Retinoscopy | |
---|---|
MeSH | D042262 |
Retinoscopy (Ret) is a technique to obtain an objective measurement of the refractive error of a patient's eyes. [1] The examiner uses a retinoscope to shine light into the patient's eye and observes the reflection (reflex) off the patient's retina. While moving the streak or spot of light through the pupil across the retina, the examiner observes the relative movement of the reflex or manually places lenses over the eye (using a phoropter or trial frame and trial lenses) to "neutralize" the reflex. [2]
Static retinoscopy is a type of retinoscopy used in determining a patient's refractive error. It relies on Foucault knife-edge test, which states that the examiner should simulate optical infinity to obtain the correct refractive power. Hence, a power corresponding to the working distance is subtracted from the gross retinoscopy value to give the patient's refractive condition, the working distance lens being one which has a focal length of the examiner's distance from the patient (e.g. +1.50 dioptre lens for a 67 cm working distance). Myopes display an "against" reflex, which means that the direction of movement of light observed from the retina is a different direction to that in which the light beam is swept. Hyperopes, on the other hand, display a "with" movement, which means that the direction of movement of light observed from the retina is the same as that in which the light beam is swept. [3]
Static retinoscopy is performed when the patient has relaxed accommodative status. This can be obtained by the patient viewing a distance target or by the use of cycloplegic drugs (where, for example, a child's lack of reliable fixation of the target can lead to fluctuations in accommodation and thus the results obtained). Dynamic retinoscopy is performed when the patient has active accommodation from viewing a near target. [4]
Retinoscopy is particularly useful in prescribing corrective lenses for patients who are unable to undergo a subjective refraction that requires a judgement and response from the patient (such as children or those with severe intellectual disabilities or communication problems). In most tests however, it is used as a basis for further refinement by subjective refraction. It is also used to evaluate accommodative ability of the eye and detect latent hyperopia. [5]
Bifocals are eyeglasses with two distinct optical powers. Bifocals are commonly prescribed to people with presbyopia who also require a correction for myopia, hyperopia, and/or astigmatism.
Far-sightedness, also known as long-sightedness, hypermetropia, and hyperopia, is a condition of the eye where distant objects are seen clearly but near objects appear blurred. This blur is due to incoming light being focused behind, instead of on, the retina due to insufficient accommodation by the lens. Minor hypermetropia in young patients is usually corrected by their accommodation, without any defects in vision. But, due to this accommodative effort for distant vision, people may complain of eye strain during prolonged reading. If the hypermetropia is high, there will be defective vision for both distance and near. People may also experience accommodative dysfunction, binocular dysfunction, amblyopia, and strabismus. Newborns are almost invariably hypermetropic, but it gradually decreases as the newborn gets older.
Visual acuity (VA) commonly refers to the clarity of vision, but technically rates an animal's ability to recognize small details with precision. Visual acuity depends on optical and neural factors. Optical factors of the eye influence the sharpness of an image on its retina. Neural factors include the health and functioning of the retina, of the neural pathways to the brain, and of the interpretative faculty of the brain.
Refractive error is a problem with focusing light accurately on the retina due to the shape of the eye and/or cornea. The most common types of refractive error are near-sightedness, far-sightedness, astigmatism, and presbyopia. Near-sightedness results in far away objects being blurry, far-sightedness and presbyopia result in close objects being blurry, and astigmatism causes objects to appear stretched out or blurry. Other symptoms may include double vision, headaches, and eye strain.
The human eye is a sensory organ, part of the sensory nervous system, that reacts to visible light and allows humans to use visual information for various purposes including seeing things, keeping balance, and maintaining circadian rhythm.
An eye examination is a series of tests performed to assess vision and ability to focus on and discern objects. It also includes other tests and examinations pertaining to the eyes. Eye examinations are primarily performed by an optometrist, ophthalmologist, or an orthoptist. Health care professionals often recommend that all people should have periodic and thorough eye examinations as part of routine primary care, especially since many eye diseases are asymptomatic.
The accommodation reflex is a reflex action of the eye, in response to focusing on a near object, then looking at a distant object, comprising coordinated changes in vergence, lens shape (accommodation) and pupil size. It is dependent on cranial nerve II, superior centers (interneuron) and cranial nerve III. The change in the shape of the lens is controlled by ciliary muscles inside the eye. Changes in contraction of the ciliary muscles alter the focal distance of the eye, causing nearer or farther images to come into focus on the retina; this process is known as accommodation. The reflex, controlled by the parasympathetic nervous system, involves three responses: pupil constriction, lens accommodation, and convergence.
Accommodation is the process by which the vertebrate eye changes optical power to maintain a clear image or focus on an object as its distance varies. In this, distances vary for individuals from the far point—the maximum distance from the eye for which a clear image of an object can be seen, to the near point—the minimum distance for a clear image. Accommodation usually acts like a reflex, including part of the accommodation-convergence reflex, but it can also be consciously controlled. The main ways animals may change focus are:
An autorefractor or automated refractor is a computer-controlled machine used during an eye examination to provide an objective measurement of a person's refractive error and prescription for glasses or contact lenses. This is achieved by measuring how light is changed as it enters a person's eye.
In optics, defocus is the aberration in which an image is simply out of focus. This aberration is familiar to anyone who has used a camera, videocamera, microscope, telescope, or binoculars. Optically, defocus refers to a translation of the focus along the optical axis away from the detection surface. In general, defocus reduces the sharpness and contrast of the image. What should be sharp, high-contrast edges in a scene become gradual transitions. Fine detail in the scene is blurred or even becomes invisible. Nearly all image-forming optical devices incorporate some form of focus adjustment to minimize defocus and maximize image quality.
Astigmatism is a type of refractive error due to rotational asymmetry in the eye's refractive power. This results in distorted or blurred vision at any distance. Other symptoms can include eyestrain, headaches, and trouble driving at night. Astigmatism often occurs at birth and can change or develop later in life. If it occurs in early life and is left untreated, it may result in amblyopia.
Aniseikonia is an ocular condition where there is a significant difference in the perceived size of images. It can occur as an overall difference between the two eyes, or as a difference in a particular meridian. If the ocular image size in both eyes are equal, the condition is known as iseikonia.
Vision of humans and other organisms depends on several organs such as the lens of the eye, and any vision correcting devices, which use optics to focus the image.
The aim of an accurate intraocular lens power calculation is to provide an intraocular lens (IOL) that fits the specific needs and desires of the individual patient. The development of better instrumentation for measuring the eye's axial length (AL) and the use of more precise mathematical formulas to perform the appropriate calculations have significantly improved the accuracy with which the surgeon determines the IOL power.
Subjective Refraction is a technique to determine the combination of lenses that will provide the best corrected visual acuity (BCVA). It is a clinical examination used by orthoptists, optometrists and ophthalmologists to determine a patient's need for refractive correction, in the form of glasses or contact lenses. The aim is to improve current unaided vision or vision with current glasses. Glasses must also be comfortable visually. The sharpest final refraction is not always the final script the patient wears comfortably.
Bagolini striated glasses test, or BSGT, is a subjective clinical test to detect the presence or extent of binocular functions and is generally performed by an optometrist or orthoptist or ophthalmologist. It is mainly used in strabismus clinics. Through this test, suppression, microtropia, diplopia and manifest deviations can be noted. However this test should always be used in conjunction with other clinical tests, such as Worth 4 dot test, Cover test, Prism cover test and Maddox rod to come to a diagnosis.
Irvin M. Borish was an American optometrist who is widely considered "The Father of Modern Optometry". Even though he entered the field of optometry because his family could only afford to pay for two years of college, he left a lasting impression in the field. He wrote one of the most renowned textbooks of optometry, Clinical Refraction. He worked to create several educational and research institutions for optometry. He also lobbied tirelessly to establish optometry as a mainstream medical practice. His contribution to optometry has been recognized through prestigious awards and recognition from his peers.
In ophthalmology, accommodative excess occurs when an individual uses more than normal accommodation for performing certain near work. Accommodative excess has traditionally been defined as accommodation that is persistently higher than expected for the patient's age. Modern definitions simply regard it as an inability to relax accommodation readily. Excessive accommodation is seen in association with excessive convergence also.
A trial frame is a tool used by ophthalmic professionals like ophthalmologists and optometrists. It is basically an adjustable spectacle frame with multiple cells, used to hold corrective lenses, and other accessories in subjective refraction and retinoscopy.
The Jackson cross cylinder (JCC) is an instrument used by ophthalmologists, orthoptists and optometrists in their routine eye examination, particularly in determination of corrective lens power in patients with astigmatism. It is also used for testing near point of the eye.