Welcome to question of the day #221

Eyetools question of the day #221 

In my practice and optical assistant carries out auto-refraction and passes the results to me. Many times the results for new patients who have not brought their current glasses with them have been way off. This increases the time it takes me to find the optimum prescription using subjective refraction. One of the older eye specialists in the practice tells me he doesn’t use the auto-refractor results and prefers to us a retinoscope to conduct objective refraction for new patients without glasses and for new patients who have brought their current glasses with them.

I agree with your colleague. When I first started working in primary care practice quickly realised that for many patients the auto-refractor results were way off and it caused me to start subjective refraction from a point far away from the optimum prescription. I had worked in an eye hospital and was very good at retinoscopy as many patients in an eye hospital are too old or too young to sit at an auto-refractor and others have anterior eye diseases that create misleading autorefractor results. I soon learnt to rely on my own retinoscopy in primary care practice.

Here are the advantages of retinoscopy. You can:

Quickly determine the objective refraction values with no communication with the patient; this gives a starting point for subjective refraction.

Get very close to the optimum prescription for patients who cannot communicate with you for subjective refraction

See a retinoscopy reflex that rapidly changes indicating fluctuating accommodation.

See slow moving retinoscopy reflexes that indicate high prescriptions.

See dim retinoscopy reflexes which indicate corneal, and/or lenticular and/or vitreous opacities.

Detect split/scissor retinoscopy reflexes that indicate keratoconus.

Detect small prescriptions in people who are claiming to see very poorly.

Provide objective refraction values when examining a person in an eye camp or in their own home.

I’m so glad I became skilled at using a retinoscope early on in my career. It’s a skill I will always have and it something that has helped me when I have faced challenging clinical situations.