Refractive status is a delicate balance of the relationship between the corneal curvature, anterior chamber depth, lens power and axial length. Changes to any one of these can cause a change in refraction and the causes of these changes may be pathological or non-pathological. It is our job as eye care professionals to diagnose and manage any potential pathology. Refractive changes can be a great clue to help with this. 

This article will consider how changes in refraction can indicate underlying pathology, such as diabetes or retinal lesions, further investigations to aid diagnosis, and what we should do if suspicions of pathology are confirmed. 

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