Ophthal PG RETINOSCOPY Brief

1. RETINOSCOPY
Dr.Asif Ullah Siddiqui
MS 1st Year
Department of Ophthalmology
Shadan Institute of Medical Sciences
Dr. Ritika Kishore
MS 1st Year
Department of Ophthalmology
Sharda Institute of Medical Sciences
Dr. Ritika Kishore
MS 1st Year
Department of Ophthalmology
School of Medical Sciences and Research, Sharda Hospital

2. Definition & Principle
It is an objective method of finding the
refractive error based on the principle of
neutralization.
When the light of retinoscope is reflected
into the eye, the direction in which light
will travel in the pupillary area depends
on the refractive status of the eye.
Retinoscopy is also caled as skiascopy,
pupillocopy, shadowscopy, umbrascopy,
scotoscopy.

3. History
Sir William Bowman - in 1859 observed linear fundus
reflex using a Helmholtz ophthalmscope.
Ferdinand Cuignet - in 1873 classified variable reflexes
into myopia, hyperopia and astigmatism. also gave
misleading term "keratoscopie" to his technique.
Edmond Landolt - suggested the source of reflex is
fundus rather than cornea.
M.Mengin - in 1878 published accurate explanation,
proving Landolt's suggestion.
H.Parent - in 1880 introduced quantitative refraction
test, measuring the exact amount of refractive error
using lenses. also coined the term "retinoscopie".
Jack C.Copeland - in early 1920s introduced streak
retinoscope, he is known as father of streak
retinoscopy.
Hand held retinoscopes began to be overtaken in 1970s
by Auto refractors making use of infra-red light.

4. Prerequisites for Retinoscopy
1. Darkroom preferably 6 m long, or which can
be converted into 6 m by use of a plane
mirror.
2. Trial box containing spherical and cylindrical
lenses of variable plus and minus powers, a
pinhole, an occluder and prisms.
3. Trial frame preferably adjustable type which
can be used in children as well as in adults.
4. Vision box, A Snellen’s self illuminated
vision box.
5. Retinoscope.

5. Types of Retinoscopes
Mirror Retinoscope:
Cheaper.
Source of light – External.
Mirror – plane or pristley-smith mirror i.e, combination of
plane and concave mirrors.
Self-illuminated Retinoscope:
Costly but handy.
Spot retinoscope and Streak retinoscope
Streak retinoscope is more popular, in it the usual
circular beam of light is modified into a linear streak, it
uses planocylindrical retinoscopy mirror and is more
sensitive in detecting astigmatism.
Generally a Plane mirror is used for retinoscopy. In patients
with hazy media and high degree of ametropia concave
mirror is more useful.

7. Parts of a Retinoscope
Retinoscope consists of a Head, Neck
and Tail.
Observing the optics of retinocope we
find two main systems
◦ Projection system
Light source
Condensing lens
Focusing sleeve
Current source
◦ Observation system
Peep hole

8. Types of Retinoscopy
Dry Retinoscopy
◦ Done without the use of cycloplegic drugs.
◦ Done in elderly individuals.
Wet Retinoscopy
◦ Done with the use of cycloplegic drugs.
◦ Done in children and young adults.
Static Retinoscopy
◦ Done by relaxing the accommodation by cycloplegic drugs or by
asking the patient to look at a distant target.
◦ Done in elderly and young adults.
Dynamic Retinoscopy
◦ Done by the use of active accommodation by asking the patient to
look at a near target.
◦ Done rarely in clinical practice.

9. Use of cycloplegics in retinoscopy
Cycloplegics are drugs which cause
paralysis of accommodation and dilate
pupil , used in retinoscopy when
accommodation is suspected
abnormally active and will hinder exact
retinoscopy.
Such situation is seen in children and
hypermetropes.

10. Mydriatics and Cycloplegic Agents in Retinoscopy

11. Procedure
The examiner sits at a distance of 1 m
from the patient.
Light is thrown into the patients eye
and the examiner observes the
movement of red reflex in the pupillary
area in both horizontal and vertical
meridians by moving the retinoscope.

12. Procedure:
The results are interpreted as:
Movement of red reflex with the movement of the
retinoscope – Emmetropia, Hypermetropia, Myopia <1D
Movement of the red reflex opposite to the movement of
the retinoscope – Myopia >1D
No movement of red reflex – Myopia of 1D

13. Neutralization
When the red glow in the pupil doesn’t move
the patient has myopia of 1 D.
When the red glow moves with the movement
of the plane mirror or when the red glow
moves against the movement of the plane
mirror, the observer has to estimate the
degree of refractive error by neutralizing the
movement.
By addition of increasingly convex (+)
spherical lenses when movement is with the
plane mirror or concave (-) spherical lenses
when movement is against the plane mirror.
If its simple spherical error, the movement of
the red reflex will be neutralized in both
vertical and horizontal meridian.

14. Neutralization
In astigmatic refractive error, one meridian is
neutralized by adding appropriate cylindrical lens
with its axis at right angle to the meridian to be
neutralized.
Examples:

15. THANK YOU!