Manifest refraction is the standard subjective refraction carried out without cycloplegic drops, relying on the patient’s responses to determine the lens powers that give the clearest vision. It reflects the refractive state under usual viewing conditions.
Process
The examiner presents different lens choices, asking which appears clearer while refining sphere, cylinder, and axis values. Techniques such as the Jackson cross-cylinder and fogging are used to balance clarity and comfort.
- Performed monocularly and then binocularly to optimise overall vision
- Influenced by accommodation, particularly in younger patients
- Starting point may come from autorefraction or previous prescriptions
- Requires patient cooperation and understanding of the task
Clinical Role
Manifest refraction forms the basis for most spectacle prescriptions in adults and older children. It is also an important benchmark for surgical planning and postoperative outcome assessment.
- Differences between manifest and cycloplegic results provide insight into accommodative behaviour
- Stable manifest refraction is desirable before refractive surgery
- Changes over time can signal progression of refractive errors or lens changes
- Results should be considered alongside visual needs and tolerance
