Skills & Techniques in interviewing and assessing refractive and accommodative conditions

Procedure		Number of Questions
A.	Patient Interview	8
B.	Measurement of Visual Acuity	6
C.	Measurement of Pupillary Distance and Static Retinoscopy	12
D.	Subjective Refraction	12
E	Nearpoint Addition	8
F.	Interpersonal and Communication Skills, Overall Impression	6
Total		52

Order of techniques to be performed:

1. Interview the patient and determine a complete profile of the patient's primary complaint, any secondary complaints or concerns, the complete history of the patient (both ocular and systemic), the family history of the patient, and their occupational, avocational, and environmental circumstances. Record your findings.
2. Measure the monocular visual acuity of the patient; unaided first, then aided, at farpoint and nearpoint, in both eyes. State and record your findings (Snellen and metric acuities allowed).
3. Measure the farpoint pupillary distance and then perform static retinoscopy on each eye. State and record your findings. 
4. Using the result from your static retinoscopy as a starting point, perform a subjective refraction on both eyes including a binocular balance of accommodation using dissociated prisms and fogging technique. Use a phoropter for this procedure. State and record your findings.
5. Using your refraction result, measure and determine the tentative add power required using one of the three methods below (please indicate the method used):
1. Sheard's method
2. Nearpoint retinoscopy
3. Monocular crossed cylinder technique
6. Determine, state and record the optimum nearpoint addition for each eye at 40 cms. with a balanced depth of field.
   

Equipment provided in room:

1. Examining chair, stool and equipment stand
2. Record paper and pen
3. Projected acuity chart (may be automated)
4. Phoropter with nearpoint rod and card
   

Equipment provided by candidate:

1. Occluder 
2. PD ruler 
3. Retinoscope
4. Nearpoint acuity card