Subjective Refraction and Prescribing Glasses: The Number One (or Number Two) Guide to Practical Techniques and Principles, Third Edition

Richard J. Kolker, MD; Andrew F. Kolker, MD
ISBN 10:
ISBN 13:
Trade Paperback
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Product Dimensions:
7.00 x 10.00 x 0.50 inches

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Book Description

Basic refraction is a foundational part of ophthalmology, and yet beginning ophthalmology residents and ophthalmic technicians are often left on their own to learn the finer points. Despite being core skills, the techniques and practical aspects of subjective refraction and prescribing glasses are often developed by trial and error, if they are developed at all.
Subjective Refraction and Prescribing Glasses: The Number One (or Number Two) Guide to Practical Techniques and Principles, Third Edition is designed as a complete guide to those essential skills, offering everything from basic terminology to tips, tricks, and best practices. This updated Third Edition has been expanded in every section with thoughtful, practical advice, and has case scenarios, in a question and answer format, of situations encountered with real-world patients. It is the most comprehensive review of clinical subjective refraction to date.
Drs. Richard Kolker and Andrew Kolker together have nearly 50 years of experience in the practice of ophthalmology and bring both the fresh eyes of a beginning ophthalmologist and the experience of a seasoned veteran to this Third Edition. While new residents and technicians will appreciate the thorough explanation of refractive fundamentals, even expert ophthalmologists will appreciate the practical tips that may have never occurred to them.
Included are:
  • Very clear, easy-to-read, practical explanations of the subjective refraction process
  • Basic practical optics to explain the steps of subjective refraction
  • The Jackson Cross Cylinder made easy to understand and use
  • Plus and mInus cylinder methods discussed separately and color coded for quick identification
  • An Appendix with a primer on retinoscopy and how to use the manual lensometer
  • The art of subjective refraction and prescribing glasses
Subjective Refraction and Prescribing Glasses: The Number One (or Number Two) Guide to Practical Techniques and Principles, Third Edition is the definitive guide to the often neglected skills involved in clinical subjective refraction. Residents and technicians will find it a critical guide in their learning process, but even seasoned ophthalmologists can benefit from the tips and tricks enclosed within.

More Information

Richard J. Kolker, MD is an Assistant Professor of Ophthalmology at the Wilmer Eye Institute of Johns Hopkins Hospital.
Dr. Kolker has taught refraction at the American Academy of Ophthalmology and the Joint Commission of Allied Health Personnel in Ophthalmology Annual Meetings.
His awards include the Wilmer Resident Teaching Award, the Wilmer Medical Student Teaching Award (three-time recipient), the Johns Hopkins School of Nursing Nurse Practitioner Program Best Course of Year Award (two-time recipient), and the University of Maryland School of Nursing Nurse Practitioner Program Best Course of Year Award.
Dr. Kolker’s hobbies include teaching refraction, tennis (former Maryland State Champion and member of the University of Pennsylvania tennis team), oldies music, studying religion, singing, theater, and travel. He lives in Baltimore, Maryland with his wife and cocker spaniel. They have four children.
Andrew F. Kolker, MD is a comprehensive ophthalmologist who practices in Clinton, Maryland.
He received his undergraduate degree from University of Pennsylvania, where he graduated summa cum laude with a BA in English. He completed his post-baccalaureate pre-medical training at Johns Hopkins University and received his medical degree from Sackler School of Medicine in Tel Aviv, Israel. He completed his internship at Maryland General Hospital and his ophthalmology residency at The George Washington University.
In his free time, Dr. Kolker enjoys creative writing, listening to music, and playing drums and guitar. Tennis is also a passion of his and, as an undergraduate, he was a 4-year varsity tennis letter winner and was co-captain of the team during his senior year.
Following college, Dr. Kolker played tennis professionally, earning a world ranking in singles and doubles. He lives with his wife, Grace, in Washington, DC.



About the Authors


Foreword by David L. Guyton, MD


Chapter 1      Practical Optics

Goal of Refraction

Six Principles of Refraction

Snellen Visual Acuity

Spherical Refractive Errors



Four Points About Correcting Presbyopia With an Add


Reading Glasses


Progressive Addition Lenses

Computer Glasses

Two Formulas: Spherical Equivalent and
Plus-Minus Cylinder Conversion


Chapter 2      Subjective Refraction and Lens Prescription

The Phoropter

Features of the Phoropter

Positioning the Patient

The Three Types of Refraction

The Four Steps of Subjective Refraction

The Adjustment Within Step 3

Instructing the Patient

No Conversation

Managing Pauses

When Straddling the Axis



Three Patient Concerns

Sixteen Tips for Accurate Subjective Refraction Results

Before Writing a Glasses Prescription

Show and Compare What You Plan to Give—Always!

Trial Run

Additional Factors to Consider Prior to
Making a Prescription Change

New Presbyope

Two Myths

Special Situations

Final Considerations

Subjective Refraction Over Current Lenses
(Spherical Over-Refraction)

Near Vision

Using the Trial Frame

Refraction Reminders

Chapter 3      Case Studies





Presbyopia Correction


Special Considerations When Prescribing Glasses


How to Use the Manual Lensometer:
Plus Cylinder Method

How to Use the Manual Lensometer:
Minus Cylinder Method

Retinoscopy Primer: Plus Cylinder Method

Retinoscopy Primer: Minus Cylinder Method