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Digital refraction technology has gone beyond the subjective refraction to the objective refraction as well, leaping from the autorefractor to the smartphone. Smartphone-based systems can capture a range of objective refractions, but the autorefractor or, in more skilled hands, retinoscopy, are still the standard because they can capture a much broader range of refractive errors in the objective, or pre-test, refraction.

Nonetheless, mobile refraction methods have become handy adjuncts when an autorefractor isn’t available for pre-testing. To Jordan Kassalow, OD, it’s like adding another pre-test room in his busy Manhattan contact lens practice. He uses the SVOne smartphone-based system from SmartVision Labs to perform not only objective refractions but also over-refractions on contact lenses when one of the two pre-test rooms in his contact lens practice is backed up.

In her four-year-old practice in Jamestown, N.Y., Kara Gibbs, OD, does not have an auto-refractor. When she opened the practice, she personally performed retinoscopy for objective refractions. But as her practice got busier and she brought in a tech, she acquired the SVOne. Now, her tech can use it to obtain objective refractions, freeing Dr. Gibbs to do other tasks.

Its utility is not just limited to the office. “When I go to nursing homes, the tech comes with me and we use the SVOne as part of our pre-testing there,” Dr. Gibbs said.

However, the SVOne can’t fully supplant the autorefractor in the office, Dr. Kassalow said. When the practice first acquired the SVOne, he and his partners found the learning curve for technicians was steeper than with the desktop autorefractor, and it cannot assess the full-range of refractive errors. “We have patients who have -40.00D prescriptions,” he said. The SVOne ranges up to about -10.00D. “When you look at the normal distribution of refractive errors it covers the bulk of them, but not the outliers.”

Dr. Kassalow has found the SVOne highly useful for the mission trips he makes through his organization, VisionSpring, which has distributed 2.3 million pairs of glasses in the developing world. “It can be hard to find well-trained optometrists, especially in the hinterlands. This broadens our ability to provide people with glasses who wouldn’t otherwise have them,” he said.

EyeNetra, a Somerville, Mass.-based startup specializing in smartphone-powered refraction technology, has introduced Blink, an on-demand, in-home vision testing service. Blink allows consumers to go online to schedule a refraction with a trained technician who comes to their location, a strategy that complies with telemedicine regulations in several states.

Kara Gibbs, OD, uses Smart Vision Labs’ SVOne for pre-testing.
The technicians, called “Visioneers,” take a health history and operate Blink’s proprietary optical measurement devices to conduct a vision test. The technician then shares the results with a Blink network optometrist in the same state as the customer—again, meeting telemedicine regulations of states that require in-state practitioners to perform telemedicine encounters.

“The optometrists in the current system are not necessarily connected to consumers in the way consumers would like to be connected today,” said Blink’s David Schafran, who is also a co-founder of EyeNetra. “So we’re extending the optometrists’ reach to do something that’s more in line with current consumer behavior. Instead of seeing one patient at any one time in their office, now they can see multiple patients remotely. It’s not one to one. It’s one to many.”

Dominick Maino, OD, MEd, FAAO, FCOVD-A, professor of pediatrics and binocular vision at Illinois College of Optometry/Illinois Eye Institute, and a private practitioner at Lyons Family Eyecare in Chicago, warns against people being lulled into believing that smartphone-based refractions can fully supplant the comprehensive eye exam.

“The concept of using your cell phone for refractions is awesome for third-world countries that lack the doctors, expertise and wherewithal to provide refractive services and materials,” Dr. Maino said. However, he cautioned, “There is no eye health assessment; there is no determination of binocular vision abilities; there is no ‘art’ in determining the refractive needs of the individual. As we know, coming up with a number that represents a prescription is only the first part to determining the actual prescription given. For instance, if a bifocal is required, a shorter person may need more power than that recommended for a taller person. A philatelist may need a different prescription than a person who plays the trumpet.”