A very useful test for “subjective refraction” in hyperope.
There are several ways to deal with refraction in hypermetropia u can find in hypermetropia capsule*
How to do proper fogging in a hyperope without cycloplegia ?
1- Fogging should be done in both eyes simultaneously you cannot fog one eye.
2- You overcorrect the hyperopia; example a child on autoref is emmetrope and you suspect hyperopia because of symptoms; this child could be anywhere between 3-6 D. why? 1-3 D would not cause symptoms in a child, more than 6 should show some hyperopia on autoref, of course there are exceptions.
3- You measure UCVA, in this case would be 6/9 or 6/6 (emmetrope on autoref), if 2 or more lines less would be amblyopia of bilateral high ametropia and error would be 5+. Now record vision in each eye separately.
4- In this case i would fog with +6 then measure BCVA, if less than UCVA i would remove 1 D and put +5.
5- Decrease plus lens by 1 D above 4D then 0.5 D until you reach UCVA at least in one eye. Remember that patient should close eyes during lens changes to avoid play of accommodation.
6- Now measure BCVA in each eye to detect anisometropia, you arrived at the refraction of the worse eye, now decrease by 0.5 infront of better eye until you reach UCVA.
7- Lets assume the worse eye reached UCVA at +3.0 and the better eye at +2, i would prescribe +2.0 and +1.5 glasse
Easy? In practice it is very easy but you need to watch it once or twice, in words its a bit hard but this is why clinical practice is important.
