I have a love/hate relationship with refraction. As an optometrist, you probably do too.
On the one hand, refraction can feel like a repetitive exercise, a script we’ve run through thousands of times. Some patients breeze through it with confidence and consistency. Others agonize over every “1 or 2,” seemingly waiting for their punishment if they give the “wrong” answer. It’s not unusual to walk out of the exam room more mentally exhausted from a refraction than from diagnosing glaucoma or discussing age-related macular degeneration.
A Profession Transition I graduated in the late ‘90s, a time when optometry was transitioning rapidly into a more medically oriented profession. It felt like every few months another state earned therapeutic privileges. Coming out of a residency in ocular disease, I was energized to tackle all ocular pathology, specifically glaucoma, ready to cast off the chains of refractive monotony and practice at the highest level.
And yet, despite joining a medically oriented optometric practice, the majority of my early patients still came in because of refractive needs. Eyeglasses. Contact lenses. Blurry vision. And yes, the endless refraction. I handled these things dutifully but not enthusiastically.
A Conduit to Care Over time, however, something changed. I came to understand that although patients may enter our exam lanes for a new prescription, what we find while they’re in the chair is often medically significant. Refractive needs may be the door in, but recognizing elevated IOP, retinal hemorrhages, optic nerve cupping, diabetic changes, and other subtle signs of systemic disease is often what’s behind that door.
This truth deepened when optional widefield imaging and ocular coherence tomography became a part of pretesting. It became undeniable how much silent pathology was uncovered. The kind of meaningful medical findings that drive long-term care relationships and enhanced patient outcomes soared.
A Turning Point Then came a major turning point: the integration of advanced refraction technology in pretesting areas. Specifically, where I practice, each location was outfitted with units capable of providing precise autorefractions and simplified technician-led refractions. At first, some of our doctors were hesitant: “Would it compromise quality?” “Were we giving up too much control?”
But the results showed otherwise. By reviewing the patient’s prior prescription, the autorefractor reading, the technician’s refraction, and bringing them all together with clinical context, our doctors could prescribe accurately and confidently. Fewer remakes. Happier patients. And when the data didn’t make sense? The doctor stepped in and did a traditional manual refraction.
That change unlocked something else: the practice’s optometrists became data interpreters instead of data gatherers. This efficiency allowed us to spend more time communicating, educating, and treating our patients. It’s a luxury in today’s fast-paced medical landscape, and it’s one we don’t take for granted.
A Critical Part Refraction may still feel rote at times, but no longer does it dominate our doctors’ time. It’s a critical part of a larger system that supports medical optometry, improves outcomes, and fosters patient trust. We didn’t abandon refraction, we reframed it. OM
