Neutralization at Infinity in Streak Retinoscopy

Boeder, Paul; Kolder, Hansjoerg E.

doi:10.1001/archopht.1984.01040031138042

Cited by 4 publications

(7 citation statements)

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“…To reduce the difference of PA, the data recorded at a PA closest to 24 months were used for data analysis and the mean (±SD) PA was 22.9 (±8.1) months (median, 22 months; range, 12 to 36 months). Cycloplegic retinoscopy was performed to measure refractive outcomes by a masked examiner (X-ZL) using a streak retinoscope 20 , 21 (66 Vision Technology, Suzhou, Jiangsu, China) after cyclopleging the patient with the drop regimen described above. To allow us to compare our results with those of the ETROP trial, we used the same definitions of refractive errors.…”

Section: Methodsmentioning

confidence: 99%

Refractive Status of Chinese with Laser-Treated Retinopathy of Prematurity

Ruan

Shan²,

Liu³

et al. 2015

Optometry and Vision Science

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PurposeTo analyze changes in myopia, astigmatism, and anisometropia after laser treatment of retinopathy of prematurity (ROP), including aggressive posterior retinopathy of prematurity (APROP), in Mainland Chinese children.MethodsThis was a retrospective study of children who had laser treatment for threshold or type 1 prethreshold ROP between January 2004 and October 2012 and age-matched control subjects with spontaneously regressed type 2 prethreshold ROP. One hundred fifteen eyes of 60 patients were included as the laser-treated group, which were further subdivided into APROP and non-APROP groups. Thirty-seven eyes of 20 patients who were diagnosed during the same period were included as the control group. Between 12 and 36 months postnatal age (PA) (mean [±SD], 22.9 [±8.1] months), cycloplegic retinoscopy was performed to measure refractive outcomes. A general linear model was used to analyze refractive changes among different groups at each PA.ResultsAfter adjusting for PA and the correlation between right and left eyes, the magnitude and proportion of astigmatism (p = 0.04 and p = 0.004, respectively) and myopia (p < 0.0001 and p = 0.006, respectively) were greater in the laser-treated group than in the control group. The differences in myopia were even greater in children with APROP than those with non-APROP, whereas the differences in astigmatism were not. Eyes with APROP had higher prevalence of high myopia and spherical anisometropia than the control (p = 0.002 and p = 0.02, respectively) and the non-APROP groups (p < 0.0001 and p = 0.04, respectively).ConclusionsChildren with laser treatment for ROP, including APROP, tended to have higher myopia, astigmatism, and anisometropia, which may progress to amblyopia. These findings highlight the need for regular refractive screening after laser treatment of ROP.

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Section: Methodsmentioning

confidence: 99%

Refractive Status of Chinese with Laser-Treated Retinopathy of Prematurity

Ruan

Shan²,

Liu³

et al. 2015

Optometry and Vision Science

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“…Microfluctutations in accommodative response increase with the stimulus to accommodation, 32, 33 and in MBR, higher lag measurements correspond to higher stimulus demands. There is also measurement ambiguity in the width of the zone of retinoscopic reflex neutrality; 34 however, while this may contribute to inter-measurement variability, the effect is the same at all levels of lag, because retinoscopy conditions are the same for all measurements.…”

Section: Discussionmentioning

confidence: 99%

Modified Bell Retinoscopy: Measuring Accommodative Lag in Children

Tarczy-Hornoch¹

2009

Optometry and Vision Science

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Purpose-To describe a modified bell retinoscopy (MBR) method for quantifying accommodative lag in children, and to assess its repeatability and comparability to other techniques.Methods-In MBR, the target is advanced toward the patient until the retinoscopic reflex is neutralized. A "standardized 40 cm target estimate" of lag was derived for each child using data from three retinoscope distances. Within-visit repeatability was assessed in normal children 5-23 months of age, a heterogenous group of clinic patients, and a group of children with Down syndrome. Clinic patients were tested on separate days for between-visit repeatability, and also with Nott retinoscopy (NR) and the monocular estimate method (MEM) on Day 2.Results-MBR correlated with NR (R=0.84) and MEM (R=0.82). MBR and NR estimates were lower than MEM for high lags. Within-visit repeatability of the standardized 40 cm target estimate of MBR in normal children and clinic patients varied with the amount of lag (p<0.0001). The repeatability index (RI) for 0.50 D lag was 0.49 D, and for 1.00 D lag it was 0.80 D. Repeatability was similar in children with Down syndrome. In clinic patients, the between-visit RI for 0.50 D lag was 0.60 D for the second estimate of each day, with lower repeatability for the first measure of each day. Repeatability did not vary with age or refractive error. The decrease in repeatability with high lag may be attributable to spatial measurement error.Conclusions-MBR estimates of accommodative lag correlate with traditional dynamic retinoscopy measures over a wide range of lags, and show comparable repeatability. MBR may be a useful addition to the repertoire of clinical tools available for assessing accommodation in young children. KeywordsAccommodation; lag of accommodation; retinoscopy; infants; children "Dynamic" retinoscopy techniques quantify accommodative lag by assessing the refractive state of the freely-accommodating eye at a single point in time. Traditional techniques include Nott retinoscopy (NR), 1 the monocular estimate method (MEM) 2 , 3 and bell retinoscopy. 4 Clinical applications of measuring accommodation include optimizing refractive correction in children at risk of accommodative deficits, from Down syndrome, 5 , 6, 7 cerebral palsy, 8,9 or retinal disorders, 10 and evaluating asthenopia and convergence insufficiency. 11 Accommodative deficits may be important to identify in children with amblyopia, 12,13,14,15 since hyperopic or bifocal correction could theoretically enhance treatment in these children. 16,17 Accommodative lag may also help distinguish between well-compensated hyperopes and Dynamic retinoscopy is challenging, however, in young children. With a moving or inattentive child, it is difficult to introduce MEM lenses briefly enough not to influence accommodation. NR, using a fixed target, is inconvenient to perform in a typical clinic setting without an assistant. The examiner's withdrawal can distract the patient, and the retinoscopic reflex seen from a distance becomes hard to judge w...

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“…These devices estimate refractive error as a function of the size and tilt of the crescent formed on the patient's pupil when illuminated with (infrared/visible) light from a known working distance. The Plusoptix 6 and SPOT vision screener 7 have been clinically evaluated and are used to detect myopia, hyperopia, astigmatism, and amblyopia in the pediatric age group [33,57]. Recently, researchers have utilized image processing and machine learning techniques in conjunction with eccentric photorefraction to estimate refractive error from eye images captured by a smartphone.…”

Section: Eccentric Photorefractionmentioning

confidence: 99%

“…In retinoscopy, the examiner observes the speed, direction, size, and brightness of the retinal reflex to achieve neutralization. In this section, we describe the optical principle behind manual retinoscopy, its mathematical formulation only using speed and direction of beam and reflex [7] (note: the formulation encapsulates information provided by the reflex size and brightness [7]), and extend it to estimate refractive error from smartphone-captured retinoscopy video.…”

Section: Optics Behind Retinoscopymentioning

confidence: 99%

“…To estimate eyes' refractive error, we extended retinoscopy's mathematical model (derived from the optical principles of streak retinoscopy [7]) to work with videos captured from a smartphone camera. Our proposed video processing pipeline automatically extracts the variables needed by the mathematical model and uses it to predict the net refractive error of the patient's eye.…”

Section: Introductionmentioning

confidence: 99%

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Towards Automating Retinoscopy for Refractive Error Diagnosis

Aggarwal

Gairola

Upadhyay

et al. 2022

Proc. ACM Interact. Mob. Wearable Ubiquitous Technol.

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Refractive error is the most common eye disorder and is the key cause behind correctable visual impairment, responsible for nearly 80% of the visual impairment in the US. Refractive error can be diagnosed using multiple methods, including subjective refraction, retinoscopy, and autorefractors. Although subjective refraction is the gold standard, it requires cooperation from the patient and hence is not suitable for infants, young children, and developmentally delayed adults. Retinoscopy is an objective refraction method that does not require any input from the patient. However, retinoscopy requires a lens kit and a trained examiner, which limits its use for mass screening. In this work, we automate retinoscopy by attaching a smartphone to a retinoscope and recording retinoscopic videos with the patient wearing a custom pair of paper frames. We develop a video processing pipeline that takes retinoscopic videos as input and estimates the net refractive error based on our proposed extension of the retinoscopy mathematical model. Our system alleviates the need for a lens kit and can be performed by an untrained examiner. In a clinical trial with 185 eyes, we achieved a sensitivity of 91.0% and specificity of 74.0% on refractive error diagnosis. Moreover, the mean absolute error of our approach was 0.75±0.67D on net refractive error estimation compared to subjective refraction measurements. Our results indicate that our approach has the potential to be used as a retinoscopy-based refractive error screening tool in real-world medical settings.

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Neutralization at Infinity in Streak Retinoscopy

Cited by 4 publications

References 0 publications

Refractive Status of Chinese with Laser-Treated Retinopathy of Prematurity

Refractive Status of Chinese with Laser-Treated Retinopathy of Prematurity

Modified Bell Retinoscopy: Measuring Accommodative Lag in Children

Towards Automating Retinoscopy for Refractive Error Diagnosis

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