Using a standard process allows clinicians to approach each refraction in a calculated and sequential manner, eliminating simple mistakes. But, what happens when it is not simple and standard? When the dreaded glasses recheck or complicated patient with underlying etiology is sitting in your chair? There is no longer a standard process. We need to be able to use the knowledge, skills and tools we have to solve the mystery that is now sitting in front of you looking for help.

1. Discuss how to troubleshoot glasses rechecks using patient cues and placement along with refraction.
2. Discuss how to determine etiology vs. refractive error.
3. Discuss using more than the refraction and differentiating changes based on the whole picture.

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