Refracting The Diseased Eye

Refractive error refers to ocular refractive status where images of objects of regard do not fall on the retina in a relaxed eye - the ametropic eye. Thus, objects are perceived as blur. Refractive error is an aberration in an otherwise normal physiological phenomenon and not a disease. Uncorrected refractive errors are the second most causes of blindness after cataract and the cause of almost half of visual impairment. Clinical refraction is a careful scientific procedure employed to correct refractive error. Given that refractive error is the most common reason patients present to the eye care practitioner, a lot of attention must be given to refraction. When an irreversible eye disease co-exist with refractive error, then correction of refractive error under this circumstance; refracting the diseased eye (RDE) become very challenging and painstaking. There will be likelihood of irregularities in the transparent refractive surfaces of the eye due to disease or surgery which make refraction difficult both for the patient and the examiner. Personal clinical experience of the author who is a low vision consultant and review of related literature from textbooks and journals are brought to bear in this article. This paper is a review of the RDE algorithm with delineation of these steps to enable an effective refractive endpoint for the eye with disease. The paper will enable young Optometrists to deal with refractive error masquerading irreversible eye disease. It is also an essential reading for the low vision Optometrist in mastering the art and science of low vision refraction.