Downloaded 416 times
Uploaded byPushkar Dhir
Retinoscopy
Dr. Pushkar Dhir gave a seminar on retinoscopy. He discussed how retinoscopy works by illuminating the retina and observing the light reflex. It can be used to objectively measure refractive error in infants and others who cannot communicate. Both dry and wet retinoscopy were explained. Challenges like an unclear red reflex due to media opacity or high refractive error were addressed. Subjective refinement using techniques like the Jackson Cross Cylinder was also covered. The seminar provided an in-depth overview of the retinoscopy procedure and techniques.
More Related Content
Retinoscopy
- 1.
- 2.
- 3. • Far Point(FP) is the farthest point at which objects can be seen clearly by the eye. • So in this patient d farthest point came out to be approx .4 mtrs. • i.e she can see all d things vch r <4metres. • To avoid this arbitrary n cumbersome method of finding refractive power ---> illumination reflexes were studeid in emmetropic and eye n correlated with the refraction power. • Power= Diopteric power – cycloplegic – 1/working distance
- 5. ASTIGMATIC FAN OBJECTIVE (what is doneby the clinician) SUBJECTIVE (refininng obj.refractn to maximize VA) AUTO.REF DUOCHROME TEST ABERROMETRYKERATOMETRYRETINOSCOPY REFRACTION BINOCULAR BALANCING JCC DRY :- Without Cycloplegics WET:- With Cycloplegics DYNAMIC:- With Accomodation
- 6. • Started byBownman in 1859 • Also known as:- Shadow test Skiascopy Pupilloscopy Korescopy • The only way to assess the refractive error in infants, small children, illiterates, uncooperative patients with speech loss patients who speak a different language. •Introduced quantitative refraction test. •Made possible to measure exact amount of refractive error using lenses. •Termed retinoscopie.
- 7. OPTICS OF RETINOSCOPY ILLUMINATION STAGE REFLEX STAGE PROJECTION STAGE Fundalarea illuminated by the light reflected into the patient’s eye . Illuminated area serves as an OBJECT Lights Rays reflected back from Fundus -> form reflex shadow in pupillary area Pupillary shadow observed by the examinar by aligning his/her eyes
- 9. Advantages of streak- Undilated pupil More accurate Astigmatism Axis of the astigmatism D GOOD OLD DAYZZ DR.SHASHI
- 10. APHAKIA- DULL GLOW HIGHMYOPIA- STREAK NOT VISIBLE
- 11.
- 12. TYPES OF RETINOSCOPES ListerReflecting Retinoscope Priestley Smith Reflecting Retinoscope Self Illuminating Retinoscope Spot Retinoscope Streak retinoscope
- 13. • Time tocharge ur laptop
- 14. Done inlong, darkened room, to aid in relaxation of accommodation The patient is made to sit at a distance of 1mt from the examiner Working distance of 2/3 mt is more convenient. Light is thrown in the patient’s eye who is instructed to look at a far point (to relax accomodation) If a cycloplegic used (wet retinoscopy) patient can look directly into the light & refraction assessed along the actual visual axis. Observe a red reflex in the pupillary area of the patient. Retinoscope is moved in the horizontal and vertical meridia, keeping a watch on the red reflex which also moves when the retinoscope is moved. ~ 50 cms
- 15. Movement (with working distance at1 metre) Against Myopia >1D With Emmetropia Hypermetro pia Myopia <1D No movement Myopia =1D
- 16. WHAT TO ASSES? Size,Speed & Brilliance Small (Narrow) Fast & Brighter Low Refractive Error Large (Wide) Slow & Dim (Faint Glow) High Refractive Error Hazy Media
- 17.
- 18. Neutralization of red reflex: in Streak Retinoscope a. Neutralization - the band of red reflex moves ‘with’ or ‘against’ the movement of the band of light from retinoscope - in simple spherical errors, at neutralization the band shaped reflex disappears and pupil appears completely illuminated. Finding the cylindrical axis i) - break in alignment is observed when the streak is not parallel to one of the principal meridia(horizontal and vertical). - the axis, can be determined by rotating the streak until the break disappears.
- 19. (ii) - widthof the streak varies as it is rotated around the correct axis. It appears narrowest when the streak aligns with the true axis. (iii)- Intensity of reflex is brighter when streak aligns with true axis. (iv)- Skewing (oblique motion of the streak reflex)
- 20. f. End pointof neutralization - width of reflex widens progressively as the neutralization is achieved, and at the end point, streak disappears and the pupil appears completely illuminated or completely dark
- 21. WET RETINOSCOPY :CYCLOPLEGICS In Retinoscopy • Paralysis of Accomodation + Dilation of Pupil. • Used in young children and hypermetropes where it is suspected that the accommodation is abnormally active and hinders exact retinoscopy. • Mydriatics to be used cautiously in adults with shallow anterior chamber
- 22. W E T R E T I N s c P Y <5 yrs 5-8 yrs8-20 yrs MYDRIATIC >CYCLOPLEGIC -do- DOSE- TDS X 3DAYS 1DROP X 10 MIN X6 TIMES 1 DROP X 15 MIN X 6 TIMEES 1DROP X15MIN X3 TIMES -do- PEAK EFFECT 2/3 DAYS 60-90MINS 80-90 MINS 20-40 MINS -do- RETINO TIME- 4TH DAY AFTER 90 MIN OF 1ST DROP AFTER 90 MIN OF 1ST DROP AFTER 40 MINS -do- EFFECT 10-20DAYS 48-72 HRS 6-18 HRS 4-6 HRS -do- 0.5%,1% 2% 1%1%
- 23. Beta Kitne Der Lagegi!!! NEED DRLIKH KAR BHEJ DETA HUN PROBLEMS IN RETINOSCOPY
- 24. PROBLEMS CAUSE SOULTION REDREFLEX NOT VISIBLE 1.SMALL PUPIL 2.HAZY MEDIA 3.APHAKIA/HIGH MYOPIA 1.TRY MYDRIATICS +CYCLOPLEGICS COMBINATION 2.REDUCE WORKING DISTANCE + BRIGHT SOURCE OF LIGHT 3.TRY LENSES OF HIGH POWER+/- 7D, IF STILL NOT ,GO HIGHER. CHANGING RETINOSCOPIC FINDINGS ACCOMODATION USED BY PATIENTS FOGGING- -- PLACE A LENS SUCH THAT VISION BECOMES 6/60 & THEN START NEUTRALISING. V R ACTUALLY TYRING D CILIARY MUSCLES BY DOING DIS. SCISSOR SHADOWS MIXED ABERRATION E.G KERATOCONUS OPT FOR ONE SLIT & ADD LENSES , SLOWLY SLIT BECOMES EQUAL,THAT’S IT. (DIRTY REFRACTION) POSITIVE SPHERICAL ABERRATIONS NEGATIVE SPHERICAL ABERRATION
- 25. Uneven wavefront (aKA“opticalaberrations”) can be because of aspherical corneal, lens & retina or uneven thickness of tear film
- 26. MEASURING OPTICAL ABERRATIONS •Shack-Hartmann (SH) aberrometer measures wavefront objectivel
- 27. Subjective Refraction • Powerof spherical and cylindrical refraction refined based on patient response • General rule: Maximum Plus for Maximum Visual Acuity. • Duochrome test: Based on chromatic aberration; red is focused more hyperopically than green; yellow is focused on retina • Letters on both red and green background should appear equally clear
- 28. SUBJECTIVE REFRACTION 1. Subjectiveverification of refraction By Trial & Error technqiue Astigmatic Dial technique 2. Subjective refinement of refraction JCC Astigmatic Fan test
- 29. • Combination oftwo sphero-cylinders: -0.25D sphere & +0.50D cylinders with axes at right angles. • Combination of two sphero-cylinders: -0.25D sphere & +0.50D cylinders with axes at right angles. • To determine end-point of magnitude, place JCC with axis parallel to the axis of the cylindrical prescription. Jacksons Cross Cylinder
- 31. Astigmatic Dial Technique •Fog the eye • Patient asked to look & identify darkest &sharpest line in astigmatic dial. • Add minus cylinder of progressively increasing power • Axis perpendicular to the darkest & sharpest line, till all lines are clear. • Revert back fogging.
- 32. REFERENCES • http://www.slideshare.net/meikocat/Refraction • http://www.eyedocs.co.uk/ophthalmology-learning/articles/optics- and-refraction/1508-retinoscopy-simulator •http://retinoscopy.blogspot.in/ • http://books.google.co.in/books?id=6I6JeDWonhQC&pg=PA2&lpg= PA2&dq=RETINOSCOPY+WITH+PLANE+MIRROR&source=bl&ots=o wV9UpZtAO&sig=ku6SiYptvYp_qlEbBi-g2YW7izM&hl=en&sa=X&ei=- mypU8K5MdeUuASBi4HIDw&ved=0CEkQ6AEwCg#v=onepage&q=R ETINOSCOPY%20WITH%20PLANE%20MIRROR&f=false • http://www.college- optometrists.org/en/college/museyeum/online_exhibitions/optical _instruments/retinoscopes.cfm
- 33. Had dat Refereehad 6/6 refined vision , Argentina would never hav won 1986 FIFA WORLD CUP!!!!! • THANK YOU EVERYONE FOR PATIENTLY LISTENING TO THIS SEMINAR. • For feedbacks & brickbats plz mail at • ykush@yahoo.co.in./drdhir2014@gmail.com HAND OF GOD