Optometric Management Tip # 182   -   Wednesday, July 13, 2005
Technician Refraction Lite

Most optometrists are a long way from wanting to delegate refraction to technicians, although some of our colleagues are reconsidering that position. Iím not here to recommend one approach or the other; I think there are advantages in having the doctor perform that task, and advantages in delegating it. Itís a matter of personal choice. In practices where the OD does the refraction, however, there are several ways to make the process much more efficient, and Iím a strong believer in that. While not actually delegating refraction, you may consider these tips as Tech-refraction Lite.

You can shave many minutes off your average exam time if you incorporate these delegated procedures into your routine.

The Phoroptor (refractor)

Editorís note: The word phoroptor is actually a trademark of Reichert (formerly American Optical), but I use it here because it has achieved such common usage in our vocabulary. Itís kind of like Kleenex as a word for tissue.

In many offices, the phoroptor is an instrument that is only touched by the doctor. That need not be the case. Technicians in my practice prepare the phoroptor for the doctor as they get each patient seated in the exam chair. This means they wipe the facial plates with an alcohol swab and then dial in the habitual spectacle Rx. Having that Rx in place may seem like a small point, but try it and youíll see that it really makes a difference.

Back in the day when we did retinoscopy on each patient before the subjective, the retinoscopy result became the starting lens. Iím sure Iíll hear from colleagues who still routinely perform retinoscopy, but in my view, technology has made the instrument unnecessary for most patients (not all).

It should be noted that digital refracting systems automatically take care of several of the issues described in this article, by electronically integrating a phoroptor with a lensometer, an autorefractor, and even with the acuity chart. But practices with standard phoroptors can still gain excellent efficiency.

Tips for having the tech dial in Visual acuity chart

Technicians are perfectly capable of measuring visual acuity accurately, and itís a major time saver, yet many ODs still do it themselves. Try delegating it. Itís an easy test to add as your assistant gets the patient ready. Consider these staff training tips. Lensometer

Iíve found standard lensometry to be one of the most difficult tasks to master for technicians Ė but they all must be proficient at it in my practice. Autolensometers are great if you have them in enough locations, but I still like techs to be able to read a lens and understand the number line concept. It helps them understand lens powers.

Donít let staff training and practice stop you from delegating the task of lensometry. Itís too time consuming and too expensive for the doctor to do this procedure on a routine basis.

Autorefractor and autokeratometer

These simple to perform pre-tests provide a wealth of information and make the subjective a snap. I have a blank space on my exam form where the printout can be taped in place.

Contact lens refractive tests

Technicians can perform several refractive tests for the contact lens patient, during the fitting process and in follow-up care.

Since most astigmatism is corrected with the contact lenses, there are many cases where only a spherical subjective over-refraction is needed. This test is easy for technicians to do. Just fog them up and bring them down to BVA, monocularly.

Technicians can also perform an objective autorefraction over diagnostic contact lenses, for an approximate idea of the level of correction. Coupled with visual acuity with contacts, as measured by the tech, the doctor gains a very good idea of the final contact lens Rx at a glance.

Best wishes for continued success,

Neil B. Gailmard, OD, MBA, FAAO
Chief Optometric Editor, Optometric Management