1. retinoscopy
Presentor:-
Dr.Pushkar Dhir
Moderator :-
Dr. Jyoti Puri

2. OPD -EXPERIENCE

3. 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

5. REFRACTION SUBJECTIVE OBJECTIVE DRY :- Without Cycloplegics
(what is done by the clinician)
SUBJECTIVE
(refininng obj.refractn to maximize VA)
JCC
DUOCHROME
TEST
ASTIGMATIC
FAN
BINOCULAR
BALANCING
RETINOSCOPY
AUTO.REF
KERATOMETRY
ABERROMETRY
DRY :- Without Cycloplegics
WET:- With Cycloplegics
DYNAMIC:- With Accomodation

6. The only way to assess the refractive error
Started by Bownman in 1859
Also known as:-
Shadow test
Skiascopy
Pupilloscopy
Korescopy
The only way to assess the refractive error
in infants, small children, illiterates, uncooperative
patients with speech loss
patients who speak a different language.
Introduced quantitative
refraction test.
Made possible to measure
exact amount of refractive
error using lenses.
Termed retinoscopie. 

7. OPTICS OF RETINOSCOPY
ILLUMINATION
STAGE
REFLEX
PROJECTION
Fundal area illuminated by the light reflected into the patient’s 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

9. Advantages of streak - D GOOD OLD DAYZZ DR.SHASHI Undilated pupil
More accurate
Astigmatism
Axis of the astigmatism

10. APHAKIA- DULL GLOW
HIGH MYOPIA- STREAK NOT VISIBLE

11. VIDEO (on u tube)

12. TYPES OF RETINOSCOPES Lister Reflecting Priestley Smith Reflecting
Self Illuminating Retinoscope
Spot Retinoscope
Streak retinoscope

13. Time to charge ur laptop

14. ~ 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 patient’s 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.

15. (with working distance at 1 metre)
Movement
(with working distance at 1 metre)
Against
Myopia >1D
With
Emmetropia
Hypermetropia
Myopia <1D
No movement
Myopia =1D

16. Size, Speed & Brilliance
WHAT TO ASSES?
Size, Speed & Brilliance
Small (Narrow)
Fast &
Brighter
Low Refractive Error
Large (Wide)
Slow & Dim
(Faint Glow)
High Refractive Error
Hazy Media

17. DEMONSTARTION http://www. eyedocs. co

18. Neutralization of red reflex : in Streak Retinoscope
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.
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.

19. (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)

20. 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

21. 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

22. MYDRIATIC >CYCLOPLEGIC
WET RETINscPY
<5 yrs
5-8 yrs
8-20 yrs
MYDRIATIC >CYCLOPLEGIC
-do-
DOSE-
TDS X 3DAYS
1DROP X 10 MIN X6 TIMES
1 DROP X 15 MIN X 6 TIMEES
1DROP X15MIN X3 TIMES
PEAK EFFECT
2/3 DAYS
60-90MINS
80-90 MINS
20-40 MINS
RETINO TIME-
4TH DAY
AFTER 90 MIN OF 1ST DROP
AFTER 40 MINS
EFFECT DURTN
10-20DAYS
48-72 HRS
6-18 HRS
4-6 HRS
PMT-
AFTR 3 WKS
AFTER 3 DAYS
8 HOURS/NEXT DAY
CORRECTION- 1D
0.5 D
0.75 D
XXX 2% 1%
0.5%,1% 1%

23. Beta Kitne Der Lagegi!!! Reflex Hi nahi dikh raha
NEED DR LIKH KAR BHEJ DETA HUN
Beta Kitne Der Lagegi!!!
Reflex Hi nahi dikh raha
PROBLEMS IN RETINOSCOPY

24. PROBLEMS CAUSE SOULTION
RED REFLEX NOT VISIBLE
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.
CHANGING RETINOSCOPIC FINDINGS
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.
SCISSOR
SHADOWS
MIXED ABERRATION E.G KERATOCONUS
OPT FOR ONE SLIT & ADD LENSES , SLOWLY SLIT BECOMES EQUAL,THAT’S IT.
(DIRTY REFRACTION)
POSITIVE
SPHERICAL
ABERRATIONS
NEGATIVE
ABERRATION

25. Uneven wavefront (aKA“optical aberrations”) can be because of aspherical
corneal, lens & retina or uneven thickness of tear film

26. MEASURING OPTICAL ABERRATIONS
Shack-Hartmann (SH) aberrometer measures wavefront objectivel

27. 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

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

29. Jacksons Cross Cylinder
Combination of two sphero-cylinders: -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.

31. 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.

32. REFERENCES http://www.slideshare.net/meikocat/Refraction

33. Had dat Referee had 6/6 refined vision , Argentina would never hav won 1986 FIFA WORLD CUP!!!!!
HAND OF GOD
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