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Delegating refraction: technician collects data, doctor performs subjective refraction
The question of delegating refraction has weighed heavily upon the optometric profession for many years. That weight becomes an ever-increasing burden to the profession as market forces, health care reform and evolving technologies necessitate resolution of the question in the interest of and the need for increased practice efficiencies and for the preservation of a high standard of vision and eye care for the public.
 Louis J. Catania |
A sound and rationale resolution to the issue of delegating refraction lies in the explanation of two fundamental concepts: What exactly is a refraction? What constitutes “appropriate delegation?” Defining these two concepts can reduce much practitioner confusion and answer the question of delegating refraction.
Refraction is generally defined as two parts. The first part is the “data-gathering” portion, wherein objective optical measurements are collected through instrumentation and comparative patient responses (i.e., “Which is better, one or two?” – frequently misconstrued as and referred to as the subjective refraction). The second part is the professional portion of the refraction, or that portion of the process wherein an authorized and licensed eye care professional (the doctor) analyzes and interprets the objective data collected and provides professional, subjective decision-making judgments leading to a final treatment plan. Thus, in fact, it is the doctor, and not the patient, who performs the subjective portion of a refraction.
Methods of delegation vary widely among health professions, from indirect supervision (professional decision-making responsibility without physical presence required) to direct supervision, including professional decision-making responsibility with physical presence required. For reasons of public safety and the elimination of potential abuses, in refraction, appropriate delegation necessitates direct supervision, including the physical presence of the responsible doctor.
In conclusion, delegating refraction is defined as the doctor directly (physically present) supervising trained, technical personnel in the gathering of objective data through instrumentation and from patient responses, and the responsible doctor establishing a plan of treatment through analysis and professional interpretation of the collected data. This definition of the delegation of refraction seems to be clear and clinically applicable in all jurisdictions wherein professional optometry is practiced. It requires no ges in existing optometric laws or professional regulatory board rules and regulations, and through its elimination of the potential risk of abuses, it provides maximal protection to visual welfare and public safety.
The following optometrists have provided their names in support of this statement:
- Richard N. Baker OD
- A. Paul Chris, OD
- Richard Clompus, OD
- Art Epstein, OD, FAAO
- Barry Farkas, OD, FAAO(DiplCL)
- Murray Fingeret, OD
- Michael A. Fregger, OD
- Ralph M. Handly, OD
- David W. Hansen, OD, FAAO(DiplCL)
- Paul M. Karpecki, OD, FAAO
- Gregory Kraupa, OD
- Jerome A. Legerton, OD, MS, MBA, FAAO
- James W. Marbourg, OD
- John A. McCall Jr., OD
- Tony McDonald, OD
- David R. McPhillips, OD, FAAO
- Joseph F. Molinari, OD, MEd
- Scot Morris, OD
- Richard Noyes, OD
- Stephen Pullen, OD
- John L. Schachet, OD
- Leo P. Semes, OD
- Joseph P. Shovlin, OD, FAAO
- Joseph Sowka, OD
- Tammy Pifer Than, MS, OD, FAAO
- Brenda J. Wahl, OD
- Walter West, OD, FAAO
- Louis J. Catania, OD, FAAO, is a member of the Primary Care Optometry News Editorial Board. He can be reached at Nicolitz Eye Consultants, Vista South Building, 7051 Southpoint Pkwy., Jacksonville, FL 32216; (904) 398-2720; fax: (904) 398-6408; lou@loucatania.com.