Self-administered, online refraction is a thorny subject, but that’s exactly why we’re tackling it this month in L&T. Although online refraction isn’t a reality yet, contributing editor Barry Santini points out in his thought-provoking cover story that various market forces are pushing us toward it, and the technology may soon be available to make it possible.

Enabling patients to refract themselves using online tools is a radical step that has widespread implications for the delivery of eyecare. It upends a basic tenet of clinical eyecare, namely that optometrists should control all aspects of the eye examination, including refraction. Taking that vital task out of the hands of optometrists and reassigning it to patients raises questions about how to insure the accuracy of the refraction and resulting prescription. It also makes one wonder whether it will discourage more patients from getting a comprehensive eye exam because they falsely assume that a refraction is all they need.

Barry believes it’s not a question of “if” but “when” online refraction will happen. Before it becomes a reality, we need to carefully consider its possible effects and prepare ourselves for this significant change in the delivery of eyecare.

Will online refraction be better or worse for eyecare professionals and patients? Please send me your comments or post them on the 20/20 blog at

—Andrew Karp