Acta Scientific Ophthalmology (ISSN: 2582-3191)

Research Article Volume 5 Issue 8

An Internationally Validated Direct Observation of Clinical Skills Rubric for Subjective Refraction

Amy V Jost1, Heather Connor2, Aaron V Shukla3, Sophia Y Fang4, Pádraig J Mulholland5,6, Shailaja P Reddy7 and Karl C Golnik8*

1Department of Operational Excellence, EyeCare Partners and Cincinnati Eye Institute, United States of America
2School of Medicine (Optometry), Faculty of Health, Deakin University, Australia
3Retired, United States of America
4Child Eye Care Associates, Tigard, Oregon and Global Ophthalmology Outreach, University of Utah, Moran Eye Center, United States of America
5National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, United Kingdom
6Centre for Optometry and Vision Science, School of Biomedical Sciences, Ulster University, United Kingdom
7Bausch and Lomb School of Optometry, Brien Holden Institute of Optometry and Vision Sciences, LV Prasad Eye Institute Hyderabad, Gullapalli Pratibha Rao Campus, India
8Departments of Ophthalmology, Neurology, and Neurosurgery, University of Cincinnati and Cincinnati Eye Institute, United States of America

*Corresponding Author: Karl C Golnik, Departments of Ophthalmology, Neurology, and Neurosurgery, University of Cincinnati and Cincinnati Eye Institute, United States of America.

Received: July 08, 2022; Published: July 20, 2022


Background: Globally, refractive error is the most common cause of correctable vision impairment. Refractometry is a skill that is difficult for beginners to learn and challenging for the evaluators to assess. A well-constructed rubric can provide guidance as a teaching tool to the novice refractionist and as an assessment tool to the instructor.

Purpose: A new rubric was created to provide clinical educators with an internationally valid and standardized method to teach and assess competency in subjective refractometry.

Methods: A panel of seven international content experts participated in a qualitative research study to create a distance vision subjective manifest refractometry rubric by identifying the key steps of the procedure, determining performance levels of competency, and creating behavioral descriptors for each procedural step and level of competency. The rubric was reviewed by a total of 34 international subject-matter experts from 18 countries and from various roles, to ensure content validity.

Results: A 15-step rubric for subjective refraction was created. Levels of competency were defined as novice, beginner, advanced beginner and competent. Precise descriptions of performance were determined for each step at each performance level. Content validity was achieved by incorporating reviewer’s comments.

Conclusions: This internationally valid and standardized rubric is an assessment tool that can be applied globally to teach and assess distance vision manifest subjective refraction.

Keywords: Subjective Refraction; Refraction; Rubric; Refractive Error; Refractionist


  1. Brodie Scott E., et al. “Section 3. Clinical Optics”. 2020-2021 Basic and Clinical Science Course, American Academy of Ophthalmology, San Francisco, CA, (2020).
  2. Ledford Janice K., et al. “Retinoscopy and Refractometry”. Principles and Practice in Ophthalmic Assisting: A Comprehensive Textbook, Slack Incorporated, Thorofare, NJ, (2018).
  3. Wassnig Sarah and Diane Russo. “Refraction Handbook for Clinicians - a Global Community - Cybersight”., n.d., (2018).
  4. “World Report on Vision”. World Health Organization, World Health Organization, (2019).
  5. Yudkowsky Rachel., et al. “Assessment in Health Professions Education”. 2nd, Routledge, (2020).
  6. Dreyfus SE. “The Five-Stage Model of Adult Skill Acquisition”. Bulletin of Science, Technology and Society 24 (2004): 177-181.


Citation: Karl C Golnik., et al. “An Internationally Validated Direct Observation of Clinical Skills Rubric for Subjective Refraction".Acta Scientific Ophthalmology 5.8 (2022): 86-92.


Copyright: © 2022 Karl C Golnik., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate35%
Acceptance to publication20-30 days
ISI- IF1.042
JCR- IF0.24

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