Why the Vision Exam is so Confusing

I’ve always said I feel like I should have a mental health professional stationed outside my office to help repair my patients’ damaged psyches following the vision test.  I say this not because of any self-professed deficiency in my exam technique, but rather due to the nature of the exam itself: it is at times frustrating, confusing, or both.

The reason for vision-test-related frustration is mostly two-fold.  First, the best way to refine and pinpoint a glasses prescription is to rule out all of the power options that DON’T work.  For example, to arrive at a prescription of -1.00D (D stands for diopters, but that’s another conversation), I would want to confirm that neither -0.75 nor -1.25 looks as good.  That’s already two different sets of “Which is better, 1 or 2?” right there.  And sometimes – especially for younger patients whose focusing muscles can mask their prescription somewhat – both choices look pretty identical, so we go back and forth a few times and have tough decisions to make.

The second cause of eye exam stress is that certain parts of the test are confusing and/or counterintuitive – I’m looking at you, astigmatism test!  To test for astigmatism, we introduce a lens called the Jackson Cross Cylinder (JCC).  Without getting into too much gory detail (too late?), as we use the JCC to test astigmatism, the goal is actually to EQUALIZE the BLUR between the two choices.  We don’t even care of either/both choices look clear; we just want them to look the same.  I try to prepare my patients beforehand that both choices may look blurry, but inevitably I’ll get patients who uneasily state “they both look pretty bad.”  Yup, they do.  Once I’ve gotten the measurements I need – again, trying to bracket by finding what DOESN’T look better – I remove the JCC and the image is magically a lot clearer.  Hopefully I can get to that point before my patient has a heart attack.

Most patients who have been through this crazy dance before take it in stride and accept that, in the end, they can expect to see well; but I don’t blame anyone who doesn’t look forward to the vision test.  It’s like what people say about most standardized tests, except even more true – you can’t study for it.

Better equipment, better prescriptions

Anyone who comes into my office will know that I’m a bit of a gadget freak.  I believe in technology and its ability to improve the quality of an eye exam.  From a health perspective, I love what the Optomap Retinal Exam allows me to see in the back of a patient’s eye, without even needing to put dilating drops in their eyes.

My love for things that are gadgety and automated extends to checking glasses prescriptions as well.  Whereas many offices are still using equipment that hasn’t been considered cutting-edge for twenty or thirty years, I’m fortunate to have a fully 21st century office.  First, an automated machine measures the power and curvature of my patient’s eye and gives an excellent starting point to refine for the glasses prescription.  At the touch of a button, this measurement imports directly to a small computer in my exam room, which controls the machine that sits against my patient’s face to flip lenses and finalize the glasses prescription.

To be honest, when I first started using the automated refraction equipment, I thought it was really just a dolled-up version of the older equipment.  However, I’ve come to greatly appreciate its accuracy and efficiency when determining my patients’ prescriptions.  By starting with a more accurate initial measurement, not only is the end result more accurate, but it also takes less time to arrive at that prescription.  Not to mention the fact that both the patient and I are saved from the endless “1 or 2” questions (not eliminated, but definitely reduced!).  Also, the computerized controls allow me to refine certain aspects of the prescription more exactly than I could with older machines and their less precise dials.

None of this is meant to take away from other doctors and what they are able to accomplish with their equipment.  I’m just very grateful for my equipment and absolutely believe that it gives me the best opportunity to give my patients glasses and contacts that they will love!