UNIVERSITY OF LA SALLE

FACULTY OF HEALTH SCIENCES

OPTOMETRY PROGRAM
LABORATORY II RETINOSCOPY
BASIC OPTOMETRIC CLINIC

RETINOSCOPY

OBJECTIVE: Determine the ocular refractive state through observation and

neutralization of the pupillary light reflex is expressed in diopters.
Objective test based on the law of conjugated lenses, in which the remote point
the patient's corresponds with the hole of the retinoscope.
INDICATIONS: Collaborating patient without strabismus in distance vision.

Generalities
Retinoscopy is based on the observation made by the optometrist, without having
consider the patient's assessments.

Static retinoscopy:
Technique and notation
1. Place the subject correctly and comfortably in the test frame or the
foropter, adjusting the distance between the pupils for distance.
2. Dim the living room light.
3. Position yourself at the distance you want to work, maintain the distance.
constant throughout the exam.
4. The subject must keep both eyes open. When using the phoropter, it
you can place the retinoscopic lens (auxiliary lens control) to
obtain the net retinoscopy directly. In case of using a frame of
tests, a positive lens can be placed with the value of the inverse of the
working distance.
The working distance is compensated as follows, always from
negative way
- 60 cm, compensates 1.50D
- 50 cm, offset 2.00D
40 cm, compensates 2.50D
5. Project the optotype of 20/200. Position yourself laterally so that the
the subject can see the optotype with the unexamined eye. To carry out the
retinoscopy of the right eye, the examiner will use the right eye.
6. Identify the type of shadow, direct or inverse. Identify if the defect is
spherical or cylindrical, if possible determine the most ametropic meridian,
focusing on the speed, width, and brightness of the shadows.
7. Neutralize the shadows with spherical and cylindrical lenses if necessary.
As the phoropter only has negative cylinders, it is required
first neutralize with spherical lenses the less myopic meridian
or more hypermetropic, that is to say, the fastest, brightest, and widest shadow in
if it were inverse; or the slowest, faintest, and narrowest if it were direct.
8. Once a meridian has been neutralized with spherical lenses, rotate the strip of the
retinoscope at 90° and identify the presence or absence of shadows. If there is a point
neutral the test has finished and it is a spherical ametropia. Yes it is
they identify shadows, which can be inverse (if the first has been chosen well.
meridian to neutralize) or direct (otherwise).
 [Link] the result in the form of a spherocylindrical formula in the history
clinic, each eye separately, with its respective visual acuity.
12. Repeat the procedure for the left eye.

If you work without a retinoscope, the patient's refractive error is:

Total value of the sphere found in front of the eyes upon neutralizing
the retinoscopy–Working distance in diopters = Final data of the
sphere, the cylinder does not change nor the axis.
If working with retinoscopic lens, the patient's refractive error is:
Total value of the sphere found in front of the eyes when neutralizing
retinoscopy –Retinoscopic Lens = Final data of the
retinoscopy.

Monocular Dynamic Retinoscopy of Merchán

The patient must be focusing on a near point, cannot be aphakic and not be
under the effect of cycloplegia.

Technique and Annotation

1. First, examine the patient's right eye, positioning yourself on the right side and
holding the retinoscope with the right hand.
Examiner located 40 cm away.
3. Occlude the right eye and ask the patient to look at the figures of the retinoscope.
4. Add lens (-) until movement is observed with or direct.
5. Evaluate first the most positive or least negative meridian.
6. Decrease lens (-) in steps of 0.25D until the last movement is obtained.
with direct, or the movement with direct faster.
7. Rotate the band 90° and neutralize that meridian.
8. The value found is the Gross Dynamic.
9. Dynamic Gross - Compensation according to the table = Dynamic Net, which
it is equivalent to long-distance refraction.
10. With the value of the Net Dynamic take the visual acuity.
[Link] the result in the form of a spherical-cylindrical formula in the history
clinic, each eye separately, with its respective visual acuity.
12. Repeat the procedure for the left eye, occluding the right eye.

COMPENSATION TABLE ACCORDING TO AGE

AGE COMPENSATION

Less than 40 1.25

40 - 43 1.25

43 - 46 1.50

46 - 49 1.75

49 - 54 2.00

54 - 58 2.25

58 - 62 2.50

Over 62 2.75
Technique and Annotation
1. Choose the most suitable medication for the patient according to age, the
visual problem and the visual demand of the patient. Instill the drug of
according to the dosage and wait for the effect before performing the examination.
2. Ensure that there is no accommodation by asking the patient to read, if not
The accommodation is stopped.
3. Occlude the patient's right eye. Ask the patient to look at the figures of the
retinoscope.
4. Neutralize the retinoscopic reflex by the conventional method. It is not
It is necessary to myopize since the patient has paralyzed accommodation.
5. Calculate the net value of the refraction, compensating for the distance of
work.
6. Measure visual acuity for distance vision monocularly.
7. Repeat the procedure for the left eye, excluding the right eye.
8. Record the data in the medical history, in a monocular manner noting the
visual acuity achieved.
9. When giving the correction, a factor must be taken into account.
corrector on the spherical power that is added to the found value,
the tone should be adjusted according to the medication used:
- Cyclopentolate: Tone = -0.50D
Tropicamide: Tone = -0.25D
10. Inform the patient about the inconveniences that this test entails:
photophobia and inability to focus on nearby objects. In the case of children
In small children, it can present as: daze, drowsiness, irritability;
effects that disappear in a few hours.

Radical Retinoscopy
Useful for patients with reduced retinal reflex due to very high refractive errors
or when there are opacities in refracting media, which makes it necessary
modify the working distance and/or the examiner's angle of observation.

Technique and Annotation

1. First examine the patient's OD, positioning yourself on the right side and
holding the retinoscope with the right hand.
2. Modify the working distance, if this is not enough, modify the
angle of observation, looking for the point where there is greater clarity of
retinal reflection in order to define the direction of the shadows, also
You can modify the retinoscope mirror from plano to concave to see if
the retinoscopic reflection is observed.
3. Neutralize the refractive defect.
4. To the obtained value, compensate for the working distance (inverse of the
distance in diopters.
5. With the previous result, take the visual acuity.
6. Repeat the procedure for the left eye.
7. Record the data in the medical history, in a monocular manner noting the
visual acuity achieved.

Mohindra Retinoscopy
For assessment in cases where refraction is difficult, for example, in
small children, with this it is possible to minimize accommodation without requiring
cycloplegics.
 5. Ask the patient or call their attention to fixate on the light of the retinoscope,
in case the patient is very small, Mohindra says that the
the fixation must be reinforced by attracting attention with noises during the
procedure, another way to maintain prolonged fixation consists of
to carry out the procedure while they provide the bottle.
6. Neutralize the movements in the main meridians with rules
esophageal or loose lenses.
7. The refractive error is determined by the compensation of -1.25 Dpt.
the thick spherical power obtained in children aged 18 months or older. This
it is an empirical value that assumes the value of the accommodation in state
the resting is 0.75 Dpt.
8. If the child is under 18 months, then a compensation of -0.75 Dpt must be applied.
thick spherical power.

TAIT RETINOSCOPY
Position yourself 30 cm from the patient.
Ask the patient to look at the light of the retinoscope or the figures that are
they find in the.
Add positive lens binocularly until achieving movement against
in both meridians.
Gradually reduce the positive power of the OD until both are neutralized.
meridians., simultaneously reduce the positive power in the OI for
avoid variations in the acc-conv relationship that could cause diplopia.
Additions +0.25 D to the last movement against and register as dynamic
big.
In patients over 40 years old, I compensate arbitrarily 1.50 D to the
Dynamic Gross to obtain the approximate Dynamic Net.
In patients under 40 years of age, measure the vertical foria induced by the
Approximate net dynamic and compensate with prisms if there are any.
What is the horizontal thrust induced by the approximate Net Dynamic, in VL
and in VP at 33 cm to find the Pexo (physiological exophoria).
Modify the value of the Gross Dynamic, according to the result of the Pexo.
compensating according to the table shown below.
- The final result is known as Net Dynamic and will be the correction.
attempt from afar.
Repeat the same procedure for the OI.

VALUE P exo COMPENSATION IN D

0–6 1.50
8 1.75
10 2.00
12 2.25
14 2.50
16 2.75
18 3.00
 UNIVERSITY OF LA SALLE
FACULTY OF HEALTH SCIENCES
Optometry Program
Basic Optometric Clinic
WORKSHOP N° 5

OBJECTIVE

Perform static retinoscopy. to a patient, to objectively determine the defect

refractive, KEEPING THE ACCOMMODATION RELAXED.

According to the learned knowledge:

Perform retinoscopy on both eyes of a patient (partner),
WITHOUT RETINOSCOPIC LENS conforming to 50cms.
GROSS VALUE: OD______________________________
HI______________________________
NET WORTH: OD _____________________________ AV _______
HI _____________________________ AV _______

WITH RETINOSCOPIC LENS of +2.00 at 50 cm with test box

GROSS VALUE: OD______________________________
HI______________________________
NET WORTH OD _____________________________ AV _______
HI _____________________________ AV _______

2. According to the result obtained, interpret whether it is: normal ______ or abnormal _______

3. Registre el dato de la Agudeza Visual: OD ___________ OI ___________

4. Registre el dato encontrado en la queratometría: OD_______________ OI _____________

Total expected refractive astigmatism: OD ____________

6. Is there a correlation between keratometry and retinoscopy? YES _______ NO _______

7. According to the response, argue the result and justify it:

8. Note the information found in the Medical History

9. According to the result, propose:

a. Continue with the exam. If____ No______

b. Should it review or do complementary tests? If ______ No _______

c. If so. What is/are __________________________________________________

c. Explain why?________________________________________________________

Independent work

According to the workshop parameters, I have completed:

1. At 5 Clinical histories: add 3 static retinoscopies with a phoropter and without a lens
retinoscopic and two with a test box with retinoscopic lens.
2. Ask the necessary questions to clarify any doubts that arose while carrying out your practice.
clinic.

NOTE: Any concerns should be referred to the discipline books or the recommended bibliography.
the Syllabus.
 UNIVERSITY OF LA SALLE
FACULTY OF HEALTH SCIENCES
OPTOMETRY PROGRAM
Basic Optometric Clinic
WORKSHOP No. 6

OBJECTIVE

Perform the MOHINDRA RETINOSCOPY on a patient to objectively determine the defect.

refractive.

According to the acquired learning:

Perform retinoscopy on both eyes of a patient (companion),

GROSS VALUE: OD______________________________

HI______________________________
NET WORTH: OD _____________________________ AV _______
HI _____________________________ AV _______

2. According to the result obtained, interpret if it is: normal ______ or abnormal _______

3. Registre el dato de la Agudeza Visual: OD ___________ OI ___________

_______________

Total expected refractive astigmatism: OD ____________

6. Is there a correlation between keratometry and retinoscopy? YES _______ NO _______

7. According to the response, argue the result and justify it:

8. Note the information found in the Medical History

9. According to the result, propose:

d. Continue with the exam. If____ No______

e. Should you review or do complementary tests? Yes ______ No _______

c. If so. What is/are________________________________________________

f. Explain why?________________________________________________________

Independent Work

According to the workshop parameters, I carried out:

At 5 Clinical histories: add 3 Mohindra retinoscopies.

2. Ask the necessary questions to clarify any doubts that arise while performing your practice.
clinic.

NOTE: Any concerns should be referred to the disciplinary books or the recommended bibliography in
the Syllabus.
 UNIVERSITY OF LA SALLE
FACULTY OF HEALTH SCIENCES
Optometry Program
Basic Optometric Clinic
WORKSHOP N°7
RETINOSCOPY UNDER CYCLOPLEGIA

OBJECTIVE
Perform retinoscopy by applying a cycloplegic to a patient, in order to determine OBJECTIVELY
the refractive defect, with accommodation paralyzed and with the patient's collaboration.

According to the acquired learning:

1. Note Habitual Visual Acuity Right Eye _________ Left Eye _________
VP OD ________ OI __________
2. Profundidad de la cámara: OD ____________ OI ____________

3. Perform retinoscopy under cycloplegia, with cyclopentolate 1 drop in the non-dominant eye.
patient (partner). Wait until he/she cannot read at near vision.
Conforopter
OD _____________________________ AV _______
HI _____________________________ AV _______

4. Record the data found in the dynamic retinoscopy OD ____________ OI ___________

5. Compare the two retinoscopies and justify__________________________________________

________________________________________________________________________

6. Perform the subjective refraction under cycloplegia in both eyes of a patient (partner) and note:
Compensation according to cycloplegic ______________________
Final formula: OD ________________________ HI ________________________

7. Is there a correlation between Keratometry, Static Retinoscopy and low cycloplegia? YES _______ NO
______

8. According to the answer, argue the result and justify it:

9. Note the data found in the Medical History

10. According to the result, propose:

g. Continue with the exam. If____ No______

h. Should additional tests be reviewed or done? If ______ No _______

c. If so, what is/are ________________________________________________

d. Explain why?________________________________________________________

INDEPENDENT WORK

According to the parameters of the workshop, I carried out:

Ask the necessary questions to clarify the doubts generated when carrying out your practice.
clinic.
 UNIVERSITY OF LA SALLE
SCHOOL OF HEALTH SCIENCES
OPTOMETRIC CLINICAL AREA
Basic Optometric Clinic
WORKSHOP N° 8

OBJECTIVE

Perform the MONOCULAR DYNAMIC RETINOSCOPY OF MERCHANT on a patient, to determine

objectively the refractive defect, KEEPING THE ACCOMMODATION ACTIVATED.
According to the acquired knowledge:
Perform retinoscopy on both eyes of a patient (a colleague),
Age
Conforopter.
GROSS VALUE: OD______________________________
HI
NET WORTH: OD _____________________________ AV _______
HI _____________________________ AV _______

Test box
GROSS VALUE: OD______________________________
HI
NET WORTH OD _____________________________ AV _______
HI _____________________________ AV _______

2. Registre el dato de la Agudeza Visual: OD ___________ OI ___________

_______________

__________

Is there a correlation between keratometry and retinoscopy? YES _______ NO _______

6. Is there a correlation between Static Retinoscopy and Dynamic Retinoscopy? YES _______ NO ______

7. According to the response, argue the result and justify it:

8. Note the data found in the Medical History

9. According to the result, propose:

i. Continue with the exam. If____ No______

j. Should additional tests be reviewed or performed? If ______ No _______

c. If yes, what is/are ________________________________________________

d. Explain why?________________________________________________________

FREELANCE WORK

According to the workshop parameters, I did:

1. At 5 Clinical histories: 3 dynamic retinoscopies with phoropter and two with test box.
2. Ask the necessary questions to clarify the doubts that arose while doing your practice.
clinic.

NOTE: For any concerns, refer to the disciplinary books or the recommended bibliography in
the Syllabus.
 UNIVERSITY OF THE SALLE
FACULTY OF HEALTH SCIENCES
OPTOMETRIC CLINIC AREA
Basic Optometric Clinic
WORKSHOP N° 8

OBJECTIVE

Perform TAIT RETINOSCOPY on a patient to objectively determine the refractive error.

KEEPING THE ACCOMMODATION ENABLED.
According to the acquired learning:
Perform retinoscopy on both eyes of a patient (peer),
Age

GROSS VALUE: OD______________________________

HI
NET WORTH OD _____________________________ AV _______
HI _____________________________ AV _______

2. Registre el dato de la Agudeza Visual: OD ___________ OI ___________

3. Registre el dato encontrado en la queratometría: OD_______________ OI _____________

__________

Is there a correlation between keratometry and retinoscopy? YES _______ NO _______

6. Is there a correlation between Static Retinoscopy and Dynamic Retinoscopy? YES _______ NO ______

7. According to the answer, argue the result and justify it:

8. Note the data found in the Medical History

9. According to the result, propose:

k. Continue with the exam. If____ No______

Should you review or do complementary tests? If ______ No _______

c. If yes, what is/are __________________________________________________

d. Explain why?________________________________________________________

FREELANCE WORK

According to the workshop parameters, I completed:

At 5 Clinical histories: 3 dynamic retinoscopies by Tait.

2. Ask the necessary questions to clarify any doubts generated while carrying out your practice.
clinic.

NOTE: Any concerns should be referred to the disciplinary books or the recommended bibliography in
the Syllabus.