Manifest Refraction Part 2

When do you fish for cyl?

if you did not scope any cyl on retinoscopy

OR

patient kicked out any cyl you did scope on retinoscopy

What axes do you fish fro cyl in?

180, 135, 90, 45

What is the first step in fishing for cyl?

put a -0.25 DC lens in!

If you are fishing for cyl and add -0.25DC and the patient says they look the same, what do you do?

Keep the -0.25 in and start axis refinement

Who is not considered a good candidate for binocular balance?

patients have have unequal refractive error

patients that cannot be corrected to 20/20

patient has constant strabismus

What is your last step of refraction for someone who can not do binocular balance?

monocular subjective

What patient population do you not NEED to do binocular balance on and why?

patients over 65+ because they have no accommodation, so there is nothing to balance

What do you do if your patient is seeing horribly after refraction?

make sure you removed your working lens + removed it in the right direction

consider rescoping or using an alternative method

What do you do if your patient is leading you around the axis wheel?

1. make sure you are flipping the JCC to the patients choice

2. if they have -0.25D of cyl, they probably don't need it

3. create a bigger bracket

4. Have patient hold and rotate the axis wheel

IF you are doing prism binocular balance and your patient cannot see two charts, what do you do?

1. check that both eyes are open

2. verify you used correct prism and right orientation

3. cover each patients eye and make sure they can see the chart monocularly

4. modify the prism to help them see 2 charts

5. use a different test

What is our first step of binocular balance?

Add 2-3 clicks of plus!

Why do we add 3 clicks of plus when performing binocular balance?

to relax accommodation and introduce blur

When do you show the patient the 20/15 line?

During the binocular subjective sphere if they can easily read 20/20