What is retinoscopy?

Retinoscopy is a medical term that literally means “visual examination of the retina”.

 It is technique to obtain an objective measurement of the refractive condition of a

 It is particularly useful in prescribing corrective lenses for patients who are unable to
undergo a subjective refraction that requires a judgment and response from the patient
(such as children or those with severe intellectual disabilities or communication
problems).

 In most tests however, it is used as a basis for further refinement by subjective

 It is also used to evaluate accommodative ability of the eye and detect latent hyperopia.
 Retinoscopy is commonly performed by optometrists, who are health care professionals
licensed to perform eye examinations used to diagnose and treat conditions that affect vision.

How it is done?

 In a dim-lit setting, the examiner uses a retinoscope to shine light into the patient's
eye and observes the reflection (reflex) off the patient's retina.

 While moving the streak or spot of light across the pupil the examiner observes the
relative movement of the reflex then uses a phoropter or manually places lenses over
the eye (using a trial frame and trial lenses) to "neutralize" the reflex.

o By observing the light, an eye doctor can determine one of three possible
conditions.

1. Myopia, or nearsightedness, a patient has difficulty seeing at a distance.

2. Hyperopia, or farsightedness, a patient sees well at distances, but has

3. Emmetropia is the absence of the aforementioned conditions and means

*A retinoscopy determines both the presence and degree of any condition.

*If the doctor determines that either myopia or hyperopia is present, he or she proceeds with
further examination and subjective testing, such as having the patient read an eye chart or fix
her sight on an object from a distance unassisted by corrective lenses. The doctor then provides
corrective working lenses for viewing the same object with either negative or positive powered
lenses. Negative power corrects myopia and positive power corrects hyperopia.

Types of Retinoscopy

1. Static retinoscopy

2. Dynamic retinoscopy

Static Retinoscopy is a type of retinoscopy used in determining a patient's refractive error.

 is performed when the patient has relaxed accommodative status.

 relies on Foucault's principle, which states that “the examiner should simulate optical
infinity to obtain the correct refractive power.”

 Hence, a power corresponding to the working distance is subtracted from the gross
retinoscopy value to give the patient's refractive condition, the working distance lens
being one which has a focal length of the examiner's distance from the patient (e.g.
+2.00 dioptre lens for a 50 cm working distance).

o Myopes display an "against" reflex, which means that the direction of movement
of light observed from the retina is a different direction to that in which the light
beam is swept.

o Hyperopes, on the other hand, display a "with" movement, which means that
the direction of movement of light observed from the retina is the same as that
in which the light beam is swept.

This can be obtained by the patient viewing a distance target or by the use of cycloplegic drugs
(where, for example, a child's lack of reliable fixation of the target can lead to fluctuations in
accommodation and thus the results obtained).

Dynamic retinoscopy is performed when the patient has active accommodation from viewing
a near target.

*Eye exams should be performed in children once every 12 months, and adults should have
their eyes checked by a licensed optometrist at least once every two years barring any vision
problems. Patients who experience a sudden change in vision, blurred vision, or headaches
should see an optometrist, who may refer the patient to an ophthalmologist, a medical doctor
specializing in the care and treatment of the eyes.

DEFINITION OF TERMS

1. Refractive condition- the working distance lens being one which has a focal length of the
examiner's distance from the patient
2. Retinoscope -is a tool that uses light refracted off the pupil to help the doctor determine
whether a patient needs corrective lenses.
3. Phoropter- an instrument used during an eye examination to measure refractive error
and determine eyeglass prescriptions.

*Typically, the patient sits behind the phoropter, and looks through it at an eye chart. The
optometrist then changes lenses and other settings, while asking the patient for feedback on
which settings give the best vision.

4. Optical Infinity-In optics, it is the region from which a point on an object sends rays of
light which are considered to be parallel onto an optical system. Consequently it forms a
clear image in the focal plane of that system. In clinical optometry, 6 metres is usually
regarded as infinity.
 5. Cycloplegic Drugs- are generally muscarinic receptor blockers. These include atropine,
cyclopentolate, homatropine, scopolamine and tropicamide. They are indicated for use in
cycloplegic refractions and the treatment of uveitis.
6. Accommodation- is the process by which the vertebrate eye changes optical power to
maintain a clear image (focus) on an object as its distance changes.

Sources:

http://en.wikipedia.org/wiki/Retinoscopy

http://www.wisegeek.com/what-is-a-retinoscopy.htm