Never underestimate the importance of refraction.

Paul B. Freeman, O.D. Dsive guidelines in both optometry and ophthalmology for care of the patient with a visual impairment, there are still those who feel that once there is a measured decrease in visual acuity based on a pathology, the only helpful recourse is magnification. Unfortunately, the ‘‘best corrected’’ visual acuity is not always determined or verified. Applying magnification without the benefit of a current refraction is like building a house on sanddit lacks a solid foundation. In some instances, refraction can measurably improve visual acuity (VA), which, at the very least, can modify the magnification needed to enhance VA, and, at best, eliminates the need for magnification devices altogether. While refraction has been reported to be a major cause of visual impairment throughout the world, especially in developing countries, a recent article (in our own developed country) addressed the refractive issues as seen from the perspective of patients having been referred to a low vision practice. The authors’ conclusion, which is most significant, is that ‘‘eleven percent of all patients improved by two lines or more of VA with refraction.’’ 4 This phenomenon is something many of us who work with visually impaired patients see, but have not formally documented. People who have visual impairments and have been told ‘‘nothing more can be done’’ (which unfortunately continues to occur, although less frequently) tend to stop seeking professional help. They do not necessarily stop looking for help in general, rather they either seek magnification resources in stores, or via the Internet, both of which can be ‘‘dangerous’’ choices in some situations. (‘‘Dangerous’’ in the sense that a