金台診所醫學美容的部落格

✍️ Most retinoscope today use a streak projection system. This streak of light is reflected from a mirror.

✍️ the streak can be moved in relation to a convex lens in the device by way of the sleeve. This allows the light to leave the device as if it were coming from a point behind the retinoscope ( plano mirror setting) which routinely used , or as if it were coming from a point between the examiner and the patient (concave mirror setting).

✍️ For Copeland retinoscopes, the plano position is with the sleeve up, while the Welch Allyn retinoscope is in the plano position with the sleeve down.

✍️ Normally, the examiner will use their right eye to perform retinoscopy on the patient's right eye and their left eye for the patient's left eye.

✍️ The examiner should align themselves just off-center to minimize lens reflections and to allow the patient to visualize the distance target to relax their accommodation.

✍️ The patient should be instructed( from time to time ) to look at a distance target such as a large Snellen letter (20/200-20/400).

✍️ When doing retinoscopy, the examiner is attempting to put the far point of the patient’s eye at the plane of the examiner’s pupil.

✍️ When the reflex shows “against” motion, the far point plane lies between the patient’s eye and the examiner’s eye, indicating myopia.

✍️ When the reflex shows “with” motion, the far point lies outside the interval between (the patient’s eye and the observer’s eye), indicating hyperopia, emmetropia or mild myopia.

✍️ let’s make a Question to be simply understood
If you obtain “with motion” during retinoscopy,

☝️ Where is the far point of the patient ..!???

• in front of the peep hole
• at the peep hole
• beyond the peep hole

Answer: Beyond the peephole. As u r dealing with hypermetrope

✍️ The goal of neutralization is to have the light reflex of the patient’s far point at the peephole.

✍️ The light at the patient’s pupil fills the entire space at once when neutrality is reached.

✍️ “With” motion requires more plus to be added to the prescription to move the far point to neutralization.

✍️ “Against” motion means that the far point is in front of the peephole. Therefore, more minus must be added to move the far point to neutralization.

✅ Retinoscopy step by step

ROOM LIGHTS OFF 💡💡💡

🎾 Ask patient to look at a non-accommodative target distance (green duochrome).

🎾 Compensate your working distance ( if you work at 2/3m, add +1.50 D DS).

🎾 Fog fellow eye with a high plus powered lens to prevent accommodation.

🎾 Aim to be as close to the patient’s visual axis without obscuring their fixation target.

🎾 If your head gets in the way, they are likely to look at it and start accommodating.

🎾 Ask the patient to tell you if this happens.

🎾 Check retinoscopy reflex:

🎾 Identify axis of astigmatism from movement of retinoscopy light as sweep across eye.

🎾 Neutralize reflex in one meridian with DS lenses.

🎾 If reflex is (with) then add PLUS, if (against) then add MINUS.

🎾 When point of reversal is reached in one meridian add cylindrical lenses to neutralize in the other meridian.

🎾 Use Plus or minus cylinders and Be consistent either work with plus or with minus cylindrical lenses.

🎾 If using PLUS cylindrical lenses, correct the most MINUS meridian .

This is identified by: 🍭🍭🍭
🍭 If both reflexes are against, then it is the slower reflex.

🍭 If one is with and one against, then it is the against reflex.

🍭 If both reflexes are with, then it is the faster reflex.

🎾 If using MINUS cylindrical lenses, correct the most PLUS meridian.

This is identified similarly:🍭🍭🍭

🍭 If both reflexes are against, then it is the faster reflex.

🍭 If one is with and one against, then it is the with reflex.

🍭 If both reflexes are with, then it is the slower reflex.

Poor reflex🎱🎱🎱

🎱 Consider media opacity:
optimize illumination🌕
check patient not accommodating on your head.

🎱Consider high refractive error:
use large steps, e.g. ± 5.00 DS or ±10.00 DS.

🎱Consider keratoconus:
if swirling or scissoring reflex or oil drop sign.