Refraction is not an "Eye Exam".

Refraction is the process you all remember from the annual trip to the eye doctor: "which is better, 1 or 2?". That's the part where we fine-tune your glasses Rx. It is usually *NOT* the part where we diagnose anything or "figure out" whether you need glasses. We already know all that by the time we start asking questions. Refraction is just fine-tuning. That's it. So many patients expect to have a refraction every time and many of them put a LOT of stock into whether they had a refraction and how long it took. A longer refraction is considered to be a "VERY THOROUGH EXAM", and a quick refraction is sometimes perceived as being a shoddy exam. Neither of those are true, because a refraction is not an "exam". It's just a prescription fine-tuning. I recently had a discussion with a 29 year old healthy patient who had 20/15 acuity. The autorefractor literally spit out "0.00" as her estimated refractive error. I performed all the health stuff: pupils and entrance testing, slit lamp, pressures, ophthalmoscopy, etc etc etc. At the end I announced she was fine. She asked when I was going to do an eye exam! Ha! Uh, I did an eye exam. She just wants a refraction because she expects to have a refraction. Why? Am I going to give a symptomless 20/15 29 year old some glasses? For what? Why would I "fine tune" her 0.00 "prescription"? Because "refraction" is listed on some "21 point exam" protocol? Because some insurance provider lists it as a "standard of care"? Technically we already DID a "refraction"...we performed an autorefraction on her. Do we really need to ask her "which one is better"? No. We do not. And I did not. I explained she didn't need that test. That's not an "eye exam". Also: having your acuity tested at the DMV (or anywhere else) is also not an "eye exam". Not even close.


  1. I was surprised at just how thorough eye testing can be...I was recently diagnosed with Hemicrania Continua and because the majority of the pain was in the area of my eye they brought in an on call eye doc immediately to check the optic nerve and then had my regular eye doc followup. Though he hadn't heard of Hemicrania Continua, it was obvious that he did everything he could to rule out any eye issue causing the pain...first time I've ever had an exam where I was made to see double and then move things around...quite an experience!

  2. when do optometrists examine the eye anyway?

  3. It's pretty funny that so many people confuse the eye exam with the refraction, or consider the refraction to be the eye exam. I've had an eye exam every year for over ten years now, and the doctor only did a refraction on two or three of those occasions. After they've done all of their other tests and examinations, they know whether or not they even need to do a refraction. Thanks for sharing!


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