1. Autorefractor Instructions

2. Seat the patient at the instrument. Hold and stabilize the chair as the patient sits down, especially if the chair has wheels. 1 1

3. Autorefractor Instructions Explain the instrument to the patient: 2 2 “This instrument was originally designed by NASA to test the vision of pilots. It is a computer that automatically measures your vision to give us a baseline of where to start with your prescription. It measures the front curve of your eye, called the cornea. This reading must be measured on a yearly basis to help Dr. take the best care of your eyes. I will begin with your right eye.”

4. Autorefractor Instructions If the patient is wearing corrective lenses (glasses or contact lens), ask him to remove them before giving the test. 3 3 The doctor may require the technician to do two screenings for contact lens wearers 1)where the contact lens are left in for the first screening (for an over-refraction) & 2)are removed for the second reading.

5. Autorefractor Instructions Align the autorefractor (AR) to the patient’s eye. This can be accomplished in two parts: a)a coarse alignment b)a fine alignment 4 4

6. Autorefractor Instructions The technician asks the patient to sit up close to the instrument before adjusting. Each eye is measured separately. 4 4 NOTE: this instrument is as accurate as the assistant operating it.

7. Autorefractor Instructions a)Course Alignment A coarse alignment is made using the automatic table, the chin rest height adjust, and/or the vertical adjustment knob with the assistant looking from the side of the instrument. 4a4a 4a4a With the patient sitting back from the instrument adjust the AR table height so the head rest is even with the patient's brows when he is sitting in an upright position. If the table is automatic, it can be easily raised or lowered by moving the toggle switch (on the base of the table).

8. Autorefractor Instructions a)Course Alignment Ask the patient to sit up close to the instrument and place his arms on the table, his chin forward against the chin rest, and his forehead lightly against the forehead rest. Adjust the chin rest so the corner of the patient's eye is level with the etched line on the headrest post. Gross adjustments might be needed with the vertical adjust knob. 4a4a 4a4a

9. Autorefractor Instructions a)Course Alignment Walk the patient through the test, telling them what to expect and what is going on. 4a4a 4a4a “Looking inside the instrument, do you see a hot air balloon (or a barn or starburst pattern)? “Good. This picture is going to come in and out of focus. Blink a few times, relax, and look at the hot air balloon (or barn or starburst pattern). The computer is measuring the length and clarity of your eye and how much near- / far-sightedness or astigmatism you have.”

10. Autorefractor Instructions 4b4b 4b4b b) Fine Alignment A fine alignment is made by moving the joystick right and left for horizontal movements or turning it for vertical movements to adjust the instrument to the patient’s eye to gain the necessary measurements.

11. Autorefractor Instructions 4b4b 4b4b b) Fine Alignment Move to the operator's side and look into the small monitor screen to operate the AR. Make sure all the correct settings are ready for running the instrument. Use the joystick (control lever) to gently bring the AR in front of the patient’s eye to find it on the monitor. The AR detects which eye is being measured.

12. Autorefractor Instructions 4b4b 4b4b b) Fine Alignment Move the joystick horizontally or turn it for vertical alignment once the patient's eye appears on the screen. Set the “bulls-eye” inside the pupil. Ask the patient to look at the picture (the Target) and relax when it comes into view. Move the joystick forward and back to focus the patient's eye until it is clearly visible. The instrument should guide you through taking this measurement.

13. Autorefractor Instructions Set the autorefractor’s settings according to the instrument model & doctor’s instructions. 5 5 The technician should be aware of what settings the autorefractor is on before running a test. ­An instrument’s settings might be different if a patient is in the office for a full exam verses a follow-up exam, or the settings may be different depending on whether the patient has his/her contact lenses in or out.

14. Autorefractor Instructions At the end of the readings, the technician should praise or say things to the patient to let the patient know that the test is finished – words like:  “Good job, you can sit back now.”  “Perfect! We’re done with this reading.”  “We’re finished; you can relax.”  “We got the readings, so you’re welcome to sit back.” 6 6

15. Autorefractor Instructions 6 6 Often times when a technician says nothing, the patient may wonder if the readings are finished, if they did a good job, or if they can sit back and relax. It is the technician’s job to help the patient understand what is going on and to make the patient feel as comfortable as possible.

16. Autorefractor Instructions Depending on your office, the readings from the autorefractor will either automatically transfer to the computer or should be printed out and recorded in the patient’s chart. 7 7 The technician should know the office procedures and follow the necessary instructions to either transfer data to a computer and/or to print the data.

17. Autorefractor Instructions The Autorefractor automatically knows which eye is being screened, so when it prints out the readings, all the readings for the right eye will be listed first and the left eye listed second. 7 7 When printed, the technician should record the information correctly in the patient chart (whether it is paper or computer format). “O.D.”  right eye = “O.D.” “O.S.”  left eye = “O.S.”

18. Autorefractor Instructions The technician should not explain the results of the test to the patient – this is the doctor’s job. If the patient inquires about the results, the technician can simply tell the patient that the doctor will go over the results during their exam. 8 8