The impact of off the visual axis retinoscopy on objective central refractive measurement in adult clinical practice: a prospective, randomized clinical study

Tay, Eugene; Mengher, L S; Xy, Lin; Ferguson, Veronica

doi:10.1038/eye.2011.79

Cited by 8 publications

(5 citation statements)

References 17 publications

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“…To reduce variability, it is necessary to consider as a precedent that during the development of the retinoscopy protocol, it is essential to control the body posture and working distance during the rst four hrs to improve precision. Studies also established that those two elements are considered the principal source of error in retinoscopy [11,18]. A clear example is the variability detected between experienced teachers in retinoscopy that has been ±0,87 D and between trainees ±3,15 D [25].…”

Section: Discussionmentioning

confidence: 99%

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Training in Retinoscopy: Learning curves using a standardized method

Estay

Plaza-Rosales

Torres

et al. 2023

Preprint

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Background Retinoscopy is one of the most effective objective techniques for evaluating refractive status, especially in non-cooperative patients. However, it presents a slow learning curve that often leads to student frustration. With the current Covid-19 pandemic and the need for social isolation, clinical education based on simulation has become more relevant. Therefore, we implemented retinoscopy laboratories and learning protocols to reduce student stress and learning time. Methods We conducted a study to evaluate the retinoscopy learning curve using a new training protocol proposal. One hundred trainees were assessed in four stages, corresponding to 08, 12, 16, and 20 hours of training. Six different refractive defects were used trying to reproduce frequent conditions of care. The time spent on the assessment was not considered as additional training time. To analyze the data, we used non-parametric statistics and linear regression to assess the variables associated with training time and performance rate. Results The mean performance score at 08 hrs was 32.49% (±16.69 SD); at 12 hrs was 59.75% (±18.80 SD); at 16 hrs was 70.83% (±18.53 SD) and at 20 hrs was 84.26% (±13.18 SD). Performance at 12 hrs was significative higher than 08 hrs of training, but did not show significant differences with the performance rate at 16 and 20 hrs. We found a strong positive correlation between performance and training time in retinoscopy (R = 0.9773, CI: 0.2678 - 0.9995 p = 0.0227). Conclusion This study showed that an increasing number of hours of practice positively correlates with performance in retinoscopy. The elaboration of a protocol and standardization of performance per hour also allowed us to estimate that a minimum of 13.4 hrs of practice is required to achieve 60% performance. Using the resulting formula, it is possible to determine the number of hours of retinoscopy practice are necessary to reach a certain level of performance.

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Section: Discussionmentioning

confidence: 99%

“…Body posture is corrected constantly, especially during the rst 4 hrs. A variation of just 5,58 degrees of visual axis is associated with a signi cative lens power error (this has been reviewed in myopes and astigmatic patients) [11]. b.…”

Section: Methodsmentioning

confidence: 99%

Training in Retinoscopy: Learning curves using a standardized method

Estay

Plaza-Rosales

Torres

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Similarly, Tay et al . [ 11 ] found that the errors in refraction during off-axis retinoscopy were not statistically significant ( P = 0.068; paired t-test) when compared with on-axis retinoscopy. The present study found significant differences between each degree in off-axis retinoscopy.…”

Section: Discussionmentioning

confidence: 99%

Refractive changes during off-the-axis retinoscopy in myopia

Chaurasiya

2022

Indian Journal of Ophthalmology

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Purpose: To analyze the refractive shift during off-the-axis retinoscopy under cycloplegic drugs in myopic patients during ocular examination. Methods: Prospective cross-sectional study was carried out among 10 myopic patients having refractive errors of −3.00 D or less. All the subjects underwent cycloplegic refraction by a single examiner at 0°, 10°, and 20°. Descriptive data were analyzed as mean and standard deviation. Paired t-test was used to compare the mean differences between on-axis (0°) and off-axis (10° and 20°) retinoscopy. Result: The mean spherical equivalent refraction of 10 myopic patients showed an increase in myopic shift with approximately 7% and 18% for 10° and 20° of eccentricity, respectively. Similarly, the mean spherical equivalent measure on axis (0°) and off axis (10° and 20°) were -2.5495, −2.737, and −3.0265, respectively. The mean spherical equivalent differences between on-axis (0°) and off-axis (10° and 20°) showed statistically significant differences with P < 0.05. Conclusion: This study concluded that a greater degree of eccentricity will induce a greater amount of errors in retinoscopy.

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“…[ 14 30 31 ] The size of the area of the retina involved in neutralization is small and reported as approximately 1/640 th the area of the optic disc, hence when performing retinoscopy on high myopes, even a small misalignment with the visual axis may induce spherical error in retinoscopic findings. [ 31 32 ] The effect of off-axis refraction was controlled in this study by (1) maintaining the same eye level between the examiner and the patient, (2) the trial frame was adjusted according to the interpupillary distance to avoid decentration, and (3) accurate centration of the reflex by aligning the streak across the vertical meridian of the patient. Furthermore, the best way to avoid transverse aberrations from influencing refraction is to neutralize the reflex across the largest visual zone and ignoring the reflex motion at the edges of the pupil.…”

Section: Discussionmentioning

confidence: 99%

Variant myopia: A new presentation?

Hussaindeen

Anand

Sivaraman

et al. 2018

Indian J Ophthalmol

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Purpose:Variant myopia (VM) presents as a discrepancy of >1 diopter (D) between subjective and objective refraction, without the presence of any accommodative dysfunction. The purpose of this study is to create a clinical profile of VM.Methods:Fourteen eyes of 12 VM patients who had a discrepancy of >1D between retinoscopy and subjective acceptance under both cycloplegic and noncycloplegic conditions were included in the study. Fourteen eyes of 14 age- and refractive error-matched participants served as controls. Potential participants underwent a comprehensive orthoptic examination followed by retinoscopy (Ret), closed-field autorefractor (CA), subjective acceptance (SA), choroidal and retinal thickness, ocular biometry, and higher order spherical aberrations measurements.Results:In the VM eyes, a statistically and clinically significant difference was noted between the Ret and CA and Ret and SA under both cycloplegic and noncycloplegic conditions (multivariate repeated measures analysis of variance, P < 0.0001). A statistically significant difference was observed between the VM eyes, non-VM eyes, and controls for choroidal thickness in all the quadrants (Univariate ANOVA P < 0.05). The VM eyes had thinner choroids (197.21 ± 13.04 μ) compared to the non-VM eyes (249.25 ± 53.70 μ) and refractive error-matched controls (264.62 ± 12.53 μ). No statistically significant differences between groups in root mean square of total higher order aberrations and spherical aberration were observed.Conclusion:Accommodative etiology does not play a role in the refractive discrepancy seen in individuals with the variant myopic presentation. These individuals have thinner choroids in the eye with variant myopic presentation compared to the fellow eyes and controls. Hypotheses and clinical implications of variant myopia are discussed.

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The impact of off the visual axis retinoscopy on objective central refractive measurement in adult clinical practice: a prospective, randomized clinical study

Cited by 8 publications

References 17 publications

Training in Retinoscopy: Learning curves using a standardized method

Training in Retinoscopy: Learning curves using a standardized method

Refractive changes during off-the-axis retinoscopy in myopia

Variant myopia: A new presentation?

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