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Retinoscopy and its
principles
Presenter : Dr.Rasika Thakur
Moderator: Dr.Monica Samant
Mr.Kunal Kishor
Introduction
History
Types of retinoscope
Far point
Optical principle
Types of retinoscopy
Problems in retinoscopy
Introduction
An accurate objective measurement of the refractive
state of an eye can be made using the retinoscope
The t...
History
• 1873,F.Cuigent the father of retinoscopy- first
described a retinoscope
1878, M. Mengin
1880, H. Parent - reti...
Types of retinoscopes
Reflecting mirror retinoscope
• A perforated mirror by which the beam is reflected in to
the patients eye and through a ce...
Reflecting mirror retinoscope
Reflecting mirror retinoscope
contd…
Self illuminated retinoscope
• The light source and the mirror are
incorporated in one
• STREAK RETINOSCOPE- Light source ...
Streak Retinoscope
Projecting system
Main purpose:
To illuminates the retina
Contsists of:
• Light source
• Condensing lens
• Mirror
• Foc...
Projecting system of Copeland
type.
Projecting system of Welch Allyn
.
....
.
Observation system
Main purpose:
To allows the observer to see the retinal reflex of the
patient.
Streak Retinoscope
Advantages of Streak Retinoscope
over Spot Retinoscope
Far point
• The far point of eye is defined as the point in space that is
conjugate with the fovea when accomodation is re...
Far point contd…
Optical Principle
• Retinoscope works on Focault's principle
• Retinoscopy is based on the fact that when light is
reflect...
Optical Principle
• The illumination stage
• The reflex stage
• The projection stage
Illumination Stage
Light is directed into the patient's eye to
illuminate the retina
Reflex Stage
An image of the
illuminated retina is
formed at the
patient's far-point
Exercises in Refractometry.
Thorofare...
Projection Stage
The image at the far-point is located by
moving the illumination across the fundus
and noting the behavi...
Emmetropic eye
Hypermetropic eye
Myopia of less than 1D
Myopia of 1D
Myopia of more than 1D
Projection Stage
Working Distance
• The distance from the retinoscope to the patient’s eye
• D = 1 ÷ F
• The length of the average person’s...
Should I use a “working lens” to
compensate for the working distance?
Advantages-
Instant identification of myope or hyp...
Formation of the Secondary Fundus
Source or "Fundus Reflex"
• Light reflected from the fundus has two components:
• A diff...
Fundal reflex
Properties of the fundal reflex indicate the refractive status
of the eye
• Brightness
• direction of motion...
Brightness of the Retinoscopic
Fundus Reflex
The brightness of the
fundus reflex is greatest
when the retinoscope
apertur...
Direction of Motion of the Retinoscopic
Fundus Reflex
No movement of red reflex indicates myopia
of 1D
Contd..
• Red reflex moves along with the movement of the
retinoscope, it indicate emmetropia or hypermetropia or
myopia o...
Contd..
• A movement of red reflex against the movement
of the retinoscope, indicates myopia of more than
1D.
Speed and width of the Retinoscopic
Fundus Reflex
• Indicates that how far we are from neutrality
• A slow moving streak r...
Finding the cylinder axis
• In the presence of astigmatism, one axis
is neutralized with the spherical lens &
the second a...
Finding the cylinder axis
Break
Break in the alignment
between the reflex in the
pupil and the band outside it
is observed...
Finding the cylinder axis
Skew
if the streak is not
aligned with the true
axis oblique motion of
streak reflex will be
ob...
Straddling
CONFIRMATION OF THE AXIS
•This is performed with approximately correct cylinder in place
Finding the cylinder power
3 Methods-
With two spheres
With a sphere and cylinder
With two cylinders
With two spheres
First neutralize one axis with appropriate sphere
Then keep on changing the sphere till the second axis...
With a sphere and cylinder
First neutralize one axis with an appropriate spherical
lens.
Neutralize the other axis with ...
Enhancement
This technique is to approximately estimate the amount
of refractive error with minimal use of trial lenses.
...
Enhancement
A rough estimation of the refractive error is
possible,based on the sleeve position
End point of retinoscopy
Types of retinoscopy
• Static Retinoscopy: the patient is looking at a distant
object, with accommodation relaxed.
• Dynam...
Dynamic Retinoscopy Techniques
MEM Retinoscopy
Help to calculate patients lag or lead
of accomodation
Lettered targets are applied to the head of a
ret...
Nott’s method
It determines lag/lead of accomodation by moving
retinoscopic apperture towards or away from the eye
Targe...
Bell Retinoscopy
The retinoscope remains in
a fixed position and the target is moved
The retinoscopy is performed from a...
Near retinoscopy /Mohindra
retinoscopy
Also known as near monocular retinoscopy
Estimate the refractive status of the ey...
Radical retinoscopy
Done in patients with small pupils, cataract, or any
other opacity
Working distance here is 20cm or ...
Chromoretinoscopy
Helps in a clinical measurement of the chromatic
aberration of an eye
Transmittance filters with selec...
Types of retinoscopy
• Wet retinoscopy- with cycloplegic retinoscopy is
performed
• Dry retinoscopy-without cycloplegic
Indications for wet retinoscopy
Accommodative fluctuations indicated by a
fluctuating pupil size and/or reflex during ret...
cycloplegic drugs used in wet
retinoscopy
 Atropine sulphate 1%
Cyclopentolate 1%
Homatropin 2%
Disadvantages of cycloplegic
retinoscopy
Temporary symptoms of blurred vision and
photophobia
The degradation of vision ...
Problems in retinoscopy
• Red reflex may not be visible -small pupil, hazy
media & high degree of refractive error
• Sciss...
contd
Patient with strabismus-it is easier to change the
fixation of good eye so that retinoscopy can be
performed along ...
contd
• Spherical aberrations -lead to variation of refraction in the
centre & periphery of pupil. It may be seen in norma...
Non-refractive uses of
retinoscopy
Opacities in the lens and iris -dark areas against the
red background
Extensive trans...
contd
Retinal detachment involving the central area will
distort the reflecting surface and a grey reflex is seen
A tigh...
Reason for false reading
Inexperience
 Not aligning with Visual axis of the patient
Definite working distance is not ma...
Thankyou
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Retinoscopy and its principles

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Retinoscopy and its principles

Retinoscopy and its principles

  1. 1. Retinoscopy and its principles Presenter : Dr.Rasika Thakur Moderator: Dr.Monica Samant Mr.Kunal Kishor
  2. 2. Introduction History Types of retinoscope Far point Optical principle Types of retinoscopy Problems in retinoscopy
  3. 3. Introduction An accurate objective measurement of the refractive state of an eye can be made using the retinoscope The technique is called retinoscopy Pupilloscopy, shadowscopy, skiascopy, umbrascopy, scotoscopy
  4. 4. History • 1873,F.Cuigent the father of retinoscopy- first described a retinoscope 1878, M. Mengin 1880, H. Parent - retinoscopie • 1927, Copeland -streak retinoscope
  5. 5. Types of retinoscopes
  6. 6. Reflecting mirror retinoscope • A perforated mirror by which the beam is reflected in to the patients eye and through a central hole the emergent rays enter the observer’s eye • Movements of the illuminated retinal area are produced by tilting a mirror, either a plane or concave
  7. 7. Reflecting mirror retinoscope
  8. 8. Reflecting mirror retinoscope contd…
  9. 9. Self illuminated retinoscope • The light source and the mirror are incorporated in one • STREAK RETINOSCOPE- Light source is a linear (uncoiled) filament
  10. 10. Streak Retinoscope
  11. 11. Projecting system Main purpose: To illuminates the retina Contsists of: • Light source • Condensing lens • Mirror • Focusing sleeve • Current source
  12. 12. Projecting system of Copeland type.
  13. 13. Projecting system of Welch Allyn . .... .
  14. 14. Observation system Main purpose: To allows the observer to see the retinal reflex of the patient.
  15. 15. Streak Retinoscope
  16. 16. Advantages of Streak Retinoscope over Spot Retinoscope
  17. 17. Far point • The far point of eye is defined as the point in space that is conjugate with the fovea when accomodation is relaxed
  18. 18. Far point contd…
  19. 19. Optical Principle • Retinoscope works on Focault's principle • Retinoscopy is based on the fact that when light is reflected from a mirror into the eye, the direction in which the light will travel across the pupil will depend upon the refractive state of the eye
  20. 20. Optical Principle • The illumination stage • The reflex stage • The projection stage
  21. 21. Illumination Stage Light is directed into the patient's eye to illuminate the retina
  22. 22. Reflex Stage An image of the illuminated retina is formed at the patient's far-point Exercises in Refractometry. Thorofare, NJ: SLACK Incorporated; 1990
  23. 23. Projection Stage The image at the far-point is located by moving the illumination across the fundus and noting the behaviour of the luminous reflex seen by the observer in the patient's pupil
  24. 24. Emmetropic eye
  25. 25. Hypermetropic eye
  26. 26. Myopia of less than 1D
  27. 27. Myopia of 1D
  28. 28. Myopia of more than 1D
  29. 29. Projection Stage
  30. 30. Working Distance • The distance from the retinoscope to the patient’s eye • D = 1 ÷ F • The length of the average person’s arm is 66 cm. The power of a lens that focuses parallel light rays at 66 cm is +1.50 D
  31. 31. Should I use a “working lens” to compensate for the working distance? Advantages- Instant identification of myope or hyperope. Working lens might help relax accommodation. No need for mental arithmetic to allow for working distance Disadvantages- Too much blur does not necessarily relax accommodation. Working lens adds extra reflections to the view.
  32. 32. Formation of the Secondary Fundus Source or "Fundus Reflex" • Light reflected from the fundus has two components: • A diffuse component, which is also called backscatter • A directed component
  33. 33. Fundal reflex Properties of the fundal reflex indicate the refractive status of the eye • Brightness • direction of motion • speed of motion • Width
  34. 34. Brightness of the Retinoscopic Fundus Reflex The brightness of the fundus reflex is greatest when the retinoscope aperture coincides with the far point of the eye In highly myopic and highly hyperopic eye the pupillary reflex appears dim
  35. 35. Direction of Motion of the Retinoscopic Fundus Reflex No movement of red reflex indicates myopia of 1D
  36. 36. Contd.. • Red reflex moves along with the movement of the retinoscope, it indicate emmetropia or hypermetropia or myopia of less than 1D.
  37. 37. Contd.. • A movement of red reflex against the movement of the retinoscope, indicates myopia of more than 1D.
  38. 38. Speed and width of the Retinoscopic Fundus Reflex • Indicates that how far we are from neutrality • A slow moving streak reflex - long way from neutrality.
  39. 39. Finding the cylinder axis • In the presence of astigmatism, one axis is neutralized with the spherical lens & the second axis still shows the movement of reflex in the direction of axis of astigmatism
  40. 40. Finding the cylinder axis Break Break in the alignment between the reflex in the pupil and the band outside it is observed when the streak is not parallel to one of the meridian
  41. 41. Finding the cylinder axis Skew if the streak is not aligned with the true axis oblique motion of streak reflex will be observed on movement of the steak.
  42. 42. Straddling CONFIRMATION OF THE AXIS •This is performed with approximately correct cylinder in place
  43. 43. Finding the cylinder power 3 Methods- With two spheres With a sphere and cylinder With two cylinders
  44. 44. With two spheres First neutralize one axis with appropriate sphere Then keep on changing the sphere till the second axis is neutralized Astigmatism is measured by the difference between the 2 spheres +2.00D +3.00D + 2.00Ds / + 1.00 Dc X 900
  45. 45. With a sphere and cylinder First neutralize one axis with an appropriate spherical lens. Neutralize the other axis with a cylindrical lens at the appropriate orientation  The spherical cylindrical gross retinoscopy may be read directly from the trial lens apparatus
  46. 46. Enhancement This technique is to approximately estimate the amount of refractive error with minimal use of trial lenses. If the reflex inside pupil gets more thinner by changing the sleeve width,it suggests a significant refractive error Thinnest retinal reflex is called Enhanced band
  47. 47. Enhancement A rough estimation of the refractive error is possible,based on the sleeve position
  48. 48. End point of retinoscopy
  49. 49. Types of retinoscopy • Static Retinoscopy: the patient is looking at a distant object, with accommodation relaxed. • Dynamic retinoscopy: the patient is looking at a near object, with accommodation active. • Near retinoscopy: the patient is looking at a near object, with accomodation relaxed
  50. 50. Dynamic Retinoscopy Techniques
  51. 51. MEM Retinoscopy Help to calculate patients lag or lead of accomodation Lettered targets are applied to the head of a retinoscope Fixation target is placed at harmon distance/50 cm with patients corrected refractive error the refractive power of the trial lens that brings neutrality is the accommodative lag/lead
  52. 52. Nott’s method It determines lag/lead of accomodation by moving retinoscopic apperture towards or away from the eye Target is the letters around the aperture of a near point card At a distance of 40 cm The accommodative response, in diopters, is subtracted from the accommodative demand,to determine the accommodative lag/lead
  53. 53. Bell Retinoscopy The retinoscope remains in a fixed position and the target is moved The retinoscopy is performed from a fixed distance of 50 cm The distance between the retinoscope and the target when the change in motion occurs is a physical measure of the lag/lead of accommodation
  54. 54. Near retinoscopy /Mohindra retinoscopy Also known as near monocular retinoscopy Estimate the refractive status of the eye The stimulus or fixation is the dimmed light source of the retinoscope in a darkened room The retinoscope is held at a distance of 50cm with hand-held trial lenses Borish's Clinical Refraction. 1998. WJ Benjamin. WB Saunders Company. Philadelphia, London, Toronto.
  55. 55. Radical retinoscopy Done in patients with small pupils, cataract, or any other opacity Working distance here is 20cm or even less upto 10cm
  56. 56. Chromoretinoscopy Helps in a clinical measurement of the chromatic aberration of an eye Transmittance filters with selected dominant wavelengths, are placed in the light path between the light source of a retinoscope and the retinoscopist's eye
  57. 57. Types of retinoscopy • Wet retinoscopy- with cycloplegic retinoscopy is performed • Dry retinoscopy-without cycloplegic
  58. 58. Indications for wet retinoscopy Accommodative fluctuations indicated by a fluctuating pupil size and/or reflex during retinoscopy Patients with esotropia or convergence excess esophoria A retinoscopy result significantly more positive or minus (>1.00 DS) than the subjective result
  59. 59. cycloplegic drugs used in wet retinoscopy  Atropine sulphate 1% Cyclopentolate 1% Homatropin 2%
  60. 60. Disadvantages of cycloplegic retinoscopy Temporary symptoms of blurred vision and photophobia The degradation of vision is caused by the abolition of the accommodation response Increase in ocular aberrations as a result of dilated pupils. Adverse effects and allergic reactions to cyclopentolate are rare
  61. 61. Problems in retinoscopy • Red reflex may not be visible -small pupil, hazy media & high degree of refractive error • Scissoring shadow-may be seen in healthy cornea but with unusual difference in curvature in the centre & the corneal opacities
  62. 62. contd Patient with strabismus-it is easier to change the fixation of good eye so that retinoscopy can be performed along the visual axis of the strabismic eye Retinoscopy in nuclear cataract shows index myopia in early stages
  63. 63. contd • Spherical aberrations -lead to variation of refraction in the centre & periphery of pupil. It may be seen in normal eyes but more marked in lenticular sclerosis. • Conflicting shadows- moving in various directions in different parts of the pupillary area with irregular astigmatism • Triangular shadow- may be observed in patients with conical cornea
  64. 64. Non-refractive uses of retinoscopy Opacities in the lens and iris -dark areas against the red background Extensive transillumination defects in uveitis or pigment dispersion syndrome -bright radial streaks on the iris Keratoconus distorts the reflex and produces a swirling motion
  65. 65. contd Retinal detachment involving the central area will distort the reflecting surface and a grey reflex is seen A tight soft contact lens will have apical clearance in the central area which will cause distortion of the reflex
  66. 66. Reason for false reading Inexperience  Not aligning with Visual axis of the patient Definite working distance is not maintained Lack of subject’s accommodation Defect in trial lenses Lack of patient’s co-ordination
  67. 67. Thankyou

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