Admittedly, a refraction (the process of measuring a glasses prescription) can be a little stressful for a patient. Sometimes it's difficult to make a choice, sometimes both choices look back, and sometimes you might even say "one" when you meant "two". People fear that, if they make one wrong decision, they're going to end up with a bad pair of glasses.

In truth, this should not happen with a proper refraction because it's a very sound process that starts by breaking your prescription into three parts, the amount of nearsightedness or farsightedness, the amount of astigmatism, and the axis (or angle) of astigmatism. For each part we show more and less amounts of power (or axis) until one of a few things happen:

  1. There's a clear cut best power.
  2. The choices start to look the same - This means we're splitting hairs so fine we that the changes were presenting are beyond the patient's threshold for seeing a difference.
  3. The flip-flopping begins.  If the answers are telling us "I want more power. No I want less power. No I want more power" we know that, again, we've narrowed the value down to a small range and we can't go any further.

In my humble opinion, the most helpful thing to do while being refracted is to limit your answers to one of three things: Lens one is better, lens two is better, or they look the same. It doesn't matter if the one you're choosing is still blurry, sometimes that's the case. We just need to know which is the clear-er of the two. The primary goal of everyone involved is to clear things up, but that might not happen until the end of the process. When we ask which is better ("one or two") we're trying to find out which direction we need to move our power - up or down, or which way to twist our axis, left or right - to reach our objective of getting the best possible vision. Most other information besides "one", "two", or "the same" is extraneous. "Choice one is better, but it's blurry" doesn't really tell us anything beyond the fact that we need to move the power in the direction of choice one. 

Optometrists learn to refract pretty quickly. Within a couple years we've done thousands of refractions and are quite proficient at it. We start to feel like finely tuned machines - if you say "one" we reflexively make our change in the instrument and ask our next question.

One thing that throws me off is when people don't tell me which choice they like, but when they tell me which one they don't like. On the surface it the distinction between the two seems insignificant. If there's only two choices, and you know which one is worse, then the other one is better, correct?

I was trying to figure out why this seemingly little thing seems to interrupt my flow so much. I was looking for something to compare it to, and I thought of another situation where you might have to make frequent choices between two options : Getting directions while driving. Sure, if someone constantly told me to "turn not left" or "turn not right" I could pretty much figure out how to get where I'm going but, the way my brain is wired, being told "turn right" or "turn left" is a lot easier for my brain to process.

All that being said, a good refractionist has to be flexible. To the best of our ability we need to educate our patients how to respond to our questions, and we need to alleviate their stressors and fears while being refracted. However, sometimes we just have to parse our patient's responses to the best of our ability and just do our best.

AuthorTodd Zarwell