Hands Up for the HandyRef

Objective refraction (retinoscopy or autorefraction) takes us to a point from which subjective methods can establish the end-point refraction accurately and quickly. With practice, and if a previous prescription is known, retinoscopy should take just minutes, autorefraction seconds. A useful autorefractor should be easy to use, incorporate features minimising errors due to accommodation or erratic fixation, and be able to record accurate readings averaged from a sequence for a wide variety of pupil sizes and media in different environments. There are patients who are unable to participate in a subjective refraction, because of limitations of understanding or communication. Very young children, or people with Alzheimer’s disease or a learning disability may require a prescription to be arrived at purely from the objective ?ndings. As many of these patients have mobility concerns, portability is important too. Autorefraction is also helpful where retinoscopy reflexes are difficult to interpret – I personally prefer to do cycloplegic refraction with an autorefractor.