Retinoscopy Part 3 Special Thanx to Mohd.Shareef.EK(2010-2014)optometry batch Alsalama College Of Optometry,Perinthalmanna)

2.  The method by which you determine the
patient’s neat point
 It defines the patient’s accommodative
posture
 It is primarily used to confirm suspected cases
of accommodative dysfunction

3.  In dynamic retinoscopy the patient is
instructed to fixate a letter, or other objects
in the plane of retinoscope
 No working distance lens is added or to
substract from the findings

4.  Same movement as with static
 With: eye conjugate to a point either behind the
eye or behind the retinoscope
 Against: eye conjugate to a point between the eye
and the retinoscope
 Neutrality: eye conjugate with the retinoscope

6. Monocular Estimate Method
 We neutralizes the reflex of the eye while the patient
accommodates to fixate a target at near (usually at 40cm)
 With motion: Lag of accommodation --- Add PLUS
 Against motion: Lead of accommodation ---Add MINUS

7.  The MEM card should be attached to the
retinoscope with the beam of the retinoscope
passing through the hole in the center of it( see
Figure 4-16).
 The test is performed under normal room
illumination.
 The patient should wear his habitual near
correction.
 The test is performed under binocular viewing
conditions.

8.  The examiner is seated slightly below the patients eye level
so the patients eye are in a moderate downward gaze when
looking at the target as would occur when reading
 Use patient’s correction for distance or a tentative near
correction
▪ Place the target at their working distance
▪ Adults: usually 40 cm
▪ Children: use Harmon’s distance
▪ Room illumination should be dim but with target
illuminated
▪ Keep desired testing distance consistent
▪ Remain as close to the patient’s line of sight as possible
when neutralizing

9.  While the patient is reading, quickly guide the streak
across the patient’s right eye and evaluate the reflex
for with or against motion or for neutrality. Be sure
to observe the reflex in the center of the pupil rather
than at the edge.
 Estimate the dioptric value required to neutralize
the observed motion (With-plus; Against-minus).

10.  Nott Method: clinician moves toward and
away from the patient until neutrality is seen
(can be performed in or out of phoropter)
 Against motion: move closer to the patient
 With motion: move further away from
patient

11.  Results
 Expected
▪ Non-presbyopes: Lag of +0.50D to +0.75D when tested
at 40cm
▪ Presbyopes: accommodation ability declines, increasing
expected lag of accommodation (dynamic ret is an
accepted form ofTNA determination)
▪ Absolute presbyopes: expected lag is +2.50D at 40cm

12.  High Lag (>+0.75D)
▪ Accommodative dysfunction: insufficiency, fatigue,
paresis, infacility
▪ Presbyopia or pre-presbyopia
▪ Uncorrected or under corrected hyperope
▪ Over minused
▪ Inaccurate results: patient not keeping the target clear
during the test and so not accommodating

13.  High Lag (+2.50D)
▪ Uncorrected or under corrected hyperope
▪ Presbyopia
▪ Inaccurate results: patient not keeping the target clear
during the test and so not accommodating

14.  Low lag or lead of accommodation (<+0.25D)
▪ Spasm of accommodation: pseudomyopia
▪ Uncorrected or under corrected myopia
 Other abnormal
▪ Fluctuation of reflex also often indicates a near
imbalance or accommodative spasm

15.  Sources of error
 Same as those with static: scissors, small pupils,
dim media (cataracts, etc.)
 More sensitive to physical arrangement for the
measurement (distance), instructions given and
patient’s cooperation
 Changes in patient’s fixation or accommodative
level (often related to failure to understand task or
to cooperate)

16. OTHER METHODS
 Sheards method
 Taits method
 Bell retinoscopy
 Low-neutral and high-neutral method
 Binocular crossed cylinder
 Book retinoscopy
 Near retinoscopy (Mohindra)

17.  Near retinoscopy differs from other forms of
dynamic retinoscopy coz It is performed in
complete darkness, the only illumination in
the room being supplied by the retinoscope