POSTSCRIPT

POSTSCRIPT
Congratulations! You now know how to perform a monocular subjective refraction. If you follow the steps we’ve outlined in this tutorial you should be able to refract the majority of the individuals you see.
However, keep in mind that what we’ve discussed in this tutorial is a framework. If you watch a number of good refractionists it’s very likely you’ll see many techniques that vary from what you’ve seen here.
As time goes by you’ll also learn to tailor your refraction to your patient. For example, for children and others with short attention spans you’ll want to ask as few questions as possible. For individuals whose best corrected vision is poor, you may have to present .50 or 1.00 Diopter changes instead of .25 Diopter changes. When doing the cylinder axis refinement step, you may decide make changes in increments less than or greater than 15 degrees based on how much astigmatism your patient has.

It’s also important to point out that the monocular subjective refraction is not a comprehensive assessment of the visual system. In fact, it’s only one of several factors taken into account when glasses are prescribed. For example, how our patient is seeing with their current glasses should be reviewed to ensure that we are making logical changes. In addition, the patient’s ability to accommodate and the functioning of their extraocular muscles should be assessed. It’s also important to thoroughly examination the ocular health, both to explain any deficiencies in vision and also to ensure our patient will continue seeing well into the future.
These issues are beyond the scope of this tutorial, but the point is that while a monocular subjective refraction gives us valuable information about the optics of each eye, we can’t forget that the visual system depends on two healthy eyes working well together. However, the first step in verifying that the eyes function well together is to ensure that each eye is seeing as well as possible by itself. Using the techniques you’ve learned in this tutorial will allow you to accomplish this very important first step.
Happy refracting