There’s an old, kind of morbid joke about an optometrist who visits a long-time patient on his death bed. His body frail and his voice raspy, the patient summons up his strength as the doctor leans in. “So I have to know before I go, Doc. Which one really was better, number one, or number two?
Of course, there really is no “right” or “wrong” answer to the question, though that’s no comfort to patients who have test anxiety. But what I’d like you to reflect on for a moment is the question rather than the answer. Notice that during a refraction the question posed is “which one is better“. At fist blush that seems a bit odd, doesn’t it? After all, the patient is viewing letters on an eye chart across the room and what the refractionist really wants to know in jotting down the subjective power is which lens made the letters look easier to see, or sharper. So why not pose the question that way? Which one is clearer, number one, or number two?
I believe the old masters of refraction were on to something in the choice of the word “better” over the word “clearer”. At some level they knew, intuitively, that the effect of a lens was not just on clarity. A lens effects change at a visceral level, and we therefore want to know something more. When contemplating a change in prescription, particularly with a patient who is visually sensitive (by whom you could probably calibrate a phoropter), it is powerful to put the lens in a trial frame or simply hold it in front of their current Rx if it is a change in sphere. Get the patient out of the phoropter and looking down the hallway or through the window and ask this question as you interpose or change the axis of a lens: “How does it look, and how does it feel?” The question isn’t meant to have a single best answer.