Article Date: 9/1/2011

Readers Voice Their Opinions

Readers Voice Their Opinions

Digital refraction debate

Editor's note: We received a number of letters regarding the article, “Is It Time to Stop Refracting,” (Optometric Management, July 2011, or visit our archives at in which Scot Morris, O.D., explained the benefits of using a digital refraction system. Many congratulated Dr. Morris on explaining the advantages of the system, which in the author's practice, includes delegating the digital refraction to trained staff members. Others argued against the system, in particular, delegating the refraction. Below are several excerpts from the latter letters.

■ Refracting is not what optometrists do; it's the core of who we are. We are physicians. Physicians examine their patients. Physicians don't sit in a back room and, “crunch numbers.” I am disappointed that Dr. Morris stated that it only takes “12-to-16 hours” of training to refract. The philosophy, science, and methodology of refraction & optics takes up a majority of the curriculum in optometry school. With the addition of three more colleges of optometry, which have just opened, and three more opening in the near future, there will be plenty of doctors who will have the time to carefully examine patients, which includes the refraction. In summary: Doctors should do the refraction, not the technician.

Max Kostecki, O.D., F.A.A.O.
St. Paul, Minn.

■ If your goal is a quick exam, there are thousands of ophthalmology offices and discount retailers who are happy to oblige. Perhaps the most significant element of consternation in Dr. Morris' editorial is that he advocates delegating a refraction because it is not cost effective, which implies a disinterest in the diagnostic value of the refractive process itself. Seeing only the end result (the prescription) as significant suggests there is nothing to be gained as a clinician by observing responses to changes in optics. Frankly, this sort of practice limits a doctor's diagnostic breadth in the name of profits and dispenses with the unique value and advantage of the comprehensive optometric examination.

Charles A. Boulet, B.Sc., B.Ed., O.D.
Alberta, Canada

■ No matter how many diagnostic instruments and techs are used, experience and knowledge are necessary to determine a usable, comfortable prescription to suit the many visual needs of the individual patient.

Louis E. Persons, O.D., F.A.A.O.
Key West, Fla.

The author responds: The article I wrote on digital refracting generated a plethora of very emotional responses, both positive and negative, and it raised several issues, which I'll address here:

First, let's differentiate between a refraction, which results in data that is used in determining a prescription, and the prescription. While a manual phoropter can allow for monocular, bi-ocular and binocular refractions, it is limited to 0.25 intervals, and results are subjective.

Digital systems measure the above to 0.125D as well as provide information about corneal topography, wavefront aberrations, optical pattern deviation, pupil size and associated effects of diffraction and K readings at 3mm, 5mm and 7mm. What doctor can ascertain this information based solely on experience or a manual phoropter?

The doctor provides the prescription as a solution to the visual needs of and visual correction for a patient, so he/she does much more than a refraction. It is the doctor who must determine the final prescriptions (plural) for distance, intermediate and near, in both light and dark. The prescription requires a face-to-face meeting between the doctor and patient to discuss visual tasks, needs, wants and concerns.

I am in no way saying that optometrists shouldn't determine the final prescription. However, I would argue that many of our peers need to spend less time refracting and more time providing the solutions (prescriptions) that our patients need.

Also, I question the assumption that patients demand a doctor to perform the refraction. My practice has a record number of patients being referred for “the new hi-tech refraction,” which trained staff perform. It's a competitive advantage.

Finally, if you have not tried a digital refraction system, I encourage you to do so. How else can you determine which system works best in your practice? OM

Scot Morris
Conifer, Colo.

How to Reach Us
Optometric Management welcomes your comments. Please be brief. All correspondence is subject to editing for style, space and relevance.

Send your letters by
Mail: Letters, Optometric Management
323 Norristown Road, Suite 200
Ambler, Pa. 19002
Fax: (215) 643-3902

Optometric Management, Issue: September 2011