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Welcome to question of the day #237

Eyetools question of the day #237

I’ve just finished my optometry diploma and have been in my first job for a week. When I was studying in optometry school I spent many hours learning how to use a retinoscope and a trail frame during the refraction process. We didn’t spend much time using an autorefractor or a phoropter. In my practice, one of the more experienced eye specialists has told me not to bother with retinoscopy nor a trial frame but to rely on autorefractor results for my objective refraction information and then to use a phoropter. Seems a shame to waste the skills I have developed with my retinoscope and trial frame. What should I do?

I was lucky in that in my first job (in an eye hospital) we didn’t have an autorefractor nor a phoropter. I trained using a retinoscope and trial frame and after 5 years in that post, I became very good at objective refraction. It was very useful for people with corneal abnormalities such as keratoconus and corneal ulcers, children, and people who could not position themselves on a chin rest.

Then I went into a primary care practice where all the other eye specialists relied on the autorefractor and many used a phoropter. I stuck to using my retinoscope and trial frame.

Refracting without an autorefractor or a phoropter has its advantages for some patients. In my experience for many practitioners, an autorefractor has replaced the use of the retinoscope to objectively determine a patient’s refractive error. The optometrists I know will very rarely reach for their retinoscope.

However, there are still a variety of patients who are better examined by an evaluation using a retinoscope and a trial frame.

Patients who cannot or should not be refracted using an autorefractor or phoropter include those who are physically unable to sit up to an autorefractor or sit behind a phoropter.

Some patients have an eye disease that prevents them from getting an accurate autorefraction or prevents an accurate refraction with a phoropter.

Examples of individuals who are better examined by retinoscopy and a trial frame refraction include:

Those who are physically incapable of raising their head due to skeletal problems.

Patients with nystagmus or reduced central vision who need to use eccentric fixation to achieve their best acuity

Children

Patients with special needs

Patients in wheelchairs

Individuals who have to use sign language or a communication device.

And of course, any patient that cannot get to your practice and needs to be examined in their own home.

Practitioners may struggle to accurately determine whether these individuals can benefit from a spectacle correction or a spectacle correction change—unless they have maintained their skills in retinoscopy and trial frame refraction.