Trial Lens Refraction Paddle Set

Trial Lens Refraction Paddle Set was developed in collaboration with Gregory R. Hopkins, OD, MS, FAAO, a Low Vision Rehabilitation specialist and clinical associate professor at The Ohio State University College of Optometry (OSUCO) within the Primary Vision Care and Low Vision Rehabilitation Services. This set is designed to help clinicians refine subjective refraction with precision, even in cases of reduced blur sensitivity.

It features a geometric progression of lens pairs, ranging from ±0.12DS to ±16.00DS, allowing practitioners to perform efficient subjective refraction, regardless of a patient's visual acuity or cognitive abilities. Ideal for use in low vision settings, specialty contact lens practice, and standard clinical environments, this tool ensures accurate and reliable refraction, especially when conventional methods may fall short.

Each set includes two paddles: a black CONVEX paddle (plus lenses) and a red CONCAVE paddle (minus lenses), both featuring 8 lenses with a 25mm diameter. The lenses range from ±0.12DS to ±16.00DS and come with protective sleeves for added durability.

Key Features:

Progressive Lens Range: Lenses span from ±0.12DS to ±16.00DS, encompassing nearly the full range of the trial lens set, allowing practitioners to adapt testing to each patient's blur sensitivity, even in cases of visual impairment.

Systematic Testing Process: The lenses are organized for smooth transitions between coarse, medium, and fine testing, with a systematic presentation that helps minimize cognitive load on both practitioner and patient.

Versatile Use Cases: Applicable in low vision clinics, specialty contact lens practices, or standard refraction settings, particularly effective for patients with visual impairments or conditions like keratoconus.

Eccentric Viewing Compatible: Lens apertures are comparable to phoropter openings, supporting eccentric viewing or null-point gaze postures for patients with nystagmus or other visual conditions.

Efficient Workflow: Reduces the need for fumbling with trial lenses and enhances psychometric response accuracy, improving patient outcomes and practitioner confidence.

How It Works:

Once the patient's best objective refraction is in place (via phoropter or trial frame), the practitioner can introduce test lenses to refine the prescription subjectively. The paddle set provides a range of lens options that allow for a systematic approach to subjective refraction, starting with heavier lens bracketing (e.g., ±2.00DS, ±1.00DS) and narrowing down to smaller adjustments (±0.50DS, ±0.25DS) as the patient's responses become more precise and their blur sensitivity becomes finer.

For patients with visual acuities like 20/25, the standard lens bracketing of ±0.25DS may be sufficient. However, for those with reduced visual acuity (e.g., 20/100 to 20/800), the paddle offers larger brackets (such as ±1.00DS, ±8.00DS, ensuring effective responses even when sensitivity is limited.

Dr. Hopkins recommends presenting the lenses in a sequence, beginning with the strongest lens set and gradually progressing to the weakest, tailored to the patient's ability to perceive and respond to blur:

Better ONE [Always a concave (minus) lens] -or-

Better TWO [Always a plano lens (no power) created by overlapping the two paddles]

Better THREE [Always a convex (plus) lens] -or-

Better TWO [Always a plano lens (no power) created by overlapping the two paddles]

This pattern of "one or two; three or two" establishes a simple rhythm that's easy for both patients and providers to follow:

Option ONE generally leans towards correcting farsightedness.

Option TWO indicates maintaining the current lens prescription (plano) over the lenses being evaluated.

Option THREE typically leans towards correcting nearsightedness.

Advantages:

Comprehensive Lens Progression: Provides a clear pathway from coarse to fine adjustments, improving patient interaction and simplifying the refraction process.

Enhanced Accuracy: Helps to eliminate guesswork by offering pre-organized lens pairs, avoiding errors in trial lens placement from frequent withdraw and insertion.

Improved Patient Engagement: Aids in clear communication with patients, enhancing their ability to identify the best lens option without confusion.

Confidence in Results: The paddle system enhances the practitioner's ability to confidently finalize a subjective refraction, even in challenging cases.