Practice Patterns of Subjective Refraction Among Eye Care Practitioners in Delhi NCR

Abstract

Background: Subjective refraction is integral to accurate spectacle prescription, but evolving technologies and practice settings may influence how optometrists perform refraction in India. Understanding these patterns in a high-demand urban region like Delhi NCR can help guide training, standardization, and quality of refractive services.

Methods: We conducted a cross-sectional, self-administered questionnaire survey among optometrists in Delhi NCR working in clinical settings (hospitals, eye clinics) and retail optical outlets. Inclusion criteria were a bachelor’s or master’s degree in optometry from India and at least one year of clinical experience. The questionnaire collected data on demographic characteristics, objective refraction methods (retinoscopy vs. autorefractor), approaches to subjective refraction (instrument choice, starting point), use of cycloplegic refraction and agents, and utilisation of the duochrome test 

Results: Of 115 respondents (50 males, 65 females), 86 (75%) were in clinical practice and 29 (25%) in retail settings. Retinoscopy was used by 62 (54%) as the primary objective method, while 53 (46%) relied on autorefractors. In retail settings, autorefractor preference was higher (≈approximately 72%) compared to 63% retinoscopy in clinical setups. Trial frames were employed by 112 (97.4%) respondents for subjective refinement; only 3 (2.6%) used phoropters. Cycloplegic refraction was undertaken exclusively in clinical practice: 62 of 86 (72%) respondents reported routine use. The most commonly used agents were atropine (mean deduction 1.75 D), homatropine (0.75 D). Duochrome testing was infrequently applied, and practitioners typically initiated subjective refraction using retinoscopy or autorefraction values, adjusting for myopia or hyperopia.

Conclusions: In the Delhi NCR region, optometrists predominantly use autorefractors in retail settings and retinoscopy in clinics, but essentially all rely on trial frames for subjective refinement. Cycloplegic refraction is limited to clinical environments, and duochrome testing is rarely used. These findings reveal notable variability in refraction practice across settings, underscoring the need for standardized guidelines and enhanced training to ensure consistency and quality in refractive care.