Static retinoscopy procedure CEVS

1. Static Retinoscopy
– By Neha D Jadhav
– B-optometry S.Y
– RAI2017BOPT5F008

2. Introduction
● 1873,F.Cuigent the father of retinoscopy – first discribed a
retinoscope
● 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.

3. Cont..
● Sir william bowman in 1859, reported the movement of
light and shadow effect.
● Used since 1873 – reflecting mirror spot retinoscopes,
externally illuminated.
● Modern streak design that brought significant cange in
1927, by Jack C. Copoeland

4. Retinoscopy techniques
● Static retinoscopy is the refractive state, determined
when patient fixates an object at a distance of 6m with
accommodation relaxed.
● It includes:
– Spot retinoscopy: light sources is spot of light
● Plane mirror effect.
– Streak retinoscopy: the bulb provides a beam in the form of a
streak rather than a spot
● Plane mirror effect.
● Concave mirror effect.

5. Retinoscopy procedure
1. Estimate refractive correction from revelent case history and V/A information
and focimetry/lensometry
2. Position the phoropter or trial frame appropriately and set the PD.
3. Dial in the working distance lenses if appropriate
4. Switch on the duo chrome (bichromatic), spotlight of a similar large target.
5. Explain the test to the patient.
6. Dim the room light.
7. Set the retinoscope mirror to the Plano position and align yourself with the
visual axis of the patients right eye.
8. Look across to the left eye and if ‘with’ movement is observed, add positive
lenses until ‘against’ movement is obtained

6. 9.Determine if the refractive error of the right eye is spherical or
astigmatic.
10.If the reflex is dim and the movement is relatively slow, use an
appropriate lens to get nearer slow to neutrality and check again for astigmatism.
11.If astigmatic determine the meridian.
12.Neutralize the most plus/ least minus meridians first.
13.Check the neutral point by moving forward and backword slightly from your
normal working distance and check the reflex movement.
14.Along the second meridian, add minus cylinder in the bracketing technique to
achieve neutrality.
15.Repeat for the patients left eye.
16.Remove the working distance lenses or subtract 1.50 or 2.00D from your final
result.
17.Measure the patients visual acuities with the net retinoscopy.

8. Adaptation to the
standard technique
– Monocular examination
– Dim reflex
– Large pupil
– Small pupil
– Patient with strabismus
– Accommodative fluctuations
– Scissor's effect

9. Recording
– Record the spherocylindrical correction that neutralized the
patients refractive error after removing your working
distance lenses

10. Interpretation
– On average, retinoscopy provides a refractive result slightly
more positive than subjective refraction in young patient.
– Subjective results are similar in presbyopia patients.
– Errors can occur in retinoscopy if it is performed off-axis or
if it is performed at an incorrect working distance
– Note – that cylinder axis of two eyes are often mirrors of
each other.

11. Most Common Errors
– Performing retinoscopy at an incorrect working distance.
– Performing retinoscopy off-axis
– Blocking the view of patients distance chart, thereby
probably stimulated accommodation
– Not concentrating on the movement in the center of the
pupil in the patient with the large pupil.