retinoscopy
TRANSCRIPT
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Presentor:-Dr.Pushkar Dhir
Moderator :-Dr. Jyoti Puri
RETINOSCOPY
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OPD -EXPERIENCE
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• 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
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ASTIGMATIC FAN
OBJECTIVE(what is done by the clinician)
SUBJECTIVE(refininng obj.refractn to maximize VA)
AUTO.REF
DUOCHROME TEST
ABERROMETRYKERATOMETRYRETINOSCOPY
REFRACTION
BINOCULAR BALANCING
JCC
DRY :- Without CycloplegicsWET:- With CycloplegicsDYNAMIC:- With Accomodation
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• 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.
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OPTICS OF RETINOSCOPY
ILLUMINATIONSTAGE
REFLEX STAGE
PROJECTIONSTAGE
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
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Advantages of streak -Undilated pupilMore accurateAstigmatism Axis of the astigmatism
D GOOD OLD DAYZZ
DR.SHASHI
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APHAKIA- DULL GLOW
HIGH MYOPIA- STREAK NOT VISIBLE
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VIDEO(on u tube)
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TYPES OF RETINOSCOPES
Lister Reflecting Retinoscope
Priestley Smith ReflectingRetinoscope
Self Illuminating Retinoscope
Spot RetinoscopeStreak retinoscope
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• Time to charge ur laptop
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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.
~ 50 cms
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Movement(with working distance at 1 metre)
Against
Myopia >1D
With
Emmetropia
Hypermetropia
Myopia
<1D
No movement
Myopia =1D
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WHAT TO ASSES?
Size, Speed & Brilliance
Small (Narrow) Fast & Brighter
Low Refractive Error
Large (Wide) Slow & Dim (Faint Glow)
High Refractive Error
Hazy Media
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DEMONSTARTIONhttp://www.eyedocs.co.uk/ophthalmology-learning/articles/optics-and-refraction/1508-retinoscopy-simulator
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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.
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.
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(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)
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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
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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
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WET RETINsc
PY
<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
TIMEES1DROP X15MIN
X3 TIMES -do-
PEAK EFFECT
2/3 DAYS 60-90MINS 80-90 MINS 20-40 MINS -do-
RETINO TIME- 4TH DAY
AFTER 90 MIN OF 1ST
DROP
AFTER 90 MIN OF 1ST
DROPAFTER 40 MINS -do-
EFFECT DURTN
10-20DAYS 48-72 HRS 6-18 HRS 4-6 HRS -do-
PMT- AFTR 3 WKS
AFTER 3 DAYS
AFTER 3 DAYS
8 HOURS/NEXT DAY -do-
CORRECTION-
1D 0.5 D 0.75 D XXX XXX
0.5%,1%
2%
1%1%
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Beta Kitne Der
Lagegi!!!
Reflex Hi
nahi dikh
raha
NEED DR LIKH KAR BHEJ
DETA HUN
PROBLEMS IN RETINOSCOPY
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PROBLEMS CAUSE SOULTION
RED REFLEX NOT VISIBLE1.SMALL PUPIL2.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 SPHERICAL ABERRATION
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Uneven wavefront (aKA“optical aberrations”) can be because of asphericalcorneal, lens & retina or uneven thickness of tear film
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MEASURING OPTICAL ABERRATIONS
• Shack-Hartmann (SH) aberrometer measures wavefront objectivel
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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
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SUBJECTIVE REFRACTION
1. Subjective verification of refraction By Trial & Error technqiue Astigmatic Dial technique
2. Subjective refinement of refraction JCC Astigmatic Fan test
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• Combination of two sphero-cylinders: -0.25D sphere & +0.50D cylinders with axes at right angles.
• 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.
Jacksons Cross Cylinder
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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.
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REFERENCES• http://www.slideshare.net/meikocat/Refraction• http://www.eyedocs.co.uk/ophthalmology-learning/articles/opti
cs-and-refraction/1508-retinoscopy-simulator• http://retinoscopy.blogspot.in/
• http://books.google.co.in/books?id=6I6JeDWonhQC&pg=PA2&lpg=PA2&dq=RETINOSCOPY+WITH+PLANE+MIRROR&source=bl&ots=owV9UpZtAO&sig=ku6SiYptvYp_qlEbBi-g2YW7izM&hl=en&sa=X&ei=-mypU8K5MdeUuASBi4HIDw&ved=0CEkQ6AEwCg#v=onepage&q=RETINOSCOPY%20WITH%20PLANE%20MIRROR&f=false
• http://www.college-optometrists.org/en/college/museyeum/online_exhibitions/optical_instruments/retinoscopes.cfm
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Had dat Referee had 6/6 refined vision , Argentina would never hav won 1986 FIFA WORLD CUP!!!!!
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