question about refractionists

**optilady1** · 02-22-2011, 10:17 AM

I mean no snark in my following question:

Shouldn't those who are refracting have knowledge of optics? I'm talking basics here. It's frustrating to receive new rx's from patients and have serious doubts about the accuracy.
Example: I read all the glasses the patients are wearing when going in for their pretesting for the techs. I prefer to write my findings to the nearest eighth diopter, since I don't know what the rx should be. I mean, if it's a -.87, how do I know if the original rx was written as -.75 or -1.00? However, my techs become flustered, and come to me in a tizzy demanding to know what is a -.87.

My annoyance becomes far more accute when I am forced to eat lenses when I have to remake them.

So I ask, since I am a mere optician, shouldn't a refractionist know how to read glasses, how to interpret them, or am I being an elitist?

**wmcdonald** · 02-22-2011, 10:22 AM

Yes, that is why it is a great role for an Optician. Many docs use techs, and most are very good, BUT they need to be well-trained.

**chip anderson** · 02-22-2011, 10:27 AM

Don't you realize being twice as accurate takes at least twice as much time. There is nothing more valuable than a doctor's time that's why our standards were decreased to 1/4 steps in the first place. Who knows in another decade or two half a diopter may be good enough. When it comes to Rx's or lack of same post cataract surgery it seem even this is more than minimum requirement in many cases. So what if you have a diopter and a half imbalance, just get youself some of dem drug stow readas.

**kcount** · 02-22-2011, 12:22 PM

Just curious why dont you simply round to the nearest quarter? Push plus if a myope, push minus if hyperope. If the technicians can't understand what your writing, write in their language. I understand your trying to be exact, but a phoropter doesn't have a .12D lens.

**fjpod** · 02-22-2011, 01:03 PM

Originally Posted by optilady1

I mean no snark in my following question:

Shouldn't those who are refracting have knowledge of optics? I'm talking basics here. It's frustrating to receive new rx's from patients and have serious doubts about the accuracy.
Example: I read all the glasses the patients are wearing when going in for their pretesting for the techs. I prefer to write my findings to the nearest eighth diopter, since I don't know what the rx should be. I mean, if it's a -.87, how do I know if the original rx was written as -.75 or -1.00? However, my techs become flustered, and come to me in a tizzy demanding to know what is a -.87.

My annoyance becomes far more accute when I am forced to eat lenses when I have to remake them.

So I ask, since I am a mere optician, shouldn't a refractionist know how to read glasses, how to interpret them, or am I being an elitist?

You open a whole lot of questions. Sure, people doing refraction should know something about optics. They should also probably know something about visual psychometrics, and physiological optics...but that's a whole 'nother story.

Not to belittle being precise, but I have never met a pair of glasses that had to be remade because of an eighth of a diopter. Now if you have an undertrained refractionist who is off 8 degrees in axis, talking to a patient that doesn't always understand questions and might be off .375, and doesn't always give precise answers which in turn get misinterpreted by .25 by an imprecise refractionist,...yeah, then you get some errors.

And not to take sides, but as an experienced refractionist, I would want the old spectacle Rx reported to me in .25 diopters. Let the auto-lensometer default where it may.

**drk** · 02-22-2011, 01:15 PM

I'm going with Optilady on this. Why not be as accurate as possible? What's the harm?

If the technicians don't like the degree of specificity, then they can adjust their work, right?

**Mark Miller- POF** · 02-22-2011, 01:30 PM

Do you know of state or national practical exam on refraction and/or vision assessment, that is not offered by the AOA?

Please let me know.

Many Thanks

Mark Miller

**Robert Martellaro** · 02-22-2011, 02:11 PM

Originally Posted by optilady1

...my techs become flustered, and come to me in a tizzy demanding to know what is a -.87.

The next time you order a pizza for lunch, ask the pizzeria to leave it uncut. Your techs can be in charge of cutting into even pieces. He or she should first cut it in half, then make quarters and finally eighths.

**chip anderson** · 02-22-2011, 02:56 PM

Back in the day before OMD's were ushered out of self referral, I saw many old Rx's for .12 cylinder in welding goggles no less.
Yeah, I know they are back in and no one remembers the reason why it was bad practice. But, surely you don't thing a highly educated eye specialist would put .12 cyl in a pair of welding goggles just to run up the price and keep the patient of pre-made glasses?
Today I often think that shadow of a second moon would go away if .12 were the tolerances in refraction and spectacles.

Chip

**optilady1** · 02-22-2011, 03:54 PM

Originally Posted by kcount

Just curious why dont you simply round to the nearest quarter? Push plus if a myope, push minus if hyperope. If the technicians can't understand what your writing, write in their language. I understand your trying to be exact, but a phoropter doesn't have a .12D lens.

I've accommodated to their requests, and I do write in .25 D. However, I learned a long time ago that, when neutralizing, one shouldn't assume which way to round. The habbit comes from the LC when we made glasses frequently from neutralizations. And my techs are taking the patients lens neutrals as a starting point, and as you can glean from my original post, I want to make it as easy for them as possible.

**fjpod** · 02-22-2011, 06:12 PM

I guess I shouldn't assume, but are you using a manual or auto lensometer? I've known many opticians (and ODs) to have bias when they use a manual lensometer...so even if you are thinking you are exact at .125 on a manual, you may not be. On an auto, I would rather see which way the computer rounds it than have the exact number.

I'm not saying my way is the only way, but it's my preferred way.

**fjpod** · 02-22-2011, 06:23 PM

Originally Posted by chip anderson

Back in the day before OMD's were ushered out of self referral, I saw many old Rx's for .12 cylinder in welding goggles no less.
Yeah, I know they are back in and no one remembers the reason why it was bad practice. But, surely you don't thing a highly educated eye specialist would put .12 cyl in a pair of welding goggles just to run up the price and keep the patient of pre-made glasses?
Today I often think that shadow of a second moon would go away if .12 were the tolerances in refraction and spectacles.

Chip

Higher order abberations have a lot more to do with circles around the moon...than .125 sphere or cyl.

**Oedema** · 02-22-2011, 07:32 PM

If 1/8 diopter is getting these techs all in a fluster, they should learn to calm the hell down. My take on it: who cares, its only 1/8, when i do my lensometry I'll usually write it in 1/8 if thats what I'm reading, but I'm not going to pretend that I'm being super accurate, chances that I'm just over-accomodating by that amount.

**optilady1** · 02-22-2011, 07:46 PM

ok, let me rephrase: shouldn't a refractionist know something about what they are doing? I mean, if a doctor is going to sign an rx pad, shouldn't the person who writes the rx have an understanding of the what those little numbers and signs mean? Should prism scare them? Should they know how to transpose? I don't know the technique of how to refract, but I understand a decent amount of what an rx means when I'm handed one.

**fjpod** · 02-22-2011, 07:54 PM

Originally Posted by optilady1

ok, let me rephrase: shouldn't a refractionist know something about what they are doing? I mean, if a doctor is going to sign an rx pad, shouldn't the person who writes the rx have an understanding of the what those little numbers and signs mean? Should prism scare them? Should they know how to transpose? I don't know the technique of how to refract, but I understand a decent amount of what an rx means when I'm handed one.

Sadly, you are 100% correct, but the "conventional wisdom" these days is that the doctors time is too valuable...and (don't take me wrong) an opticians time is also too valuable...so we have "technicians" refracting that have very little optical experience.

**chip anderson** · 02-22-2011, 08:01 PM

Shoot doesn't this fit in with "doctor's excuses" being handed out to teachers without an exam? Appearently education isn't the answer to integrity any more, if it ever was.