Yes .... that wasn’t very clear but what I mean by “ tighten the collar” is pulling the streak focusing collar down from the top a small amount. Then it is easier to see the axis of streak. But don’t pull it down so far that the reflex appears neutral. It’s a tricky skill to get used to but definitely worth doing.
Thank you that makes sense to try that, another thing is can we use binocular refraction for a patient who is a hyperope in their 60s instead of monocular refraction. To save balancing the vision afterwards. ? Also, some people do balancing in older patients is it actually needed? I'm a pre-registration trainee so I am looking for ways to speed up my routine.
Hi Dja M I always use binocular refraction. No matter what age. It saves balancing. Although there’s not a lot of balancing with people who can’t accommodate. Although I sometimes find that balancing does change things if I refract monocularly with somebody with cataract or a squint. Maybe it’s something to do with pupil size. Not sure. The only times I revert to monocular refraction is if there is a squint. Or uneven va. Or high dominance to the other eye. My big tip is to use +1.50 as the fogging lens. Not +0.75. Much more reliable. I sometimes come down to +1.25 if I’m confident that there is not much problem with dominance. But that’s less these days.
@@lenshuffler5261 Really good tips there! Thank you so much for your replies as well as new video!. I've been doing as you describe binocular on most px except the certain exclusions, and it's quicker! One thing sometimes patients say with the opaque occluder is that post removal of it they get double. I guess that is because it's like cover test. Is there any advantage to a frosted occuluder? I'm not sure of its use? Also one thing I get with Ret is sometimes much more cylinder than the patient will accept. Is that due to poor technique do you think or is this normal? E.g finding maybe -2.00DC when the px won't take more than -1.25DC? Thank you
Hi Sorry for delay in replying. I've never tried a frosted occluder - but i guess it would have the same effect as a solid one. No chance to fuse. I think the higher cylinder situation you describe could be caused by being off axis. Either being too high or being too low. Alternately off axis to the left or right will cause error. Have a look at Part 2 of the Masterclass video. That deals with alignment issues. Having said all that, sometimes i get the same as you and there is no obvious reason. The cornea is an unusual shape so off axis doesn't help. For that matter the lens is complex too.
Yes .... that wasn’t very clear but what I mean by “ tighten the collar” is pulling the streak focusing collar down from the top a small amount. Then it is easier to see the axis of streak. But don’t pull it down so far that the reflex appears neutral. It’s a tricky skill to get used to but definitely worth doing.
Thank you that makes sense to try that, another thing is can we use binocular refraction for a patient who is a hyperope in their 60s instead of monocular refraction. To save balancing the vision afterwards. ? Also, some people do balancing in older patients is it actually needed? I'm a pre-registration trainee so I am looking for ways to speed up my routine.
I'm very grateful for your videos and help
Hi Dja M
I always use binocular refraction. No matter what age. It saves balancing. Although there’s not a lot of balancing with people who can’t accommodate. Although I sometimes find that balancing does change things if I refract monocularly with somebody with cataract or a squint. Maybe it’s something to do with pupil size. Not sure.
The only times I revert to monocular refraction is if there is a squint. Or uneven va. Or high dominance to the other eye.
My big tip is to use +1.50 as the fogging lens. Not +0.75. Much more reliable. I sometimes come down to +1.25 if I’m confident that there is not much problem with dominance. But that’s less these days.
@@lenshuffler5261 Really good tips there! Thank you so much for your replies as well as new video!. I've been doing as you describe binocular on most px except the certain exclusions, and it's quicker! One thing sometimes patients say with the opaque occluder is that post removal of it they get double. I guess that is because it's like cover test. Is there any advantage to a frosted occuluder? I'm not sure of its use? Also one thing I get with Ret is sometimes much more cylinder than the patient will accept. Is that due to poor technique do you think or is this normal? E.g finding maybe -2.00DC when the px won't take more than -1.25DC? Thank you
Hi
Sorry for delay in replying. I've never tried a frosted occluder - but i guess it would have the same effect as a solid one. No chance to fuse. I think the higher cylinder situation you describe could be caused by being off axis. Either being too high or being too low. Alternately off axis to the left or right will cause error. Have a look at Part 2 of the Masterclass video. That deals with alignment issues. Having said all that, sometimes i get the same as you and there is no obvious reason. The cornea is an unusual shape so off axis doesn't help. For that matter the lens is complex too.
Do you check accuracy, relative to Snellen and Trial Lens method?
Auto Refractors are worse!
Accuracy was checked with Trial Lenses
Thank you very much great video, what does tighten the collar for the cyl mean ?
Hey where is from
sorry - I don't understand