Theory of

Retinoscopy

DEFINITION
Retinoscopy is the name given to the

objective method of determining the

refractive errors by using retinoscope.

Retinoscopy

procedure
The fundus is illuminated by means of a

mirror or by a self illuminated streak

retinoscope situated classically 1 or 2/3
meter away from the subject.

Principle
The illuminated area of fundus is not

seen by the observer but only acts as a

source. The rays emanating from the
source from an illuminated area in the
plane of the pupil of the subject which is
called retinoscope shadow or reflex.

Objective method
Examiner sits at 67 cms away from the

patient ( Point of reversal is at 1.50D)

The Patient is normally seated and looking
towards the far end of the room.
Source of light is from behind the patient.
The Examiner looks through a plane mirror
with central perforation, and light is
reflected into the patients eye.
The Examiner is slowly moved from side to
side in different meridians, and movement
of the shadow is noted.

Stages of retinoscopy
Illumination stage :

Light is directed into the patients

eye to illuminate the retina .
Reflex stage :
A image of the illuminated retina is
formed at the patients far point.
Projection stage :
The image at the far point is located
by moving the illumination across the
fundus and noting the behavior of the luminous
reflex seen by the observer in the
patients
pupil.

Illumination Stage Plane mirror

Illumination by Streak
Retinoscopy

Reflex Stages

Reflex Stages

Reflex Stages

Projection Stage
Hypermetropia

Emmetropia

Myopia less than 1.50D

Myopia of 1.50D

Myopia > 1.50D

Retinoscopy Movement
Speed
Brilliance
Width

Methods
In Hypermetropia, emmetropia and myopia <1.50D =

the reflex moves in the same direction.( with

movement)
In Myopia of 1.50D= there is no shadow
In Myopia of > 1.5D= the shadow moves in the
opposite direction.
( against movement)
The procedure is done for each meridians separately
In astigmatism, they are different. If the axes are
oblique, the shadow themselves will seem to move
obliquely and the mirror is then tilted accordingly.

Calculation
Refraction of Patients eye = lens required

to reach end point =

-1.50D(Myopia)
Since the Examiner is sitting at 1mt
distance and if he is at 2/3rd mt, it will be
-1.5D(myopic)
So the refraction of the eye= -1.50D
+lens

Example
If the end point is with +4.0D lens:

Refraction = -1.50D +4.0D lens= +2.50D

Similarly with -3.50D lens:
Refraction = -1.50D -3.50D = -5.0D
If the end point is with +1.50D lens
Refraction = -1.50 +1.50D = 0
the patient is emmetropic
In case of astigmatism, each meridian is to
be calculated separately

Subjective Verification
of Refraction

Subjective Verification
After objective test, it
should always be verified
subjectively by testing the
visual acuity

Procedures
Each eye is to be tested separately, the

other eye being blocked, and then finally

tested together.
Appropriate lenses, as found by objective
test, are inserted in the trial frame.
Slight modification of the inserted lens
gives a maximum visual acuity.
Verification may be needed with a cross
cylinder, or astigmatic fan in case of
astigmatism

Duochrome Test
To test if the eye

has been under

corrected or over
corrected or is
properly
corrected

Astigmatic fan
To know the axis and power in Astigmatism.

Jackson's Cross Cylinder

To refine the axis and power of Cylinder.

Fogging Method
Sometimes fogging method is

necessary to induce a relaxation

of accommodation especially in
hypermetropia.

Example
Here, the eyes are made artificially

myopic by addition of convex lenses

(Ex+4.0D). This is then gradually
lessened by a small fraction (0.50D)
until the maximum acuity is just
reached. The first lens is not removed
until the next is in position, to prevent
from accommodation becoming
active.

Procedures
As a rule, the patient is given the strongest

hypermetropic, or weakest myopic

correction with normal visual acuity.
The addition of the correction for near work
(if necessary), and testing of the acuity with
near- types, uniocularly and then binocularly
Then the spectacles have been ordered with
necessary comments (Ex) Constant wear,
Near works only