Retinoscopy

RETINOSCOPY

With these tests, the refractive error or refractive defect of the patient is determined, without the patient having to...
intervene in the result. This is the most important technique that an optometrist must master,
since, in addition to determining the refractive defect, we also obtain qualitative information from
visual system through the observation of the characteristics of the retinal reflex (intensity of
reflex, intensity oscillations, pupil diameter oscillations, etc.).

GENERALITIES:

It is the objective method for investigating, diagnosing, and evaluating the refractive errors of the eye.
based on the principle of the patient's conjugate foci of the retina and the nodal point of
examiner.

When illuminating the eye with the light of the retinoscope, the retina behaves like a mirror that
absorbs and reflects light to the patient's pupil. This reflex is what the examiner observes and
it is used to determine the refractive state of the patient.

OBJECTIVE

Determining the refractive state for distance vision in cooperative patients

MATERIAL

Retinoscope

Box and trial frame or phoropter (greens)

Optotypes

CHARACTERISTICS OF THE RETINOSCOPE:

There are two types of retinoscope, according to the beam of light they emit.
One in the shape of a dot and the other in the form of a luminous slit. The latter allows observation with
greater clarity of the axis of astigmatism.

WORKING DISTANCE AND DIOPTRIC VALUE TO BE COMPENSATED

66 cm....................................+ 1.50 D
50 cm....................................+ 2.00 D
40 cm....................................+ 2.50 D
33 cm....................................+ 3.00 D
25 cm....................................+ 4.00 D
20 cm....................................+ 5.00 D
 10 cm....................................+ 10.00 D

The optical system of the retinoscope contains a mirror that varies the focuses.
The flat mirror reflects the parallel rays as if they were coming from infinity.
The concave mirror has a focal point that reverses the effect of the reflected rays, which is why the
the movement of shadows is observed opposite to the flat mirror, and is used to confirm the
neutralization point.

CHARACTERISTICS OF RETINOSCOPIC REFLEX

SIZE: In high or medium refractive errors, the reflection is smaller than the diameter.
pupil. At the neutralization point, the pupil becomes full (like a full moon)

INTENSITY: In high ametropias, the reflection is confusing and faint.

SPEED: In high ametropias, the displacement through the pupil is slow.

DIRECTION:
Movement Against = MYOPIA
HYPERMETROPIA

Types of retinoscopy
TYPES OF RETINOSCOPY:

STATIC RETINOSCOPY
DYNAMIC RETINOSCOPY

STATIC RETINOSCOPY

OBJECTIVE:

Determine the objective refraction for distance vision, keeping accommodation at rest.

REQUIREMENTS:

That there is no TROPIA in distant vision.

DYNAMIC RETINOSCOPY

There are 6 types of dynamic retinoscopy, but the most commonly used and widespread technique is the method.
merchandising dynamics and what we will mention in the following item.
 OBJECTIVE:

Determine the objective refraction for distance vision while keeping accommodation active, by fixing
at a close distance.

CHARACTERISTICS:

MONOCULAR;
WITH ACTIVE ACCOMMODATION;
PATIENT FOCUSING ON THE LIGHT OF THE RETINOSCOPE OR THE MAGNETIC FIGURE
HEAD OF THE RETINO;
DONE 40 cm FROM THE PATIENT;
DEDUCT FROM THE FINAL VALUE (-1.25 esf), THIS IS THE ACCOMMODATION LAG
ACCORDING TO THE TABLE;
IT IS A RETINOSCOPY PERFORMED IN SPECIAL CASES, OF CHILDREN
NON-COLLABORATORS, STRABISMUS AND ACCOMMODATIVE PROBLEMS.

REQUIREMENT:

The patient cannot be aphasic.

1. Work distance = choose your work distance according to the length of the
your arm or at a distance that feels comfortable. Keep it constant during the execution
do the exam, since any variation affects the results. This distance must be compensated for
final result through:

•The RL or retinoscope lens is a positive lens, whose diopter value is equal to the inverse of
working distance in meters and this value is taken as the starting point.

If you do not use RL, compensate for the "NEGATIVE AND ALGEBRAIC" work distance of the
lens with which he neutralized the shadows.

Neutralized with + 4.00 - 1.00 X 0º

Neutralized with - 2.00 scoops.

Use reduced ambient light in the cabinet, as it dilates the pupil and helps you see better.
reflection.

3. If using the phoropter or greens: Adjust the chair so that the patient's eyes
be at the same height as their eyes. Place the phoropter in front of the patient with the
respective pupillary distance and adjust the level of the instrument by centering the eyes on the openings.

4. Position the working lenses binocularly according to the working distance.

5. Ask the patient to look over their ear at the letter 'E' on the chart (20/200).

6. Position yourself on the visual axis of the patient's right eye. Observe with your right eye through
from retinoscope the retinal reflex. Keeping both eyes open (examiner). Do not obstruct
with your head the patient's view.

7. Observe the horizontal meridian with the light band of the retinoscope in the vertical position. Do
a gentle horizontal movement and observe the intensity, speed, and direction of the
shadow. Now place the light band of the retinoscope in the horizontal position to observe the
vertical meridian; and with a smooth vertical movement observe the characteristics of the reflection.

8. The direction of the shadows that accompany the reflection compares to the movement that...
performed with the retinoscope.
According to this movement, add:

Positive lenses, if the movement of the light slit to the right generates a shadow that
to accompany to the same side, we say that the shadow is "in favor". The shadow in favor of
retinoscope movement occurs in the case of hyperopia.

Negative lenses, if the movement of the light slit of the retinoscope generates a shadow
opposite to its direction, generating a 'counter' shadow. The counter shadow of the movement of
retinoscope occurs in cases of myopia.

Dynamic Retinoscopy
Dynamic retinoscopy technique
TECHNIQUE:

Merchan Monocular Dynamic Retinoscopy:

Position yourself 40 cm from the patient.

2. Close the left eye and ask the patient to look at the figures of the retinoscope.

3. Observe the movement of the shadow and start the neutralization in steps of 0.25 or of
0.50.

4. The value for distance vision is compensated according to age and according to the table.
continue

AGE COMPENSATION
 Less than 40 -------------------------- 1.25
40–44 -------------------------------- 1.50
45–48 -------------------------------- 1.75
49–52 -------------------------------- 2.00
53–56 -------------------------------- 2.25
57–60 -------------------------------- 2.50
61–64 -------------------------------- 2.75
More than 64 ----------------------------- 3.00

5. Repeat the procedure for the left eye.

6. Generally, this technique develops soon after obtaining the refractive data.
through static retinoscopy, which allows for an objective analysis of the state of the
patient accommodation. Dynamic retinoscopy is 0.50 to 0.75 dpts more plus
that static retinoscopy. If the difference is greater or lesser, it will indicate problems in
accommodation.