> rebeccaNO_SPAM[at]lasermyeye.org (Rebecca) wrote in
> news:120ffab4.0403030427.336e21b7[at]posting.google.com:
> > Toastmaster <woohah[at]noemailme.com> wrote in message
> > news:<tF91c.4315$Wo2.2185[at]twister.nyc.rr.com> ...
> > > Something troubles me.
> > > Any comments on this assistant's practices?
> > > It's kind of a universal complaint - how refractions are performed.
> > Pisses me off too, and I've experienced this with some awfully good
> > docs too. "Come on, just try a little harder. Give yourself some
> > time." And my favourite - "Come on, no guesses even???" I've never
> > come across this in a manual explaining how to test a patient but it
> > seems to come up a lot in real life.
> > What are the odds that a patient can "guess" 5 or 4 out of six letters on
> the 20/20 line, and then say that they really couldn't "see" it? Some
> people, and this is especially true for children, will not say anything
> unless they are absolutely sure. Well, the nature of "threshold" testing
> is such that the patient is correct 50% of the time. We are testing the
> "threshold" of visual acuity. If the patient breezes through the 20/20
> line, then we go down to 20/15, and so forth. Similarly, many patient will
> read the 20/400 "E" unaided, but add "it is really blurry," as though I
> thought that it somehow would be clear.
> I agree that some visual quality issues are not resolved by Snellen acuity
> charts. What do we replace it with, or do we perform additional tests
> routinely, or do we do additional tests just on post-LASIK patients...?
> Contrast sensitivity charts have been around since before LASIK, but were
> never widely used. I think the bottom line is that you do testing that is
> reasonable to satisfy the patient's complaint, but since the beginning of
> time, we have had patients who have to "strain," who have to "guess," who
> have to "blink alot" in order to achieve their BVA, or best visual acuity.
> DrG

> It's not that we don't try to correct people to beyond 20/20, it's just
> that we cannot.

> The average human visual system consisting of the optics, the retina, and
> that visual cortex, is incapable of resolving letters smaller than 20/20.
> However, since the advent of "adaptive optics," or wavefront, we have
> learned that the human visual system is limited by naturally occurring
> aberrations and the limits imposed by its optics. This is probably why
> some people can read 20/15, and a very small number can read 20/10. I
> don't know if you had a wavefront treatment, but that could explain the
> 20/10- in your case. I have heard it said that 20/10 is probably the
> potential for most people if the natural aberrations could all be
corrected
> with wavefront technology.
> DrG

> Toastmaster <woohah[at]noemailme.com> wrote in message
> news:<tF91c.4315$Wo2.2185[at]twister.nyc.rr.com> ...
> > Something troubles me.
> > Any comments on this assistant's practices?
> It's kind of a universal complaint - how refractions are performed.
> Pisses me off too, and I've experienced this with some awfully good
> docs too. "Come on, just try a little harder. Give yourself some
> time." And my favourite - "Come on, no guesses even???" I've never
> come across this in a manual explaining how to test a patient but it
> seems to come up a lot in real life.

> Toastmaster <woohah[at]noemailme.com> wrote in message news:<tF91c.4315$Wo2.2185[at]twister.nyc.rr.com> ...
> > Something troubles me.
> > Any comments on this assistant's practices?
> It's kind of a universal complaint - how refractions are performed.
> Pisses me off too, and I've experienced this with some awfully good
> docs too. "Come on, just try a little harder. Give yourself some
> time." And my favourite - "Come on, no guesses even???" I've never
> come across this in a manual explaining how to test a patient but it
> seems to come up a lot in real life.

> Something troubles me.

> Any comments on this assistant's practices?

> Thanks Doc
> Don't know how mine came up with 20/12 Maybe I missed a couple of
> letters so she really ment 20/10-2 !!
> Why is the term 20/20 still regarded in general - probably not by
> people in the trade, but the general public to be perfect eye sight.
> Does it mean that if you have 20/20 or better then there is no real
> need for correcting it to 20/10 with glasses as its good enough as it
> is ? Regards
> Wal
> > Forget post-LASIK patients. We all have non-surgical patients who
> > perform exactly the same on Snellen acuity. I know that when a
> > patient's acuity
> is
> > variable, or they have to blink alot, or their refraction is
> > difficult to pin down, that they typically have a tear film disorder,
> > i.e. dry eye, and that they are struggling to create a pristine
> > refracting surface on the cornea, as it varies from blink-to-blink.
> > However, that particular
> problem
> > is diagnosed and charted separately as dry eye. Traditionally, eye
> doctors
> > do not raise an eyebrow when confronted with 20/20 but variable
> > vision.
> It
> > is not that uncommon.
> > > Hope this helps.
> > > DrG
It's not that we don't try to correct people to beyond 20/20, it's just

> "Wal" <notmewally[at]hotmail.com> wrote in
> news:Eya1c.84335$Wa.59766[at]news-server.bigpond.net.au:
> > Hi Toastmaster,
> > > "Toastmaster" <woohah[at]noemailme.com> wrote in message
> > news:tF91c.4315$Wo2.2185[at]twister.nyc.rr.com...
> > > Something troubles me.
> > > > > The day after I had Lasik done, I had my checkup. The person
> > > examining me (an assistant, before my doc came in) had me read lines
> > > off the chart. When she put up the 20/20 line, I couldn't read it at
> > > all. She told me to focus on it and blink a few times. After a while
> > > I was able to make out the line, so I thought. After I read what I
> > > thought it said, she tells me "Congratulations, you have 20/20
> > > vision". When she left the room, I got a better look at the chart and
> > > realized I got at least three of the letters wrong.
> > > > > Any comments on this assistant's practices?
> > > > > I am now two months post op and I am better than 20/20 now, as I was
> > > actually able to read the chart well this time.
> > > Its got me stuffed too. On my first day my best eye read most of the
> > bottom line. She said that was around 20/12. A week later my other eye
> > read quite a lot of the bottom line (not quite as good ) and she said
> > its around 20/15. Still excellent but they were both reading the
> > bottom line. They must count how many you get right do you think?
> > I'd be interested to hear how its worked out too.
> > Regards
> > Wal
> > > > The lines on the standard Snellen chart, from bottom up, read 20/10,
20/15,
> 20/20, 20/25, 20/30, 20/40, 20/50, etc. There is no 20/12 line. If you
> miss letters on any line, it should be noted as 20/20- however many
letters
> are missed. The notation of a plus or a minus gives some idea of quality
> of vision, i.e. how easily the patient was able to perform the test.
> Forget post-LASIK patients. We all have non-surgical patients who perform
> exactly the same on Snellen acuity. I know that when a patient's acuity
is
> variable, or they have to blink alot, or their refraction is difficult to
> pin down, that they typically have a tear film disorder, i.e. dry eye, and
> that they are struggling to create a pristine refracting surface on the
> cornea, as it varies from blink-to-blink. However, that particular
problem
> is diagnosed and charted separately as dry eye. Traditionally, eye
doctors
> do not raise an eyebrow when confronted with 20/20 but variable vision.
It
> is not that uncommon.
> Hope this helps.
> DrG

> Hi Toastmaster,
> "Toastmaster" <woohah[at]noemailme.com> wrote in message
> news:tF91c.4315$Wo2.2185[at]twister.nyc.rr.com...
> > Something troubles me.
> > > The day after I had Lasik done, I had my checkup. The person
> > examining me (an assistant, before my doc came in) had me read lines
> > off the chart. When she put up the 20/20 line, I couldn't read it at
> > all. She told me to focus on it and blink a few times. After a while
> > I was able to make out the line, so I thought. After I read what I
> > thought it said, she tells me "Congratulations, you have 20/20
> > vision". When she left the room, I got a better look at the chart and
> > realized I got at least three of the letters wrong.
> > > Any comments on this assistant's practices?
> > > I am now two months post op and I am better than 20/20 now, as I was
> > actually able to read the chart well this time.
> Its got me stuffed too. On my first day my best eye read most of the
> bottom line. She said that was around 20/12. A week later my other eye
> read quite a lot of the bottom line (not quite as good ) and she said
> its around 20/15. Still excellent but they were both reading the
> bottom line. They must count how many you get right do you think?
> I'd be interested to hear how its worked out too.
> Regards
> Wal

> Glenn - USAeyes.org wrote:
> > > This is one of those things that really tick me off. In real life you
> > do not stop, blink, focus, stop, blink, focus, then guess and call it
> > good vision. If it was me, I'd go directly to the surgeon and request
> > an explanation.
> Hey, this was the assistant of a CRSQA certified surgeon

> Something troubles me.
> The day after I had Lasik done, I had my checkup. The person examining
> me (an assistant, before my doc came in) had me read lines off the
> chart. When she put up the 20/20 line, I couldn't read it at all. She
> told me to focus on it and blink a few times. After a while I was able
> to make out the line, so I thought. After I read what I thought it said,
> she tells me "Congratulations, you have 20/20 vision". When she left the
> room, I got a better look at the chart and realized I got at least three
> of the letters wrong.
> Any comments on this assistant's practices?