November 4, 2016 | POSTED BY | Articles, Clinical Optometry, Clinical Pearls
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Does a retinoscope actually matter in low vision rehabilitation if the patient’s vision is so poor?Retinoscopy

I have found that a retinoscope, yes that dusty instrument you only use at health fairs, is invaluable in low vision rehabilitation. Firstly, the typical low vision patient has an etiology where their best field is not centrally, and every auto-refractor only works if the patient is staring straight ahead! Find out with a hand-held eye chart or observing the patient’s eccentric viewing position where that best field is. If it is the inferior field that is the best, raise the patient in the exam chair and measure that field, telling them why. I have found on many patient encounters, this is key to getting the right starting point for your trial frame refraction. In doing a retrospective study where I work at an HMO, I found that in 25 patients, this was an average of 1.55D more plus than the auto-refractor found. In the eventual near prescription, this accounted for a 3 to 4 line improvement in near and computer-monitor visual acuity. Don’t have the patient eccentrically view instead…they will probably do so at a more extreme angle than what is necessary, and of course the VA falls off at that angle.

Gary Asano, OD, FAAO

Council Member, AOA VRS

Vice Chair, COA LV Rehabilitation Section

  • Sushma Nandyala

    I follow your website constantly, I like your articles, they are very informative and interesting.
    But somehow I do not agree with this article. I feel retinoscope plays a very important role while prescribing low vision patients. As these patients have very less vision they could not make out the difference between every 0.50DS in subjective acceptance as the normal vision patients could do. Hence we should actually rely mostly on an objective method. It could either be be a retinoscope or an Auto-refractor, but again as auto refractor does not account for the proximal accommodation if the patient is kid.
    Correct me, If I am wrong in my assumptions.