Appendix
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Ophthalmology/Optometry

Objective Refraction Technique: Retinoscopy

Retinoscopy is an examination technique that permits objective measurement of the refractive error of the eye. The information gleaned from retinoscopy can help determine the best-corrected visual acuity and may be applied to subjective refraction techniques. Retinoscopy can also provide qualitative data on various underlying ocular pathologies, including cataracts, corneal ectasia, and retinoblastoma. Retinoscopy requires provider training but very little equipment; once proficient, the skilled

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  • Retinoscopy can also provide qualitative data on various underlying ocular pathologies, including cataracts, corneal ectasia, and retinoblastoma.
  • Leukocoria identified during retinoscopy may indicate pediatric cataracts, retinal hamartomas, or retinoblastoma.
  • The Bruckner test may be performed during retinoscopy to determine amblyopia or anisometropia.
  • Primary care practitioners should know critical retinoscopic signs and their triage indications, particularly when practicing in a system characterized by a shortage of specialized eye health professionals.
  • Retinoscopy is an examination technique that permits objective measurement of the refractive error of the eye.
  • The information gleaned from retinoscopy can help determine the best-corrected visual acuity and may be applied to subjective refraction techniques.
  • Retinoscopy can also provide qualitative data on various underlying ocular pathologies, including cataracts, corneal ectasia, and retinoblastoma.
  • Retinoscopy can also detect irregular corneal and lenticular astigmatism, seen as a scissor-like motion of the retinoscope streak.
  • Leukocoria identified during retinoscopy may indicate pediatric cataracts, retinal hamartomas, or retinoblastoma.
  • Objective refraction may be the only way to determine a refractive endpoint in young children or patients with significant ocular deviation.
Mohindra retinoscopy technique
derives final objective values using an algebraic sum of objective findings and a constant factor of -1.25 D from the habitual working distance and resting state of accommodation.
Monocular Estimation Method (MEM)
The impression of an accommodative lag or lead can be derived from the resultant dioptric powers.
Nott dynamic retinoscopy
The distance between the instrument and the patient is used to derive the accommodative response.
Bruckner test
may be performed during retinoscopy to determine amblyopia or anisometropia.
  • Retinoscopy is an examination technique that permits objective measurement of the refractive error of the eye.
  • The information gleaned from retinoscopy can help determine the best-corrected visual acuity and may be applied to subjective refraction techniques.
  • Static retinoscopy can be employed during routine noncycloplegic or cycloplegic objective refraction assessments.
  • Noncycloplegic objective refraction using the retinoscope is carried out while the accommodative facility of the patient remains naturally intact; this is colloquially termed dry retinoscopy.
  • Cycloplegic retinoscopy is performed after the instillation of cycloplegic agents to restrict the natural accommodative response temporarily and may be referred to as wet retinoscopy.
  • Dynamic retinoscopy requires fixation at a near target at a distance less than optical infinity and is employed to determine innate accommodative response to presented stimuli at given distances.
tropicamide
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cyclopentolate
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scopolamine
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homatropine
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atropine
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  • In cases where cycloplegic agents are not indicated or inappropriate, the Mohindra retinoscopy technique may be employed.
  • While the most commonly utilized retinoscopic techniques are the monocular estimation method and the Nott method, other techniques include the Bell, Book, stress point, and binocular cross-cylinder retinoscopic methods.
  • There are no known contraindications to retinoscopy.
  • Refinement of the cylindrical axis can be pursued during a subjective refraction procedure.
  • Lens transposition formulae can convert to plus cylindrical findings following retinoscopy if preferable.
  • Complications of retinoscopy are restricted to cycloplegic agents and may include blurred vision or temporary photophobia; allergic reactions to cycloplegic agents are uncommon.
  • The accuracy of the results from retinoscopy is very dependent on the skill and observation of the examiner.
  • Procedural variation in vertex distance and spectacle plane-to-mirror distance influence objective outcomes.
  • Reflex saccades and involuntary extrinsic ocular movements alter streak orientation.
  • The attention span of the patient undergoing retinoscopy must be adequate to ensure completion of the procedure; retinoscopy may be of limited use in specific populations.
  • Failure to pull the retinoscope sleeve into the correct position can lead to false negative results.
  • General measures of instrument care are essential to avoid misalignment of the internal projecting apparatus or damage to components of the illumination system.
  • Retinoscopists must be aware of atypical reflexive movements, often due to spherical aberrations, astigmatism, or scissoring reflexes.
  • review
    Objective Refraction Technique: Retinoscopy. StatPearls [Internet] — Ehimare S. Enaholo, Mutali J. Musa, Marco Zeppieri — StatPearls Publishing, 2023

Decision support only. Verify against local protocols and current labeling. Source: www.ncbi.nlm.nih.gov