What adjustments, if any, do UK optometrists make to the subjective refraction result prior to prescribing?

Aim: To determine whether UK optometrists routinely prescribe the subjective refraction result, or whether adjustments are made to aid patient comfort and adaptation.

Method: A questionnaire was distributed by post and via the internet to UK optometrists. It incorporated eight case scenarios that included information regarding a patient's age, symptoms, habitual refractive correction, subjective refraction and any other pertinent clinical information. For each case, they were asked to indicate what refractive correction they would prescribe.

Results: A total of 426 questionnaires were completed. In three cases with asymptomatic patients with negligible changes in visual acuity, about 45% of respondents indicated that they would prescribe the subjective refraction result and about 40% would prescribe the habitual correction. In a further case involving a 75 year-old asymptomatic patient, 55% prescribed the habitual correction. In two cases with large cylinder power changes, about 40% of respondents indicated they would partially prescribe the cylinder power. However, there was a large variation in the suggested modification of sphere powers to accompany the partial cylinder changes.

Conclusion: A large sample of UK optometrists indicated that they would prescribe the subjective refraction result regardless of patient age, symptoms and difference between habitual correction and subjective refraction. Optometrists who partially prescribe, employ a wide variety of techniques including some that conflict with conventional teaching.