Abstract
Accurate determination of refractive error is one of the most critical components of a pediatric eye examination. According to the National Eye Institute, refractive errors are the most common causes of correctable reduced vision in children. Children with uncorrected refractive error are more likely to have developmental delays, visual-related academic problems, and poor social skills or interactions. In addition to difficulty seeing, uncorrected refractive errors can contribute to developmental deficits of accommodation, binocular vision, and certain forms of strabismus, amblyopia, and perceptual function. The author provides the clinician an in-depth guide on how to determine the refractive error in pediatric patients. The chapter focuses on the specific techniques, advantages and disadvantages, equipment required, and step-by-step procedures for performing retinoscopy, objective refraction, and subjective refraction on children.
TopBackground
Retinoscopy is an objective method to measure refractive error and is a valuable skill to the pediatric eye care provider. Retinoscopy can be performed on patients of all ages, is fast when performed by a practiced clinician, does not require any verbal responses and only minimal cooperation from the child, and can be performed with minimal equipment. For the younger child who lacks the maturity, understanding or ability to provide subjective responses, retinoscopy may be the sole method for measuring refractive error. For the older child who can perform a subjective refraction, retinoscopy provides a starting point that can be fine-tuned by a subjective refraction.
Key Terms in this Chapter
Binocular Balance: Is a subjective technique used to ensure the two eyes are accommodating equally when determining the final refraction.
Hyperopia: A refractive error where the eye is shorter and light rays focus behind the retina.
Objective Retinoscopy: A technique to measure the refractive state of an eye without the need for responses from the patient.
Astigmatism: A refractive error where the eye is not spherical due to an irregular cornea of curvature of the lens.
Myopia: A refractive error where the eye is elongated, and light rays focus in front of the retina.
Phoropter: An instrument that a patient sits behind which allows the examiner quick access to changing of lenses all incorporated in the instrument.
Cycloplegic Retinoscopy: A technique to measure the refractive state of an eye while controlling accommodation with a cycloplegic eye drop.
Mohindra Retinoscopy: A near retinoscopy technique that provides a distance value.
Subjective Refraction: A technique to measure the refractive state of an eye with responses from the patient.
Jackson Cross Cylinder (JCC): Is a tool that is used to refine the axis and power of astigmatism.