Hrynchak Patricia K, Mittelstaedt Andrea M, Harris Joel, Machan Carolyn M, Irving Elizabeth L
School of Optometry, University of Waterloo, Waterloo, Ontario, Canada.
Optom Vis Sci. 2012 Feb;89(2):155-60. doi: 10.1097/OPX.0b013e31823efdfd.
The purpose of this study was to determine how optometric practitioners modify the subjective refractive result when prescribing spectacles.
Refractive data were gathered for patient visits at the School of Optometry, University of Waterloo, between January 2007 and January 2008. The entering prescription, subjective refraction, and exiting prescription were analyzed from 5001 records for patients aged ≥ 7 years.
The refraction was modified to create the prescription in at least one eye in 45% of cases; specifically, 27% of cases for the sphere power, 18% for the cylinder power, 25% for the cylinder axis, and 21% for the add. Significant differences, defined as ≥ 0.50 D in sphere, cylinder, or add power or a change in axis of 15° for cylinders < 1 D, 10° for cylinders between 1 and ≤ 2, and 5° for cylinders >2, were made in at least one eye in 17% of cases; specifically 9% of cases for the sphere power, 6% for the cylinder power, 6% for the cylinder axis, and 5% for the add. Spheres were more likely to be modified in the minus direction (weaker plus and stronger minus power) (18 vs. 11%), cylinder powers reduced (14 vs. 5%), and adds increased in power (12 vs. 8%). Modifications to create the exiting prescription were made to be closer or the same as the entering prescription 97% of the time. However, modifications were such that the entering prescription was duplicated exactly only 0.7% of the time.
Optometric practitioners routinely modify the subjective refraction to create the prescription. Small modifications are common, whereas larger modifications are used more sparingly. Because there is a significant amount of clinical judgment involved in determining the refractive prescription, reliance on automated or subjective refraction alone would not be prudent.
本研究的目的是确定验光从业者在开具眼镜处方时如何调整主观验光结果。
收集了2007年1月至2008年1月间滑铁卢大学验光学院患者就诊时的验光数据。对5001例年龄≥7岁患者的初始处方、主观验光结果和最终处方进行了分析。
在45%的病例中，至少有一只眼睛的验光结果被调整以确定最终处方；具体而言，球镜度数调整的病例占27%，柱镜度数调整的病例占18%，柱镜轴位调整的病例占25%，附加度数调整的病例占21%。在17%的病例中，至少有一只眼睛出现了显著差异，定义为球镜、柱镜或附加度数变化≥0.50 D，或柱镜度数<1 D时轴位变化15°，柱镜度数在1至≤2 D之间时轴位变化10°，柱镜度数>2 D时轴位变化5°；具体而言，球镜度数调整的病例占9%，柱镜度数调整的病例占6%，柱镜轴位调整的病例占6%，附加度数调整的病例占5%。球镜更倾向于向负方向调整（正度数变弱，负度数变强）（18%对11%），柱镜度数降低（14%对5%），附加度数增加（12%对8%）。在97%的情况下，调整后的最终处方与初始处方更接近或相同。然而，只有0.7%的情况下，初始处方被完全复制。
验光从业者通常会调整主观验光结果以确定最终处方。小的调整很常见，而大的调整则使用得较少。由于在确定屈光处方时涉及大量临床判断，仅依赖自动验光或主观验光并不谨慎。
