97 Comments

  1. Dr. M. Montali says:

    Best explanation I have ever had on this topic, (I don’t know how many attempts I made to learn the retinoscopy in observing my prof)
    thanks!!

    Margherita Montali
    p.s. only a question: can you determine accurately the axis with the retinoscopy?
    I mean how can you be sure than what are you measuring, for example, in an axis of 60° instead of 70°? Because, I notice, in the prescription of glasses, normally the patient can appreciate a difference of 10°.

    1. Gurparshad says:

      During retinoscopy to find the astigmatism angle i.e parallel to trail frame’s angle

  2. Thanks Dr. Montali,
    In answer to your question … no, I can’t always tell the exact axis using retinoscopy, though we can often get close.

    If I have an adult (who might notice these subtle axis issues) than I can usually get them up to the phoropter anyway. I start with my retinoscopy estimation, then using the phoropter I tweak my power and axis to the exact prescription.

    In kids, I just do the best I can and trust my retinoscopy. I like to put my final prescription in a trial frame to make sure the kid likes it (if old enough). Good luck!

    -Tim Root

  3. Dr. M. Montali says:

    Thanks Dr. Root,
    yes I see.
    Can I take up your time once again?

    When I was student (in Italy), my prof told me it was the best technique to measure the refractives troubles. Now I am in Switzerland, and I continue to be surprise they prefer do another kind of measuration: once obtained the cycloplegia they use the autorefratometer.
    What do you think about?
    Best,
    Margherita M.

  4. The autorefractor is fine … we use it in our clinic prior to refracting new patients and children (if old enough). It gives a good place to start before manifest refraction with the phoropter. Plus, technicians can use the autorefractor with minimal training.

    However, you can’t autorefract everyone … including young children, wheel-chair patients, or the demented. Also, the autorefractor is sometimes wrong or the machine refuses to take a good reading. In these cases, loose-lens refraction is the only way to go.

  5. Brilliant approach, thanks so much. You are really making a difference in the ophthalmic education of many people across the world.

  6. From the content point of view it look very good. Till I not seen the video.

    AK Singh
    FAculty Optometrist
    Quality Control Manager

  7. Can you explain how to do it if you use minus cylinders only

  8. DR.ROOT
    THANK FOR WONDERFUL EXPLANATION ABOUT RETINOSCOPY.AS OPHTHALOMOLGIST ETHIER WE DEPEND ON AUTOREF OR ON OPTOM ,BUT AFTER THIS AND WITH GOOD PRACTIVE WE ABLE TO GIVE CORRECT CORRECTION.

  9. Fantastic! Best instruction on this topic that I have seen! Many thanks, David

  10. waheed zaman says:

    the video was good and simple to understand, however we at the moment in classess work, slightly different to whats on the video, for exmple, we choose the most positive value between the two values as a sphere, then we use a negative cycl to correct for the astigmatism with axis at the positive sphere. however in this video, what type of technique is being used in the video positive cycl form or negtative, as im getting the impression its positive cycl form.

    for example: we have two different meridian powers
    +4.00 axis90 and +2.00 axis 180

    +4.00/-2.00/x90

    subtract wrokin distance
    +5.50/-2.00×90
    thats how we work it out

  11. Thank you very much
    It is very nice lecture

  12. sisozizo egypt says:

    thanks very much.i am a begining resident &i admired it very much .thanks again.

  13. abdelsattar says:

    I cannot express my great thanks for your wonderful teaching talent

  14. THNX Dr.DAVID.. UR LECTURE IS REALLY HELPFUL…

    a small query. wud b kind of u if u cud reply…

    how do u select the the axis for spherical power from which the workin distance is subtracted in case of un-rule astigmatism? is it the first one whichever gives complete bright red reflex?

  15. THNX Dr.TIMOTHY UR LECTURE IS REALLY HELPFUL…

    a small query. wud b kind of u if u cud reply…

    how do u select the the axis for spherical power from which the workin distance is subtracted in case of un-rule astigmatism? is it the first one whichever gives complete bright red reflex?

  16. Thanks alot Dr. Tim. I’m an under grad and this video has become the standard study material for retinoscopy amongst all my friends. Have also seen all of your other videos. you made optha easy and interesting.

  17. Lynn Sullivan says:

    How do I get the audio portion to work? Am I required to purchase a video? Can I just buy a download?

    thanks!!

    Lynn S

  18. it was a very good demo.thank u so much.but i would like to know how u would do it in a keratoconus patient and how to appreciate oil drop reflex.
    thank u

  19. Big ( Thank you ) Dr. amazing,
    very interesting very nice very informant video. and for all your videos.

  20. I’m not sure of the last two cases

  21. Clive Novis says:

    Brilliant lecture Dr Root. I think the best way to learn retinoscopy is using a practice model eye which you can make out of a toilet roll! Please contact me and I will send you some photos and more details.
    Clive Novis (South Africa)

  22. Tulika Gupta says:

    could never have understood retinoscopy without this video..u’ve made it so understandabl that i’m so mch interested in smthn i earlier dreaded..
    Today as i did retinoscopy fr d 1st time,i cn only thank u fr d knowledge u’ve given..Thank u so vry mch..lukn fwd to more of sch videos..obliged to b ur student..
    al d best!!

  23. mohmedfawzy says:

    you are making difference to many people thank you very much i am from Egypt and i have learned a lot thank you again .

  24. iam an optometrist , i was see the vidoeo really iam fine . this teaching is not neglect in my life . thank u

  25. very good vedio. I am student optometry. do you can help me at search about miyopia

  26. its awesome..thank you so much..it was a great help..:)

  27. Dr.Venkatesh says:

    hello doctor,

    Greetings from India. Thanks for the exhaustive explanation. very easy to understand ‘FINALLY’ .i will be looking forward to see many of your videos and lectures.
    Thank you

  28. Dr.Venkatesh says:

    hello doctor,

    Greetings from India. Thanks for the exhaustive explanation. very easy to understand ‘FINALLY’ .i will be looking forward to see many of your videos and lectures.
    Thank you

  29. ganesh bhamare says:

    i am vitreo-retina consultanat
    very nice and informative lecture with easy steps and less confusion

  30. hello..i have questions:
    how the distance between instrument and patient’s eye?
    what object seen by patient? & how the distance?
    the the last one how if i want to use minus cylinder, any different method?
    thanks

  31. ruwan janaka says:

    I,m a beginner from srilanka.i,m interesting about your explanation and need to be a professional in the trade and want some more information about retinoscopy.

  32. rodney salvador says:

    excellent lecture i am passing on this site to my fellow techs. I have switched from a + cyl phoropter to – cyl, how do i find the astigmatic power now?

    thank you

    Rodney in Boston

  33. Thank you for this lectures>>>iwant from you to increased your
    vedio about astigmatism.finally thank you.

  34. Pons Macalintal says:

    How about cylinder retinoscopy.Can u explain or discuss it.
    thank you

  35. Mark Andro Tapiz says:

    Dear Dr. Root.

    You said the word “ALONG”the meridian right? so you need to convert it to ÄXIS” so if its along 90 or @ 90 and the AXIS would be 180? am I right? I’m sorry but I’m a little bit confused, as according to the book, they use the term “@”or ÄLONG” then should convert it to axis.

    Hoping for a quick respond regarding on this matter.

    Best Regards,

    Mark

  36. Timothy Root, M.D. says:

    Mark,
    In this video … I am using the “@” sign to mean “at.” In retrospect, perhaps I should have used the more traditional “x” sign or just spelled out “at” but I didn’t.

    I wouldn’t focus on the words ALONG or AT if I were you. As long as you remember that power and axis are 90 degrees from each other, you should be ok.

    Tim Root

  37. Hello Dr Root,

    Thank you so much for your AMAZING videos! They really help understand concepts from our ophthalmic technician training course!

    My doctor prefers minus cylinder, do you have instructions for doing retinoscopy in minus cylinder?

    Marissa

  38. Prabhamali says:

    It was a really educational video. I really got a better knowledge at retinascopy. Thank you so much.

  39. Timothy Root, M.D. says:

    Marissa,
    Most optometrists work in minus cylinder (which is fine). I’m not used to working in minus cylinder, however, so I don’t plan on making a minus video instruction (these videos take forever to put together). Thanks!

  40. Thanks alot Dr Root Excellent practical demonstration for learners as well as professionals.
    Dr KHAN

  41. Akansha Sinha says:

    Dear Dr. Root,

    Ive always believed reading up from a textbook is entirely different from whats to be practised, which is why I kept forgetting most of the things I read up prior to applying it in real life. Here, your lecture on something this interesting is as close as I could get to a practical experience. I hope to take it forward and learn the most from the foundation you’ve helped me ascertain. Thank you very much.

    Regards,
    Akansha Sinha.
    INDIA

  42. Thoufeer .KP says:

    in case of kc how yo see

  43. Nematullah Sial says:

    very easy and understandble

  44. excellent vidéo…

    juste i want to ask you , how do the transposition ?

    thanks…

  45. Dr· Carlos Guerra says:

    Their vidz help me a lot for understanding many things obout ohpthalmology a speciallity that soon i want to doit.. thanks ..greeting from panama!!!

  46. Thank you very much doctor,,

    But if i have faster and brighter reflex, is it mean i’m not far to the nuetrilize

  47. elshafie kamal says:

    very nice video…thank you

  48. Thank you very much doctor. After long time I understood how to do Retinoscopy. This video is very helpful to many Optometrist. Hope to see more of your lectures. Thank you!

  49. Excellent. Concise and positive!

    We have a preference for starting with a working distance +1.50, neutralising the most with and then using -ve cyls. The rationale being that it minimises the probability of under-plussing due to the Px (particularly children) accommodating.

    …a great lecture and the visuals make this method totally clear.

    Thank you.

  50. Gerardo Bellas says:

    Brilliant Dr Root

    If you work in minus cilinder, jose, you must do the same process.

    You can use the second lens to obtain the sphere value(please, don’t forget to substrat 1.50)

    The difference between the fist and the second lens is the cylinder. Is always the same absolute value.

    And the axis: you can determinate the value
    adding or substracting 90
    or using the first lens, not the second lens for test the axis

    Other way?,…. you can use the Optician tips for convert positive cilinder in negative cylinder.

    I’m sorry. I’m spanish and my English is not fluent enough, jose, but if you can speak my language, I could explain it with more detail.

    Regards
    Gerardo Bellas Spain

  51. ARVIND RAUT says:

    thanks,very nice

  52. Very helpful. All my class-fellows prepared for our final Ophthalmology OSCE from this video. And Dr. Root, you are mad hot! ^_^

  53. great work,,,u r excellent teacher.may GOD bless u

  54. I’ve attempted for several years to learn retinoscopy. I’ve even had a workshop where I thought I finally understood the with and against, however that and no other means of learning ever stuck. It felt like learning calculus … having to memorize complex formulas to apply every step of the way. This is the first explanation/demonstration that flipped the switch on … and it be brightly lit rather than a flickering dimmer bulb that even moths weren’t attracted to. It finally makes complete sense. Sense enough that I’m wondering why it was so hard for me to get before. Thanks so much for putting this together! I’m taking my COT in 5 days and this was the last thing for me to learn … the only thing that has been holding me back for years!

  55. Hi Dr,

    Firstly excellent video.
    2ndly, what do u mean by writing down the
    rx as “at [axis in degrees]”?

    Is it the same as “X [axis in degrees]”

    for example +0.50 +1.00 at 90 = +0.50 +1.00 X 90 ?

    Thanks and keep up the awesome vids.

  56. hello dr root
    some one ask me why we substract sphere only after doing retinoscope
    will you please give me the correct answer i should reply to the the person

  57. I just recently did a COT practical exam (computer simulated) and part of the exam was various instructions that you would give to the patients prior to retinoscope and refraction?

    1)Is telling the patient to keep both eyes open during retinoscope and refraction a required instruction? I figure since they are behind the phoropter naturally the eye not being looked at the moment would be occluded anyway, since one eye is always retinoscope and refracted first at a time. When one eye is done you go on to the other one and occluded the eye not being looked at. Am I right?

    2) Is telling patient to keep both teeth together reguired during retinoscope and refraction?

  58. very simple thank fr videos

  59. thank u lectures.good video

  60. Thank you very much………its verys usefull…♡♥

  61. Dr n varda says:

    Nice video procedure made easy to understand…

  62. kavya pankaj verma says:

    Nice video…

  63. amir kumar shrestha says:

    sir this is very supportive lecture i learned more from this video.my weakness is on astigmatism that is when i do retinoscopy on oblique case i get confuse to determine the actual axis so. can u plz add more videos for astigmatisam.plz add more videos for how to use jackson cross cylinder to find out the axis of prescription glasses .

  64. R.Ramu siddharthan says:

    thanks,sir
    for the wonderful class,iam a resident from india.any videos regarding indirect ophthalmoscope ,perimetry, ffa kindly post it sir

  65. excellent…
    but I can’t download the file completely. is it possible to send it to my E mail address.

  66. this was very helpful. Auther is really able to teach well.could be follwed easily.thank you

  67. Manoj Sharma says:

    Retinoscopy made very simple and practical .Thanks Root!

  68. Hi Dr Root,
    Would the prescription of practitioner affect the working distance?
    I am with +1.50. If my working distance is 67cm, will there be any effect?
    Wendy

  69. When correcting the astigmatism (2nd Axis) in your example, are you using spherical lenses, or, cylindrical lenses placed at the axis of the direction of light?

  70. ramusiddharthan says:

    i have doubt
    how to appreciate the brightness of reflex in media opacity

  71. Vincent Carpentier says:

    Dear Dr Root,

    I’m a french student in Optometry who’s trying to grow up his comprehension in Ophtalmology.
    First of all I would like to thank you for the great and really complete job you made which is helping me a lot in my studies. (Website and book)
    I have one question remaining about this topic : I was wondering if starting with “against” reflects in both axis couldn’t be better for inhibate the subject’s accommodation and find the most convex prescription than starting with “with” reflect. Can you help me to make the good choice with your experience ?

    Thanks again for all your helpfull work all around the world.
    Vincent Carpentier

  72. thank you very mch avery useful lecture

  73. Oh, such a brilliant explanation!!! Thank you so much!!!
    I had a problem to find something similar in russian language, but was lucky to find yours.

  74. Christy.M.Sany says:

    Give more examples for this, like -ve sphere & -ve sphere,-ve sphere &+ve sphere,low -ve & high +ve,high -ve & low +ve sphere s

  75. Amazing tutorial, especially for residents starting out. Will always refer to it.

  76. Dorcas Makoha says:

    I would like to know how to do retisnoscope and settle on minus cly.

  77. ruby rasheed says:

    thank u so much Dr. Root for this Amazing video.
    i just wanna ask a question that in which cases we can find scissor reflex other than keratoconus?

  78. optometrist NILESHLGAIKWAD says:

    really beautiful and simple to understand how to perform a retinoscopy

  79. Usama Abubakar says:

    Great explanation

  80. HI,
    I love your lecture. Just curious when working with a phoropter do we still take the difference of the sphere and cyl power to come up with the final cyl. power or do you document the cyl. that shows on the phoropter when working with (+) cyl.

    1. The phoropter already does the calculation for you … you just document the cyl that shows up on the machine.

  81. It was very helpful .now I can actually see something by using the retinoscope,as they say the eye can not see what the mind doesn’t know.

  82. Kostas Doulas says:

    Amazing presentation …after so many years practicing ophthalmology I have rarely seen such an explanatory and easy learning presentation the credits are with Tim root for sharing this with us

  83. Very efficient, informative lecture! I just want to clarify, is it essential to dilate the pupils prior to Retinoscopy? Bcos in our setting, my seniors don’t usually dilate pts that are for retinoscopy. They simply bring the pt in a dark room in the office and then proceed with the procedure. I just want know if dilating both pupils is the standard. Thank you and more power!

  84. How do we correct for astigmatism
    …Am a novice

  85. I am an ophthalmologist tech in a small clinic. My M.D. began teaching me this skill today. I was sooooooo lost at what I was looking at and what I was supposed to do. Your video is VERY informative and now I can go to work tomorrow and practice more on our practice eye! Thankyou!!

  86. HENRY EGWIM says:

    WHAT A WONDERFUL EXPLANATION. THANKS A BUNCH.

  87. Zak Plaskow says:

    Optometrist and Opthmologists use -ve cylinders what’s the method for this?

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