When I’m carrying out the Jackson cross-cyl test as part of the subjective refraction my patients seem to get confused with the options, I give them what should I do?

How you explain to patients what is required of them during subjective testing is very important in order to have a successful examination.

Make it very very easy for the patients to understand what you want them to look out for and what to say in response when they see that.

So, during the Jackson cross-cyl subjective portion of the refraction you could say:

I am going to show you two lens and ask you with which one the dots (or black and white circles if you prefer to use the Verhoeff rings) look clearest. Neither lens may be perfect; I want you to tell me which one is best.

I prefer to use the cluster of black dots for this. If they aren’t on the chart, I’m using then I will use the Verhoeff rings. Letters are no good for this test because they consist of several components, some of which may look better with one lens option and other components look better with the other option.

I prefer to number the two options 1 and 2. So I say:

Do the dots look better with lens 1 or with lens 2?

I only use these numbers. I have seen other practitioners change the numbers each time they make a change to lens power or the lens axis. Such as:

Do the dots look better with lens 1 or 2? Do the dots look better with lens 3 or 4? Do the letters look better with lens 5 or 6?

I have seen practitioners get to numbers 13 and 14. I have also seen patients get totally confused and heard responses such as:

Lens 12 was better than lens 13 and lens 14.

In my mind using number options beyond 1 and 2 will led to a confused patient unless the end point is reached before lens option 6.

When the patient starts to become indecisive, that is, the end point has nearly been reached I add:

…or do the dots look the same?

I only give this option near the end point. It is better for the patient to have only two options for most of the test and then to have three options near the end.

Do everything you can to help your patient understand what is required of them.

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