpose of asking “which is better 1 or 2” to many of my patients. I try to share the fact that I average all the answers and that by using a “method of limits” I reduce any possible error regarding the refraction. Still, I am sure that some patients doubt whether their answers are in fact correct. I try to reassure them that they cannot “fail” this examination. As an Optometrist for many years, I have become aware of our patients anxiety and try to make them feel good about the results of their examination. If I can improve their vision they are usually happy with the results of their exam and that is all I can ask of my patients. I appreciate your comments and hope that all eye care professionals are sensitive to the “Refractive” concerns of their patients.

    Warmest regards

    Herb Price OD
    Logansport and Rochester Indiana

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