Refraction help

[UWStudent]

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Hello
I am a foreign train optometrist from UK and wish to practice optometry in Canada. I have a few questions regarding the standard procedures that is done in North America refraction procedures. Members response are greatly appreciate. If you can put your answers below each of my question.


1) For motility test, UK optometrist mostly do a star pattern, while in Canada optoms do the double H pattern. When we do the H pattern, do we do 2 times 1 for the LE and 1 for the RE. When we do RE motility, we ask the patient fixate LE at the distance target while we move the pentorch in front of his eye. Then we swap eye and do the other side. I read in a book it mentions septum, but I am not sure what this mean?

2) For near reading add, the UK optometrist start estimate from age (for example 40yrs old we start from +1.00DS and then we go up/down +/-0.25DS using the flipper). For Canada board examiners, they request to do mono add assessment, using sheard method, mono crosscyl or near retinal result. But, what if the near add differ between the 2 eyes? We will just report different add between 2 eyes? I am not sure about this?

3) When we do amplitude of accommodation, if patient wear corrective do we measure with habitual corrective rx?

4) Binocular balance? In the Canada exam, the patient is presbyope, say 45yrs old. Do we still binocular balance, because technically 45 yrs old won't have anymore accommotion left. Many people argue that doing binocular balance is to balance the phoria between 2 eyes but not only for accomodative purpose, so it is necessary to do it regarless of age? What is the correct way?

 

[KHE]

I practice in the USA so don't take anything of what I say to mean anything with respect to Canadian licensing exams, but for what it's worth, here's what I would say.

Hello
I am a foreign train optometrist from UK and wish to practice optometry in Canada. I have a few questions regarding the standard procedures that is done in North America refraction procedures. Members response are greatly appreciate. If you can put your answers below each of my question.


1) For motility test, UK optometrist mostly do a star pattern, while in Canada optoms do the double H pattern. When we do the H pattern, do we do 2 times 1 for the LE and 1 for the RE. When we do RE motility, we ask the patient fixate LE at the distance target while we move the pentorch in front of his eye. Then we swap eye and do the other side. I read in a book it mentions septum, but I am not sure what this mean?

This makes no sense to me. Sorry. lol.

2) For near reading add, the UK optometrist start estimate from age (for example 40yrs old we start from +1.00DS and then we go up/down +/-0.25DS using the flipper). For Canada board examiners, they request to do mono add assessment, using sheard method, mono crosscyl or near retinal result. But, what if the near add differ between the 2 eyes? We will just report different add between 2 eyes? I am not sure about this?

I think this is one of those goofy licensing tests where yes, you would report the difference between the two eyes but in practice, we rarely prescribe different adds.

3) When we do amplitude of accommodation, if patient wear corrective do we measure with habitual corrective rx?

Best corrected distance Rx.

4) Binocular balance? In the Canada exam, the patient is presbyope, say 45yrs old. Do we still binocular balance, because technically 45 yrs old won't have anymore accommotion left. Many people argue that doing binocular balance is to balance the phoria between 2 eyes but not only for accomodative purpose, so it is necessary to do it regarless of age? What is the correct way?

The purpose of a binocular balance is to equalize the stimulus to accommodation, not a phoria. As such, it doesn't make a lot of sense to do it on an absolute presbyope per se, but I still usually do it on people who don't have significant cataracts because if you have one eye that's slightly over corrected and one that is slightly under corrected, you might still get 20/20 OU whereas a binocular balance makes them both slightly over or slightly under. In general, you want that to be the same.