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Subjective Refraction is a technique to determine the combination of lenses that will provide the best corrected visual acuity (BCVA). [1] It is a clinical examination used by orthoptists , optometrists and ophthalmologists to determine a patient's need for refractive correction, in the form of glasses or contact lenses.
While moving the streak or spot of light through the pupil across the retina, the examiner observes the relative movement of the reflex or manually places lenses over the eye (using a phoropter or trial frame and trial lenses) to "neutralize" the reflex. [2] Static retinoscopy is a type of retinoscopy used in determining a patient's refractive ...
A subjective refraction requires responses from the patient. Typically, the patient will sit behind a phoropter or wear a trial frame and look at an eye chart. The eye care professional will change lenses and other settings while asking the patient for feedback on which set of lenses give the best vision.
By measuring this zone, the autorefractor can determine when a patient's eye properly focuses an image. The instrument changes its magnification until the image comes into focus. The process is repeated in at least three meridians of the eye and the autorefractor calculates the refraction of the eye, sphere, cylinder and axis.
To measure the horizontal deviation, the Maddox rod is placed in front of the right eye (it is done on both eyes) with the cylinder horizontal, making the red line vertical. The patient is then asked whether the white light is superimposed on the red line, or if it is to the left or right of the red line.
This was a device produced in Camden, New Jersey, which contained a battery of convex lenses for each eye, a battery of concave lenses for each eye, and auxiliary lenses which gave it a total power range of +15.75 to -19.75, as well as a Maddox rod and Risley prism for each eye, and a Steven's phorometer.
The refraction part of the exam was done with trial lenses that fit into the back of the same trial frame. Optometer was the generic name for devices, crude and simple, with rotating batteries of sphere and cylinder lenses placed in front of each eye, one at a time; so there was no testing for binocularity.
The eye not being tested is patched and the room lights are dimmed prior to commencement of the test. [12] The patient is positioned appropriately and comfortably against the forehead rest and chin rest. Minor adjustments to the head position are made to centre the pupil on the display screen to allow eye monitoring throughout the test.