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.