1. Examination Techniques for Accuracy and Efficiency
Autorefractor/Trial Frame vs. Retinoscope/Phoropter
A VOSH-Florida Presentation

2. Autorefractor pros and cons
Phoropter pros and cons

3. Autorefractor/Trial Frame Approach:
Autorefractor Pros:
Fast
Accurate – with some exceptions
Minimal skill or training required
Newer models allow subjective testing
Auto-Keratometry included

4. Autorefractor Cons: Expensive Sensitive computer circuitry:
Sensitive to temperature and humidity
Sensitive to power spikes
Expensive service contracts
Potentially long down-time for repairs
Relatively short service life

5. Autorefractor Cons:
Limited accommodative control for children and young adults. Susceptible to proximal accommodation.
Poor results due to media opacities and small pupils.
No feedback on retinal reflex brightness or integrity.
Difficult to position a physically impaired patient using a table top instrument.

6. Trial Frame/Trial Lens Pros:
Trial frame is relatively inexpensive
Minimal maintenance
Trial lenses are durable and relatively inexpensive
Portable
Minimal physical limitations
Astigmatism correction can be accurate with the use of an astigmatic dial chart or hand-held Jackson Cross Cylinder.

7. Trial Frame/Trial Lens Cons:
Time consuming
Limited control of accommodation (Red/Green projected charts)
Astigmatism testing more complicated
Prism testing not practical
Near point analysis and Add testing very limited
Multiple frames required for adults and children

8. Retinoscope/Phoropter Approach:
Retinoscope Pros
(Lens Rack method or Phoropter):
Fast
Accurate
Portable
Minimal physical limitations
Inexpensive

9. Retinoscope Pros:
Accommodative feedback through direct retinal reflex observation
Retinal reflex brightness and integrity directly observed.
Dynamic retinoscopy possible for pediatric evaluation

10. Retinoscope Cons:
Steep learning curve to acquire high level of accuracy and speed.
Poor results due to media opacities and small pupils.

11. - Phoropter Pros: Fast Accurate Minimal physical limitations
Low maintenance
No electric circuitry
Stable (Gold Standard) refraction technology

12. Phoropter Pros: Excellent ability to control accommodation
Built-in JCC for ease of astigmatism testing
Built-in Risley prisms for ease of prism testing
Near point rod for ease of near point testing

13. Phoropter Cons: Moderately expensive
Steep learning curve to acquire high level of accuracy and speed.
Requires an adjustable stand and optional adjustable chair.
Best results/efficiency with projected chart
Requires a trained technician for cleaning and servicing.
Not highly portable due to stand requirement.

14. Summary:
The retinoscope/phoropter combination provides the best method for performing multiple, complex refractive exam procedures.
The retinoscope with lens rack and trial frame is second in speed and versatility.
The autorefractor and trial frame provides fast, but limited refractive capabilities.