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Delayed Subjective Refraction
PURPOSE To maximally relax a patient’s accommodation and subsequently stimulate the acceptance of plus when determining the correction of a refractive error．
INDICATIONS
This technique is particularly useful for patients with suspected latent hyperopia or an accommodative spasm．
EQUIPMENT
·A phoropter with nearpoint rod．
·Nearpoint cards．
·Distance acuity chart．
SET-UP
·This technique is performed following a complete routine refraction．
·Perform the phorometry tests with the NRA test last(see Chapter 4)．
·Leave the plus from the NRA test in the phoropter．
STEP-BY-SEEP PROCEDURE
1．Isolate a line of letters equal to the patient’s best distance acuity (but no smaller than 20/20)．
2．Remove the nearpoint rod and direct the patient to view the distance target．The patient should report that it is blurry．
3．Reduce the plus binocularly, in 0.25 D steps, until the letters are again clear．
4．Confirm the endpoint using the duochrome test(optional)．
RECORDING
·Writer “Delayed Subjective．”
·Record the correction and the patient’s visual acuities
EXAMPLE
Delayed Subjective：
OD +1.50= -0.75×175 20/15
OS +1.25= -0.25×010 20/15
EXPECTED FINDINGS
·If latent hyperopia or an accommodative spasm exists, this technique may produce a greater plus acceptance than was indicated by routine refractive procedures． |
