Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

83 Cards in this Set

  • Front
  • Back
What is the purpose of dynamic retinoscopy?
to determine the near point of the eye
Dynamic retinoscopy aka ____
near retinoscopy
In STATIC retinoscopy, accomodation must be ____
relaxed (fogging left eye, looking for against OS, blocking right eye with your head).
In STATIC retinoscopy, you are determining the patient's ___ ___.
far point
In DYNAMIC retinoscopy, accomodation must be ____
In DYNAMIC retinoscopy, you are determining the patient's ___ ___.
near point
Do you have to worry about taking out your working distance with dynamic ret?
What do you ask the patient to do when performing dynamic ret?
Keep the target clear! Ask the patient to engage their accomodation.
True or False: Dynamic retinoscopy is done without a working lens.
True: the lens is supplied by the eye.
True or False: Dynamic retinoscopy uses the same movement determination as static retinoscopy.
define "with motion"
eye conjugate to a point eye's near point is behind the retinoscope.

eye is underaccomodating

lag of accomodation
define "against motion"
eye conjugate to a point between the eye and the retinoscope (in front of the retinoscope)

indicates that the eye's near point is in front of the retinoscope (between clinician and patient)

eye is overaccomodating

lead of accomodation
define "neutrality"
eye conjugate with the retinoscope

indicates that the eye's near point is located at the retinoscope aperture

no lag, no lead

eye is accomodating exactly +2.50 D at 40 cm
When you perform you determine the eye's near point, you are determining the eye's accomodative ___, or ___
response, POSTURE (where in space the accomodative system likes to hang out)
What other test will also help you gauge accomodative posture?
Fused Crossed Cylinder (FCC)
Is the eye's accomodative response equal to the accomodative demand?
generally not
Is the eye accomodating exactly +2.50 D for an object at 40 cm?
USUALLY NOT... usually the eye UNDERaccomodates by about +0.50-0.75 D (lag)
Is the response always equal to the stimulus?
Name two things that define the demand?
1) stimulus - where in space the target is

2) have a refractive error that is not their own (overplussed/overminused)
True or False: dynamic ret also reveals the stability or the degree of fluctuation of the accomodative system

Results stable - means accomodation is not fluctuating much (GOOD!)

Results fluctuate - means you may be dealing with an accomodative spasm OR the patient may not be fixating correctly
The ____ is provided by the distance from the eye to the target.
accomodative STIMULUS (i.e. target at 40 cm = 2.50 D stimulus)
The ____ is provided by the target distance as well as refractive error/uncorrected refractive error.
accomodative DEMAND (i.e. target at 40 cm and patient overminused by 1.00 D = 3.50 D demand
The difference between the accomodative stimulus and accomodative response equals the ___ or ___ of accomodation.
lag, lead
Stimulus of 2.50, but only accomodating 2.00 = __ of __
lag, +0.50
Stimulus of 2.50, but accomodating 2.75 = __ of __
lead, -0.25
When the accomodative system is ___, there is a lag of accomodation.

The system is lagging ___ the target.

Patient's eye is focused where?


at a point beyond the target
When the accomodative system is ___, there is a lead of accomodation.

The system is ___ the target.

Patient's eye is focused where?


at a point in front of the target.
How does a lag or lead work, and still have a clear image?
Because of depth of focus and depth of field, the accomodative response is generally less than the stimulus (usually by +0.50 to +0.75)
If at 40 cm Brian has a normal lag of +0.50, his accomodative system is focused where?
10 cm behind the target

(he's only accomodating 2.00 D for 40 cm, so he has a +0.50 lag - he's focused at 50 cm instead of 40 cm, so that's 10 cm behind the target)
When do we perform dynamic ret?
1) Any adult exam where they have a near complaint or where you suspect an accomodative spasm

2) suspect overminused or overplussed

3) suspect latent hyperopia or accomodative spasm

4) possible emerging presbyopes

5) presbyopes, in order to determine tentatve add power

6) All pediatric eye exams

7) BV exams, follow-ups if warrranted
Near complaints include:
1) near blur
2) asthenopia
3) diplopia
4) headache
5) trouble reading
6) focusing problems at near
7) unable to read for prolonged periods of time
What are the results of this test used for?
-Primarily used to confirm suspected cases of vergence of accomodative dysfunction

-to determine whether a patient is over or undercorrected

- results give you the same info as FCC - dont do both
How do you perform dynamic retinoscopy?
neutralize the reflex of the eye while the patient accomodates to fixate a target at near (40 cm)
With motion means?
lag of accomodation
Against motion means?
lead of accomodation
Name the two accepted methods of dynamic ret?
1) MEM (monocular estimate method)
2) Nott Method
What kind of trial lenses do you add when you see against motion with MEM?
What kind of trial lenses do you add when you see with motion with MEM?
Where is the target placed when doing both MEMs and the Nott Method?
at patient's working distance (usually 40 cm)
How do you perform the Nott Method?
clinician with retinoscope moves toward and away from the patient until views neutrality

through phoropter: manifest dialed into phoropter and patient fixating 40 cm target. clinician moves in or out with retinoscope until reflex is neutralized.
in the Nott method, if you see against motion, which direction should you move?
move closer to patient
in the Nott method, if you see with motion, which direction should you move?
move further away from patient
Can you perform MEMs with the phoropter instead of trial lenses?

(BVA dialed into phoropter; the clinician with retinoscope must stay at the plane of the target)
Should MEMs and the Nott method be performed with the patient's correction for distance or near on?
Yes (glasses/CLs, phoropter with BVA, trial frame)
If the patient is a presbyope, should MEMs be done through the distance or near portion?
near add
True or False: Cylinder should not be corrected when doing MEMs
FALSE! cylinder SHOULD be corrected, unless very small amount

(if 1.00 D cyl - put in trial frame)
True or False: Patient is viewing target binocularly, but eyes are examined one at a time.
True or False: For kids, the target for dynamic ret is placed at 40 cm.
FALSE!! Kids hold things closer, so use Hartmann's distance.
What is Hartmann's Distance?
used for determining target distance for kids in dynamic ret.

put hand behind ear, that distance to elbow is where you do retinoscopy on a kid.
The target should be an excellent stimulus for accomodation. What is this size?
.37 to 1M
What is the lighting like when doing dynamic ret?
Low light intensity (of retinoscope)


dim room lighting, but target illuminated with stand lamp
Rapid estimation means?
be quick with dazzle of light from retinoscope; beam into pupil for short periods of time (1 sweep across pupil, 2 at most)
Do you need the stand lamp on during dynamic ret?
Yes, the target is illuminated with the stand lamp
If you do dynamic ret from an oblique angle, will that skew your results?
Yes, remain as close to the patient's line of sight as possible when neutralizing reflex.
What are your instructions to the patient?
1) Ignore the light!
2) Steadily view the target, keep it clear!!
3) Read the letters to yourself/or out loud!
How do you perform the MEM method?
1) briefly place lenses to neutralize the reflex (examine the reflex in the horizontal meridian- light beam vertical)
2) retinoscopist and target at patient's preferred working distance (usually 40 cm)
3) patient wears correction for distance or near (if they have both, choose near)
When doing MEMs, do you keep the beam vertical or horizontal?
vertical, only sweeping the horizontal meridian (b/c they have their correction on and you already corrected their cylinder)
True or false: the lens should not be there longer than 1/2 sec.
True or false: the lens that creates neutrality is the value of the accomodative lag/lead
True: plus (lag), minus (lead)
Should you bracket?
Yes, it assures an accurate endpoint
What lens should you try first when you see with motion? against motion?
With motion: add plus; start with +1.00 or +0.75

Against motion: add minus; start with -0.50
True or False: measurement should be made within 2 sweeps, or 1 second (per lens used)
True (minimizes dazzle of light and effect of lens on accomodative system)
What are the norms of the accomodative system?
-lag of +0.50 to +0.75 at 40 cm
-equal results between the 2 eyes
-stable results when fixation is maintained
-results should be similar to that of FCC/BCC (net)
Will presbyopes have a normal lag of accomodation of +0.50 to +0.75?
No, their accomodative ability declines, increasing the expected lag of accomodation (with absolute presbyopia: expected lag is +2.00 to +2.50 D, without an add in place)
True or False: lag of accomodation changes as a funtion of the stimulus distance
Expected lag ___ dramatically as the accomodative demand increases.

This can happen when the target distance decreases or the patient is overminused or overplussed.
What is the clinical implication of the AC/A ratio? Or what does it have to do with MEMs?
the relationship between vergence and accomodation can be demonstrated by the accomodative posture.
What does a high lag of accomodation (>+0.75D) mean? What are circumstances in which you would have a high lag?
1) normal: 5.5%
2) Esophoria at near (with insufficient compensating vergences)
3) Accomodative dysfunction (insufficiency, fatigue, paresis, infacility)
4) Presbyopia, prepresbyopia
5) uncorrected hyperopia (latent hyperopia)
7) Patient not keeping the target clear... not acccomodating
Why would someone have a lag greater than +2.50 (with target at 40 cm)?
1) uncorrected hyperopia/latent hyperopia
2) overminused
**These are the only factors that could account for such a high lag.
Why would someone have a low lag, or lead of accomodation (+0.25 or less)?
1) Normal: 8%
2) Exophoria at near (with insufficient compensating vergences)
3) Spasm of accomodation (pseudomyopia)
4) uncorrected myope
5) malingerer
6) overplussed
Unequal results between the two eyes usually results from a ___ ___.
near imbalance
such as:
1) anisometropia (unequal accomodative demand)
2) improper balance of distance Rx
3) unilateral or asymmetric Adie's tonic pupil
____ __ ____ also often indicates a near imbalance or accomodative spasm.
Fluctuation of reflex
What is the proper way to record dynamic ret results?
Dynamic Ret (MEM): +0.50 lag OD, OS
What are some sources of error that affect both dynamic and static retinoscopy?
1) scissors
2) small pupils
3) dim media (cataracts)
4) angle
What are some sources of error that affect dynamic retinoscopy?
1) changes in fixation or accomodative level
2) failure of patient to understand or cooperate, poor motivation
3) patient looking at a target at a different distance than requested
4) inadequate visibility of target (by patient) or the reflex (by clinician)
5) adaptation of lenses with MEM technique - relax when plus lenses are in front of eye, stimulated when minus lenses are in front of eye
What is the latency of the accomodative system?
250-500 ms (0.45 -0.50 sec) - that's why lenses should be moved in and out quickly
measurement should be made within __ sweeps or __ second
2, 1
What are practical problems of the Nott Method?
1) lag too large - difficult to see the reflex (you get too far away)
2) lead - your head gets in the way
What other tests should you look at to determine the clinical significance of your findings?
1) patient's correction (retinoscopy, refraction)
2) accomodation
3) phoria
4) vergences
5) AC/A
Patients with a ___ AC/A ratio will be more likely to have their accomodative posture affected
Can dynamic retinoscopy be used to determine a near add?
How do you determine a near add using dynamic retinoscopy?
same technique, lens that neutralizes reflex is tentative near add
What did the Comet II study show abut SV vs. PAL's in relation to myopia progression?
showed some evidence that a HIGH lag of accomodation may be predictor of good results with this mechanism of preventing progression of myopia in kids.