Examination Techniques for Accuracy and Efficiency Autorefractor/Trial Frame vs. Retinoscope/Phoropter A VOSH-Florida Presentation

Autorefractor pros and cons Phoropter pros and cons

Autorefractor/Trial Frame Approach: Autorefractor Pros: Fast Accurate – with some exceptions Minimal skill or training required Newer models allow subjective testing Auto-Keratometry included

Autorefractor Cons: Expensive Sensitive computer circuitry: Sensitive to temperature and humidity Sensitive to power spikes Expensive service contracts Potentially long down-time for repairs Relatively short service life

Autorefractor Cons: Limited accommodative control for children and young adults. Susceptible to proximal accommodation. Poor results due to media opacities and small pupils. No feedback on retinal reflex brightness or integrity. Difficult to position a physically impaired patient using a table top instrument.

Trial Frame/Trial Lens Pros: Trial frame is relatively inexpensive Minimal maintenance Trial lenses are durable and relatively inexpensive Portable Minimal physical limitations Astigmatism correction can be accurate with the use of an astigmatic dial chart or hand-held Jackson Cross Cylinder.

Trial Frame/Trial Lens Cons: Time consuming Limited control of accommodation (Red/Green projected charts) Astigmatism testing more complicated Prism testing not practical Near point analysis and Add testing very limited Multiple frames required for adults and children

Retinoscope/Phoropter Approach: Retinoscope Pros (Lens Rack method or Phoropter): Fast Accurate Portable Minimal physical limitations Inexpensive

Retinoscope Pros: Accommodative feedback through direct retinal reflex observation Retinal reflex brightness and integrity directly observed. Dynamic retinoscopy possible for pediatric evaluation

Retinoscope Cons: Steep learning curve to acquire high level of accuracy and speed. Poor results due to media opacities and small pupils.

- Phoropter Pros: Fast Accurate Minimal physical limitations Low maintenance No electric circuitry Stable (Gold Standard) refraction technology

Phoropter Pros: Excellent ability to control accommodation Built-in JCC for ease of astigmatism testing Built-in Risley prisms for ease of prism testing Near point rod for ease of near point testing

Phoropter Cons: Moderately expensive Steep learning curve to acquire high level of accuracy and speed. Requires an adjustable stand and optional adjustable chair. Best results/efficiency with projected chart Requires a trained technician for cleaning and servicing. Not highly portable due to stand requirement.

Summary: The retinoscope/phoropter combination provides the best method for performing multiple, complex refractive exam procedures. The retinoscope with lens rack and trial frame is second in speed and versatility. The autorefractor and trial frame provides fast, but limited refractive capabilities.