1. A useful technique to assess accommodation
Dynamic Retinoscopy
A useful technique to assess accommodation
Complete prior to cycloplegia while wearing distance refractive correction
G. Vike Vicente, MD
Assistant Professor of Clinical Pediatrics and Ophthalmology, Georgetown University Hospital

2. What is dynamic retinoscopy?
Retinoscopic technique used to evaluate a patient’s ability to accommodate
Indications:
Patients with esotropia
Patients with asymptomatic high hypermetropia
Subjective complaints of blurred near vision, headaches, or eye strain
Patients with Down syndrome or developmental delay
Other conditions where inability to accommodate is suspected
If accommodative deficiency is present, the patient may benefit from reading glasses or a bifocal

3. How to Perform Dynamic Retinoscopy
It should be completed prior to dilating or using cycloplegic drops and with the patient’s refractive correction in place
The examiner should be standing at a near working distance from the patient i.e. 33cm.
In one hand the examiner should hold a near accommodative target such as small print on a popsicle stick/tongue depressor. For younger patients, a sticker with fine detail may work better
The near target should be held adjacent to retinoscope without occluding the peephole

4. Need picture

5. The examiner holds the near target close to the peephole of the retinoscope. In this case a fixation cube is utilized.

6. How to Perform Dynamic Retinoscopy
Ask the subject to fixate on distant target and assess retinoscopic reflex (“with motion” should be observed)
Check in several meridians in case astigmatism is present
Ask the patient to read or focus on the near target while the light intercept is swept across the pupil

7. Results of Dynamic Retinoscopy
If the patient is able to accommodate, the “with” motion should quickly change to neutralization (the pupil “fills in” ) or “against” movement.
If the pupil reflex shows “with motion” as the patient is attempting to accommodate, this indicatess accommodative deficiency

8. This means the patient can completely accommodate on the near target
Fills in… just right
This means the patient can completely accommodate on the near target
G. Vike Vicente MD

9. With motion…. While patient is trying to read a near card
This means the patient can not completely accommodate on the near target
Patient may need an Rx at least for near.
G. Vike Vicente MD