The document discusses dynamic and static retinoscopy techniques for assessing refractive errors in patients, highlighting the types, procedures, and uses of these methods. It details various dynamic retinoscopy techniques like Mohindra near retinoscopy and the procedures involved, as well as static retinoscopy involving cycloplegic agents. It also emphasizes the significance of these methods in diagnosing accommodative disorders and determining suitable refraction for different age groups.

1. DYNAMIC AND STATIC RETINOSCOPY
PRESENTER –SOURAV THAKUR
MODERATOR –PRIYANKA MAM

2. Contents-
• DYNAMIC RETINOSCOPY
• USE OF DYNAMIC RETINOSCOPY
• TYPES OF DYNAMIC RETINOSCOPY
• STATIC RETINOSCOPY

3. Choice of refraction for different age groups
• Mohindra near retinoscopy
• Retinoscopy with or without
cycloplegics.
• Photorefraction
Infants

4. *Retinoscopy with or without cycloplegics
*Distance {by showing fixation
*Dynamic –MEM for Near
*Book Retinoscopy
*Subjective refraction
*Keratometry
*Cycloplegic refraction
*dynamic refraction
*subjection refraction
Pre-school
School aged

5. Dynamic retinoscopy
refractive state is determined while subject fixates an object at some
closer distance ,usually at or near the plane of retinoscope itself .
..History of dynamic retinoscopy-
.when patient asked to fixate near object .
.A .J. CROSS is credited with introducing the basic theory and
method of dynamic retinoscopy .
NOTT,SHEARD ,SKEFFINGTON-elaborated on the theory and
procedure .
.

7. Use of dynamic retinoscopy -
1 it is primarily use to confirmed suspected causes of vergence or
accommodative disfunction also used to determine a patient is over or
under corrected .
2 to check for accommodative disorders
3 to help decide amblyopic therapy.
4. It revels the stability or degree of fluctuation of accommodative system
.
WITH MOVEMENT –eye conjugate to a point either behind the eye or behind the
retinoscope .
AGAINST MOVEMENT – eye conjugate to a point between the eye {patient }and
retinoscope .
NEUTRALITY –eye conjugate with retinoscope .

8. Accommodative response =stimuli
in front of target {lead of accommodative }
behind the target { lag of accommodation }
Lag of accommodation at near refer to an accommodative
response less than accommodative demand .
Lead of accommodation refer to accommodative response that
exceeds the accommodative demand .

9. TYPES OF DYNAMIC RETINOSCOPY
MEM BELL RETINOSCOPY NOTT RETINOSCOPY
CROSS
RETINOSCOPY
SHEARDs
RETINOSCOPY
TAITs RETINOSCOPY
BOOK
RETINOSCOPY
NEAR
RETINOSCOPY BY
MOHINDRA

10. ‘
OTHER TYPES
CROMO RETINOSCOPY
STRING RETINOSCOPY
LENS BAR RETINOSCOPY
RADICAL RETINOSCOPY

11. MEM –{ Monocular Estimate Method
}
Founder dr .harold Haynes
clinician neutralize the reflex of eye while patient accommodate
to fixate a target at near usually 40cm .

13. Procedure -
1..MEM should attached to retinoscope with beam of retinoscope
passing through hole in center of it .
2..Test performed normal room illumination {40cm }
3..The patient should wear habitual glasses
4..Performed under binocular correction .
5..Keep desired testing distance consistent
6..Remain as close to patient line of sight as possible when neutralizing
7..Observe the reflex
8..Estimate the dioptric value required to neutralize the observed
motion .

14. Interpretation –
WITH MOVEMENT :LAG OF ACC. ………ADD PLUS
AGAINST MOTION :LEAD OF ACC ……….ADD MINUS
Lag of acc. Is amount of plus lens that neutralized the reflex .
No working distance compensation is done .
No power added or subtracted to neutralized power.
.

15. Nott retinoscopy –
developed by{ I.S Nott on 1920 }
Main purpose identical to MEM method
Distance 40cm
Procedure =
1.Wear his compensating distance lenses .
2.Distance to read the letters .
3.Perform retinoscopy by moving farther from plane of regard until
motion is neutralized .

18. 1. Dioptric difference between these two distance equals the lag of accommodation
2. Distance from the target to spectacle plane =40cm
3. Distance from retinoscope to spectacle plane = 50 cm
Lag of accommodation
=2.50-2.00D
=0.50D
INTERPRETATION

19. Bell retinoscopy

20. Sheard method
Charles sheard {1920}
• Introduced the concept of “lag of
accommodation “.
• Add plus lens power until neutrality occurred .

21. Tait method
{1953}
• Working distance 33cm .
• Fogging with considerable amount of plus lens power
and then approaches neutral by reducing the plus lens
power .
• Found average approx. +1.50D more than sheard system
, thus total lag of accommodation +2.25D.
• Close to +2.50D i.e. negative relative accommodation. .

22. Near retinoscopy
 By mohindra in 1977
 For use in determining refractive state of infant and children .
 The stimulus or fixation is dimmed light source of retinoscope in darkened room.
 Distance 50cm .
Near retinoscopy differ from other ways of dynamic
retinoscopy
1. It is performed complete darkness , the only illumination in room supplied by
retinoscope with child fixating at retinoscope light
2. It is monocular procedure that eye not being examined occluded
3. The adjustment factor -1.25 is algerbrically combined with spherical component
of gross sphero-cylindrical lens power.

23. RADICAL RETINOSCOPY
• Due to small pupil /cataract /other media opacities /faint
retinoscopic reflex .
• The practitioner find easy as moving closer to patient .
• Involve a working distance as close as 20cm /or even 10cm
.
• Eg :if possible at 20cm WD +5.00D is subtracted from lens
power in refractor

24. Static retinoscopy
is condition where the refraction is done when accommodation is
relaxed .
Relaxation of accommodation is done by asking patient look at object at 6m or
far or using cycloplegic eye drops .{ ATROPINE ,CYCLOPENTOLATE }
Done by two ways
Done with the instrument named retinoscope which is
two types
1.Spot retinoscope
dry wet

27. CYCLOPLEGIA-
1.It is the paralysis of ciliary muscle of the eye ,resulting is
the loss of visual accommodation .
2.Accommodation is the ability of lens to change its
refraction power to view the near object clearly .
3.It is brought about by the contraction of ciliary muscle .

29. principle of cycloplegic refraction
• Determination of total refractive error during paralysis of cililary muscle as an
instillation of cycloplegic drugs which otherwise does not manifest on
subjective non –cycloplegic refraction .
TOTAL HYPERMETROPIA
LATENT
HYPERMETROPIA
MANIFEST
HYPERMETROPIA
ABSOLUTE FACULTATIVE

31. Pmt {post mydriatic test }
Assessment of the finding of cyclo-refraction by
subjective means after the effect of cycloplegia is
eliminated .
In case of cycloplegia this test is usually done after
3-5 days and 1 month later on in case of atropine .
*NOTE –IF PATIENT IS HYPERMETROPIC ,GIVE
THE MOST PLUS [+] POWER POSSIBLE
WITHOUT REDUCING VISUAL ACUITY .

32. ,