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RETINOSCOPY

Presentor:Dr.Pushkar
Dhir

Moderator
:Dr. Jyoti
Puri

O
P
D
E
X
P
E
R
I
E
N
C

Far Point (FP) is the farthest point at which objects can be


seen clearly by the eye.
So in this patient d farthest point came out to be approx .4
mtrs.
i.e she can see all d things vch r <4metres.
To avoid this arbitrary n cumbersome method of finding
refractive power ---> illumination reflexes were studeid in
emmetropic and eye n correlated with the refraction power.
Power= Diopteric power cycloplegic 1/working distance

OBJECTIVE

REFRACTIO
N

SUBJECTIVE

(what is done by the


clinician)

(refininng obj.refractn to maximize


VA)

JCC

RETINOSCO
PY

AUTO.R
EF

DUOCHROM
E
TEST

KERATOMET
RY

DRY :- Without Cycloplegics


WET:- With Cycloplegics
DYNAMIC:- With Accomodation

ASTIGMAT
IC
FAN

ABERROMET
RY

BINOCULAR
BALANCING

Started by Bownman in 1859

Introduced quantitative

Also known as: Shadow test


Skiascopy
Pupilloscopy
Korescopy

refraction test.
Made possible to
measure
exact amount of
refractive
error using lenses.
Termed retinoscopie.

The only way to assess the refractive error


in infants, small children, illiterates, uncooperative
patients with speech loss
patients who speak a different language.

OPTICS OF RETINOSCOPY
ILLUMINATION

Fundal area illuminated


by the light reflected
into the patients eye .
Illuminated area serves
as an OBJECT

Lights Rays reflected


back from Fundus ->
form reflex shadow in
pupillary area

Pupillary shadow
observed by the
examinar by aligning
his/her eyes

D GOOD
OLD DAYZZ
DR.SHASHI

Advantages of
streak Undilated pupil
More accurate
Astigmatism

APHAKIA- DULL GLOW

HIGH MYOPIA- STREAK NOT

VIDEO
(on u tube)

TYPES OF RETINOSCOPES

Lister Reflecting
Retinoscope

Priestley Smith
Reflecting
Retinoscope

Self Illuminating
Retinoscope

Spot Retinoscope
Streak
retinoscope

Time to charge
ur laptop

~ 50
cms

Done in long, darkened room, to aid in relaxation of accommodation


The patient is made to sit at a distance of 1mt from the examiner
Working distance of 2/3 mt is more convenient.
Light is thrown in the patients eye who is instructed to look at a far point (to relax
accomodation)
If a cycloplegic used (wet retinoscopy) patient can look directly into the light &
refraction assessed along the actual visual axis.
Observe a red reflex in the pupillary area of the patient.
Retinoscope is moved in the horizontal and vertical meridia, keeping a watch on the red
reflex which also moves when the retinoscope is moved.

WHAT TO ASSES?
Size,
Small
Speed
(Narrow)
& Brilliance

DEMONSTARTION
http://www.eyedocs.co.uk/ophthalmology-learning/articles
/optics-and-refraction/1508-retinoscopy-simulator

Neutralization of red
reflex :
in Streak
Retinoscope
a. Neutralization
- the band of red reflex moves
with or against the
movement of the band of light
from retinoscope
- in simple spherical errors, at
neutralization the band shaped
reflex disappears and pupil
appears completely illuminated.

Finding the
cylindrical axis
i) - break in alignment is observed
when the streak is not parallel
to one of the principal
meridia(horizontal and
vertical).
- the axis, can be determined
by rotating the streak until the
break disappears.

(ii) - width of the streak varies as it is rotated


around the correct axis. It appears narrowest
when the streak aligns with the true axis.

(iii)- Intensity of reflex is brighter when streak


aligns with true axis.
(iv)- Skewing (oblique motion of the streak
reflex)

f. End point of neutralization


- width of reflex widens progressively as
the neutralization is achieved, and at the
end point, streak disappears and the pupil
appears completely illuminated or
completely dark

WET RETINOSCOPY : CYCLOPLEGICS


In Retinoscopy
Paralysis of Accomodation + Dilation of
Pupil.
Used in young children and
hypermetropes where it is suspected
that the accommodation is abnormally
active and hinders exact retinoscopy.
Mydriatics to be used cautiously in
adults with shallow anterior chamber

WET
RETIN
scPY

2%
1%
<5 yrs

1%

0.5%,1
%
MYDRIATIC
>CYCLOPLE
GIC

5-8 yrs

8-20 yrs

1DROP X
10 MIN X6
TIMES

1 DROP X
15 MIN X
6 TIMEES

1DROP
X15MIN X3
TIMES

-do-

60-90MINS

80-90
MINS

20-40 MINS

-do-

AFTER 90
MIN OF 1ST
DROP

AFTER 90
MIN OF
1ST DROP

AFTER 40
MINS

-do-

1020DAYS

48-72 HRS

6-18 HRS

4-6 HRS

-do-

PMT-

AFTR 3
WKS

AFTER 3
DAYS

AFTER 3
DAYS

8
HOURS/NEX
T DAY

-do-

CORRE

1D

0.5 D

0.75 D

XXX

XXX

DOSEPEAK
EFFECT
RETINO
TIMEEFFECT
DURTN

TDS X
3DAYS
2/3
DAYS

4TH DAY

-do-

NEED DR
LIKH KAR
BHEJ DETA
HUN

x
e
fl
Re hi
a
n
i
H
h
k
i
d
a
h
a
r

Beta
Kitne
Der
Lagegi!!!

PROBLEMS IN
RETINOSCOPY

PROBLEMS

RED REFLEX NOT


VISIBLE

CHANGING
RETINOSCOPIC
FINDINGS

SCISSOR
SHADOWS
POSITIVE

CAUSE

SOULTION

1.SMALL PUPIL
2.HAZY MEDIA
3.APHAKIA/HIGH
MYOPIA

1.TRY MYDRIATICS
+CYCLOPLEGICS
COMBINATION
2.REDUCE WORKING
DISTANCE + BRIGHT
SOURCE OF LIGHT
3.TRY LENSES OF HIGH
POWER+/- 7D, IF STILL NOT
,GO HIGHER.

ACCOMODATION USED
BY PATIENTS

FOGGING- -- PLACE A LENS


SUCH THAT VISION
BECOMES 6/60 & THEN
START NEUTRALISING.
V R ACTUALLY TYRING D
CILIARY MUSCLES BY
DOING DIS.

OPT FOR ONE SLIT & ADD


MIXED ABERRATION E.G
LENSES , SLOWLY SLIT
KERATOCONUS
BECOMES EQUAL,THATS IT.
(DIRTY REFRACTION)
NEGATIVE

Uneven wavefront (aKAoptical aberrations) can be because of


aspherical

MEASURING OPTICAL ABERRATIONS

Shack-Hartmann (SH)
aberrometer measures wavefront
objectivel

Subjective
Refraction
Power of spherical and cylindrical
refraction refined based on patient
response
General rule: Maximum Plus for
Maximum Visual Acuity.
Duochrome test:
Based on chromatic aberration; red is
focused more hyperopically than
green; yellow is focused on retina
Letters on both red and green
background should appear equally
clear

SUBJECTIVE REFRACTION
1. Subjective verification of refraction
. By Trial & Error technqiue
. Astigmatic Dial technique
2. Subjective refinement of refraction
. JCC
. Astigmatic Fan test

Jacksons Cross Cylinder

Combination of two spherocylinders: -0.25D sphere &


+0.50D cylinders with axes at
right angles.

Combination of two spherocylinders: -0.25D sphere &


+0.50D cylinders with axes at
right angles.

To determine end-point of
magnitude, place JCC with
axis parallel to the axis of the
cylindrical prescription.

Astigmatic Dial Technique


Fog the eye
Patient asked to look &
identify darkest &sharpest
line in astigmatic dial.
Add minus cylinder
of progressively
increasing power
Axis perpendicular to
the darkest &
sharpest line, till all
lines are clear.
Revert back fogging.

REFERENCES
http://www.slideshare.net/meikocat/Refraction
http://www.eyedocs.co.uk/ophthalmology-learning/articles/o
ptics-and-refraction/1508-retinoscopy-simulator
http://retinoscopy.blogspot.in/
http://books.google.co.in/books?
id=6I6JeDWonhQC&pg=PA2&lpg=PA2&dq=RETINOSCOPY+
WITH+PLANE+MIRROR&source=bl&ots=owV9UpZtAO&sig
=ku6SiYptvYp_qlEbBi-g2YW7izM&hl=en&sa=X&ei=mypU8K5MdeUuASBi4HIDw&ved=0CEkQ6AEwCg#v=onep
age&q=RETINOSCOPY%20WITH%20PLANE
%20MIRROR&f=false
http://www.college-optometrists.org/en/college/museyeum/o
nline_exhibitions/optical_instruments/retinoscopes.cfm

Had dat Referee had 6/6 refined vision ,


Argentina would never hav won 1986 FIFA
HAND OF
WORLD CUP!!!!!

GOD

THANK YOU EVERYONE FOR PATIENTLY LISTENING TO


THIS SEMINAR.

For feedbacks & brickbats plz mail at


ykush@yahoo.co.in./drdhir2014@gmail.com

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