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An automated refraction (sight test) is a quick, safe, and accurate way for individuals who wear glasses to check their vision before purchasing a new pair of glasses. An automated refraction, however, is not an eye health exam. While the automated technology is very accurate at measuring an individual’s visual clarity and determining the power of corrective lenses, it is not intended to identify underlying eye health problems that may affect vision that are more likely to be found during an eye health exam. Therefore, individuals with underlying health problems or eye-health risk factors need to have an eye health exam, which includes having their eyes dilated to examine the retina, having visual field tests, and eye pressure tests. An Ophthalmologist or Optometrist, not an Optician, conducts an eye health exam.

This section describes automated refraction and its history in BC, as well as the guidelines the COBC has established to ensure that automated refraction is conducted safely and effectively by all registered automated refracting opticians. It also include information on who should not have an automated refraction. A vision test is recommended before you consider eyeglasses or contact lenses.

Frequently Asked Questions

Q: Why do people want automated refractions?

The vast majority of Opticians’ clients are individuals who are long-time wearers of eyeglasses and contact lenses. They most often seek Opticians’ services because they want to update their eyewear or to replace lost or damaged glasses.

In the past, Opticians were not allowed to check their clients’ visual acuity and dispense new corrective lenses, even with a slight modification; they could only repeat the previous prescription. This meant the client who wanted to be assured of their visual acuity before paying for new glasses was required to return to the Ophthalmologist or Optometrist for a test that determines visual acuity, but in many cases, tests for visual acuity are part of eye health examinations. This has been an often unnecessary, cumbersome and expensive process for eyeglass wearers, who in British Columbia must pay about $90 for an eye test whether they need the full test or not. This meant that some individuals would not bother to update their eyewear or not have their vision checked at all.

Q: What is an automated refraction?

An automated refraction is a computerized assessment of how the eyes bend and focus light to create an image on the retina. The process has been scientifically proven a safe, reliable, and reproducible test. It uses equipment and a sophisticated computer program to test and measure visual acuity. It also calculates whether clients would see more clearly with the help of corrective lenses and determines the strength of lenses needed.

This kind of equipment and sophisticated computer program is not new and is commonly used to test and measure visual acuity before laser surgery vision correction, and in Ophthalmologist or Optometrist offices. In Optometrist offices, this equipment may be run by office staff before the client meets with the Optometrist.

In Optician offices, only the Optician runs this equipment. A number of automated refracting Opticians have been trained to use the equipment and have been offering it in their stores so clients can ensure the power of their lenses are exactly what they need before agreeing on a new pair of glasses.

Q: What is the status of sight testing in British Columbia?

Opticians have been doing the automated refractions since 1996, initially with the oversight of an ophthalmologist. However, Ophthalmologists decided they did not want sign off on tests when they had not personally examined the client. The B.C. Supreme Court ruled in 2001 that Opticians had a right to provide the automated refraction service. As a new practice, however, it is not currently defined under the existing act that governs Opticians. Therefore, an amendment is needed to the Opticians Regulation to set the rules and regulations that will apply to Opticians providing this service.

In March 2004, the provincial government announced its intention to amend the Opticians Regulation to enable Opticians to conduct automated refractions without the oversight of a medical doctor and to establish strict guidelines for eligibility that will enable Opticians to give the tests to healthy, consenting adults, between age 19 and 65 who have no risk factors of underlying eye health problems. The amendment would also allow Opticians for the first time, following a duly conducted automated refraction, to make modifications to the lens power, under specific criteria. Extensive consultations have been held over the draft amendment.

Q: What is the College of Opticians doing to ensure automated refractions are done safely and effectively?

The College has established the following strict guidelines around automated refraction. These guidelines, which are in the current standards of practice of the College, will become part of the Opticians Regulation once the amendment is adopted. It is anticipated that the new guidelines include the following conditions:

As of October 1, 2007, all Opticians in B.C. who perform automated refractions must have successfully completed an advanced educational program and passed a certification exam to ensure they all meet high quality professional standards for automated refraction and for safeguarding public safety.

The COBC has developed a clear and effective Standards of Practice document that outlines the necessary protocol for providing a safe and effective automated refraction.
Automated refraction service is only appropriate for healthy adults who do not have underlying risk factors for eye health
problems.

The advanced educational program ensures that Opticians fully understand the limitations of automated refractions and that they have effective communication and education skills for their interactions with consumers.

Opticians in B.C. will fully inform and educate consumers about the limited nature of automated refractions. This process will include both the oral and written provision of clear and understandable information about who should have the automated refraction and who should instead have an eye health examination.

All clients will be required to sign a Client Information form before proceeding with the test.

Opticians in B.C. will properly identify, through a multi-level screening process, those individuals who should not have automated refrations and who should instead have an eye health examinations by an Optometrist or an Ophthalmologist.

The College of Opticians will enforce the Standards of Practice around the use of automated refraction and will hold Opticians accountable for their professional practice.

Q: Who is not eligible for an automated refraction?

Under the existing College guidelines, potential clients with the following conditions are screened out and ineligible for automated refractions:

  • Are over the age of 65, since the leading causes of visual impairment are age-related.
  • Have specific illnesses and health condition such as diabetes, macular degeneration, cataracts and cardiovascular disease, unless already under a doctor’s supervision for their condition.
  • Have high risk health conditions for retinal detachment such as hypertension, recent trauma to the head, recent pain in the eye, or people with lens prescriptions of greater than + 8.00 diopters or – 10.00 diopters.
  • Have specific visual symptoms such as recent onset of floaters, haloes, distortion, double vision, flashing lights etc.
  • Have a history of any eye surgery.

In addition, clients who have undertaken an automated refraction will be referred to an Ophthalmologist or Optometrist for an eye health examination if they cannot achieve 20/30 or better vision or if their vision shows a change of more than plus or minus 1 dioptre in a six month period or total change of more than 2 dioptres from the original prescription.

These screening criteria, which are currently being followed by Opticians, along with the College standards and a focus on the effective training and communication of Opticians, will ensure that automated refractions are conducted in B.C. in a safe and effective manner that benefits all B.C. consumers.

Q: Where do I go for more information about automated refractions?

The following links can provide more in depth information about automated refractions:

OBC: Opticians of British Columbia– the association has additional information on sight testing. Information on sight testing can also be found under “For Consumers”.

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