Acceptance of auto-refractor and clinician prescriptions: A randomized clinical trial

Purpose. We compared patient acceptance of spectacle prescriptions from an autorefractor with those obtained from a clinician in a randomized clinical trial. Methods. Two hundred and three patients (17 to 57 years) were recruited from the campus community and attended for examination by one of four clinicians. Contact lens wearers, optometry students, patients with acuities worse than 20/30 in either eye, and individuals with systemic diseases affecting refractive error were excluded. Seven patients were deemed by the clinician not to need a spectacle prescription after the exam and were excluded from the study. Additionally, two patients were lost to follow-up. Five auto-refractor readings were taken per eye, and later averaged, prior to a comprehensive exam by a study clinician. The two spectacle prescriptions were made up in a frame of the patient's choice. Patients wore the two spectacle prescriptions in double-masked, randomized, cross-over design, each for at least three weeks. Following each wearing period, subjects completed a short questionnaire regarding wearing schedule, adaptation and satisfaction. At the end of their participation, they were asked to select and retain their preferred prescription. Results. In response to the question "If you had purchased these spectacles for $100, would you be happy with them?", 115 patients considered both pairs acceptable, 42 accepted the clinician prescription only, 20 accepted the auto-refractor prescription only, and the remaining 17 rejected both pairs (p < 0.05). When asked which prescription they would like to keep, 99 patients preferred the clinician prescription, 54 preferred the auto-refractor prescription, and the remainder considered both equally acceptable. Patients rated the quality of vision significant higher for the clinician prescription and less difficulty with adaptation (p < 0.05). There was no significant difference for visual acuity nor wearing time. Conclusions. Overall, patient acceptance and satisfaction was lower for autorefractor prescriptions than for the clinician prescriptions.