Introduction
Refraction test is one of the most common procedures performed by an eye surgeon to check vision.
Definition
Refraction test is a part of routine eye examination that is used to determine the refractive error in the eyes.
Purposes
- To determine vision.
- To determine types of glasses and contact lens for correction.
Indications
- Macular degeneration.
- Retinal vessel occlusion.
- Retinitis pigmentosa.
- Retinal detachment.
- Astigmatism.
- Hyperopia.
- Myopia.
- Presbyopia.
Articles
Preparation of the Equipment
| Articles | Purpose |
| Snellen chart | To check the vision. |
| Ishihara chart | To test for color vision. |
| Fine print reading chart | To determine choice of glass or contact lens. |
| Pinhole | To evaluate visual acuity in cataract. |
| Hatpin | To hold hair. |
| Ophthalmoscope | To visualize the retina. |
| Pen torch | To inspect the eye. |
| Mydriatic eye drops | To dilate the pupils. |
Preparation of the Patient
- Ask the patient to remove the lens at least 2-3 days before the rest is to be performed.
Procedure
| Nursing Action | Rationale | |
| 1. | Explain the procedure to the patient. | Allays anxiety and gains cooperation from the patient. |
| 2. | Obtain informed consent from the patient. | Serves as legal evidence. Prevents litigation of the staff. |
| 3. | Instill the eye drops as per the physician’s order. | General preparation before the procedure. |
| 4. | Position the patient sitting on a chair. | Provides comfort to the patient. |
| 5. | Ask the patient to lean forward and place his or her head properly on the head rest. | Enhances the visualization of the eye. |
| 6. | Instruct the patient to view into the device and identify the images. | To aid in performing the procedure. |
| 7. | The test is performed on one eye at a time. | To avoid errors. |
| 8. | Place different lens and ask about the clarity of the chart. | To identify the correct lenses for correction. |
| 9. | A specialized light is reflected in the eyes. | To determine the refraction. |
| 10. | Document the procedure; Record the date, time, and patient’s response to the procedure. | Serves as legal evidence and prevents duplication of care. |
Special Considerations
- Consider presbyopia, slower response times, and comorbidities like cataracts or macular degeneration.
- Use nonverbal cues, picture-based charts, or retinoscopy for objective assessment.
- Use symbol-based charts (e.g., Tumbling E, Landolt C) and confirm understanding before testing.
- Ensure the patient is not wearing contact lenses (if required) and has rested eyes.
- Ask about recent eye strain, medications, or systemic conditions that may affect vision.
- In younger patients, cycloplegic refraction may be necessary to prevent over-accommodation and reveal latent hyperopia.
- If using retinoscopy, subtract the dioptric equivalent of your working distance (e.g., 2.00 D for 50 cm) from the final result.
- Combine objective methods (e.g., autorefractor, retinoscopy) with subjective refinement using a phoropter or trial lenses.
- Disinfect phoropters, trial frames, and handheld lenses between patients.
- Practice hand hygiene before and after the procedure.
- Sudden changes in vision, unexplained asymmetry, or poor visual acuity despite correction may indicate underlying pathology.
- Refer promptly for further ophthalmologic evaluation if abnormalities are detected.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
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