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Dynamic retinoscopy a useful test

Orlando—Dynamic retinoscopy is an underutilized test in ophthalmology that, according to Burton Kushner, MD, has changed his practice. He uses the test to determine patients’ accommodative ability and status and to predict the development of esotropia.

During dynamic retinoscopy when a patient shifts from distance fixation to a target just below the retinoscope light, the accommodation is normal if there is a brisk change to neutrality with retinoscopy that is sustained. The accommodation is abnormal if there is a sluggish change to neutrality; and when there is persistence with motion, the patient is not accommodating on the target, said Dr. Kushner, of the Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison.

“The utility of the test is to determine those children who might have an accommodative insufficient,” he said. “I find it most useful in children with a neurologic impairment. These patients may not accommodate well and may benefit from full hyperopic correction or bifocal.”

This test can tell the physician whether to correct hyperopia and the degree of the hyperopic correction in infants who are orthotropic and have moderate hyperopia. It also may have a role in determining the plus correction in amblyopic patients with hyperopia.

The theory is that in infants with a high plus and normal gaze and who can fully accommodate at near, their fusional mechanism is probably normal and they should be observed and they might not become esotropic. When retinoscopy is abnormal, children might not be “crossing” because they are not accommodating and may be at risk of developing esotropia when they start accommodating or they may develop bilateral refractive amblyopia, Dr. Kushner explained.

In a study of 211 patients, of 65 patients with a subnormal retinoscopy test, 50% developed esotropia, and of 141 with normal dynamic retinoscopy, none developed esotropia, he said.

“Dynamic retinoscopy is a useful, yet underutilized test that assesses accommodation in real-life situations and it can help to correct hyperopia,” Dr. Kushner concluded.

For more articles in this issue of Ophthalmology Times Conference Brief click here.

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