Scribd
Upload
24 views37 pages

Dynamic Retinos

The document outlines the course on Dynamic Retinoscopy, focusing on its learning objectives, types, procedures, and interpretations. It covers various methods such as MEM, Nott, and Bell retinoscopy, detailing how to assess accommodative responses and diagnose visual anomalies. Additionally, it discusses sources of error and provides references for further reading.

Uploaded by

atharhabibshahani335
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
24 views37 pages

Dynamic Retinos

The document outlines the course on Dynamic Retinoscopy, focusing on its learning objectives, types, procedures, and interpretations. It covers various methods such as MEM, Nott, and Bell retinoscopy, detailing how to assess accommodative responses and diagnose visual anomalies. Additionally, it discusses sources of error and provides references for further reading.

Uploaded by

atharhabibshahani335
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 37

ADVANCE REFRACTION AND VISUAL

FUNCTIONS
Course Code: OD-133
Lecture by
Rabia Saeed
Lecturer, DOVS-FAHS
DYNAMIC RETINOSCOPY

Learning Objectives:

Students will learn about


• Dynamic retinoscopy
• Types of dynamic retinoscopy
• Source of Error
DYNAMIC RETINOSCOPY

• The refractive status is determined while the


subject fixates an object at some closer distance usually at
or near the plane of retinoscope itself with
accommodation under action.
• For measuring the amplitude of accomodation
• For measuring the accomodative lag
• Diagnosing binocular anomalies
• Helpful in retinoscopy of infants and toddlers.
• Primarily used to confirm suspected cases of
vergence and accommodative dysfunction.
• Also useful to tell whether a patient is over or under
corrected.
• Eye exam in which a patient has near complaint.
• Latent hyperopia
• Accomodative spasm
• Record near complaints(near
blur,asthenopia,diplopia,headache)
• It reveals the stability or degree of fluctuation of
accommodative system
Movement reflex
• With motion: eye conjugate to the point behind the
retino
• Against motion: eye conjugate to the point between eye and
the retino
• Neutralized: eye conjugate with the retino
Accommodative response
• It is a measure of actual accomodation that is present
• If your accomodative system like to hang out
• Right on the target:accmodative response=stimulus
• In front of the target:accomodative
response>stimulus(accomodative lead)
• Behind the target:accomodative response<stimulus
(accomodative lag)
• The dioptric value in which accommodative
stimulus exceeded the accommodative response
Types of Dynamic Retinoscopy
• MEM retinoscopy
• Nott retinoscopy
• Bell retinoscopy
• Book retinoscopy
• Cross retinoscopy
• Sheard’s Retinoscopy
• Tait Retinoscopy
• Near retinoscopy by Mahindra
• Lens bar retinoscopy
• Cromo retinoscopy
• Radical retinoscopy
• String retinoscopy
MEM (Monocular Estimate Method)
Clinician neutralize the reflex of the eye while patient
accommodates to fixate a target at near usually at 40cm.
Materials:
• Series of cards with a central aperture mounted on a
retinoscope.
• Cards have printed letters or words, or pictures that
range in size from 20/160 (6/120) to 20/30 (6/9).
• Arranged around the aperture.
PROCEDURE

• Instructed to keep the targets clear


• Sweeps the retinoscope beam
• Observes the motion the retinoscopy reflex
• Quickly changed a trial lenses at the spectacle plane.
INTERPRETATION
Lag of accommodation is the amount of plus lens that
neutralized the reflex.
The lens that creates neutrality is the value of the
accommodative lag/lead
Record lag as net (+) and lead as net (-)
NOTT RETINOSCOPY

• Patients wears best correction


• Target at 40 cm is fixated
• Examiner moves towards or away from the target till
neutrality occurs
INTERPRETATION
• Dioptric distance between these two gives lag of
accommodation
• D from target to spectacle plane= 40cm
• D from retino to spectacle plane =50 cm
• Lag of accommodation = 2.50 -2
• = 0.50
Bell Retinoscopy
• This procedure was named for the small shiny bell dangling
from a string.
• Was used as a fixation target. In practice the bell has
generally been replaced with a wolf wand (shiny gold
1/2inches metal ball mounted on the end of rod) the wand
is held by examiner and the midway between the two
eyes.
PROCEDURE
• The ball will be moved closer to and fro from the
Patient- slower then 2 inches/second.
Retinoscope is positioned at a fixed distance of 50cm
(20 inches).
Patients fixates the target and the examiner notes the
direction of reflex.
Target is moved closer to the patient there will be the
point where the motion changes from “with” to against.
• Target is moved closer to patient till with to against
movement is observed (inward shift)
• Target is moved away from patient till against to with
movement is observed (outward shift)
• 35-42 cm for inward (with to against)
• 37cm to 45cm for outward (against to with)
• If not in the range add plus lenses thus determining the
accommodative lag
Sources of error
• Scissoring reflex
• Small pupil
• Dim media
• Distance
BOOK RETINOSCOPY
Also known as getman retinoscopy

PROCEDURE:
Patient is given reading material
Retinoscope is performed as the subject reads aloud
Information is gathered in real time with a task that is
close to their normal work situation.
The response level with this technique can be described
by the following.
A. Free reading level- Desirable, reflex varies from
neutral to with
B. Instructional level- more demanding than the free
reading level, reflex is a varying fast against motion.
C. Frustration level- Even though the subject is
focused on the page he is not interpreting the
information properly, slow against motion.
• Reflex color is bright and white when words are
understood.
• Reflex color is more pink and dims slightly if the
patient is struggling to comprehend a word or
passage.
• Reflex color is dull and brick colored when the
patient has given up on comprehending a word or
reading passage.
CROSS RETINOSCOPY
Andraw J. Cross (1911)
Start with static retinoscopy findings.
Patient made to view target at 40cm.
Remove the working distance lens- retinoscopy with
motion.
Examiner performs retinoscopy adding plus lens till
neutrality.
A alternative to cycloplegic refraction.
SHEARD’S METHOD

Charles sheard (1920)


Introduced the concept of “ Lag of accommodation”.
Add plus lens power until neutrality occurred.
Normal range of lag +0.25- +0.75.
PROCEDURE

Use reading distance as working distance for dynamic


retinoscopy.
Add plus lens until obtained the neutrality.
Immediately stop adding plus lens once obtained the
neutral motion.
Subs tract 0.50 from the dynamic retinoscopy finding.
EXAMPLE

Static retinoscopy= +3.25/-1.25* 20


Dynamics retinoscopy + 4.50/-1.50*20
Dynamic finding= +1.25
Lag of accommodation= +0.75
TAIT’S METHOD

Working distance= 33cm


Fogging with considerable amount of plus lens power and
than approaches neutral by reducing the plus lens power.
Found an average of approximately +1.25 D more than
sheard’s system, thus total lag of accommodation= +2.25
D.
Mohindra (Near Retinoscopy)
Near retinoscopy by mohindra in 1977.
For use in determining the refractive state of infants
and children.
The stimulus or fixation is the dimmed light source of
the retinoscope in a darkened room.
The retinoscope is held at a distance of 50cm with
hand held trail lenses.
It is monocular procedure that is eye not being
examined is occluded.
REFERENCES
• Internet
• Clinical optics by AK Khurana
• Clinical optics by Elkington
• Clinical optics by American Academy

You might also like