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K.M. Daum, W.S. Abel, J.A. Essinger, S.E. Simms; Comparison of Retinoscopy Findings of Novice and Experienced Clinicians . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1180.
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© ARVO (1962-2015); The Authors (2016-present)
Retinoscopy is an essential skill for the objective assessment of refractive error. The objective of this project was to compare the retinoscopy findings of a cadre of experienced clinicians (EC) to those of a group of novice clinicians (NC). We hypothesized that this technique requires skills gained through experience. Consequently, the errors made by experts should be smaller and more consistent than those made by the novices.
Without knowledge of the results of any other clinician, each participating clinician performed non–cycloplegic retinoscopy on both eyes of adult subjects recruited to be at least 15 yrs old with no exclusion criteria. The data for each eye were analyzed using a vector technique that allowed the retinoscopy data to be expressed as the resultant of three orthogonal lenses and/or as a single number, vector diopters (VD). The median of three orthogonal lenses of each EC created a standard finding for each eye. Standards for EC were formed from the median of the remaining EC and did not include their own findings. Every finding was compared to the standard to provide an estimate of the vector dioptric difference (VDD) for each clinician for each subject’s eye. Assessments of the median VDD and the interquartile range was taken as an indicator of retinoscopy ability.
Four EC (mean experience, 16.5 yrs, SD 12.4, range 3 to 28 yrs; 2 m, 2 f; mean age, 47.0 yrs, SD 14.5, range 31 to 65) and 119 NC (<1 yr experience) took part. Evidence suggested that the VDD was not normally distributed (Anderson–Darling test, p<0.005). The median VDDs for EC were significantly smaller than those of the NC (0.40 vs. 0.50 VD; Kruskal–Wallis, H=92.8, p=0.0001). Median VDD for EC ranged from 0.40 to 0.43 (n=271 to 341) while those for NC ranged from 0.27 (n=24) to 0.82 (n=53). The minimum and maximum VDD for NC (n=6529) and EC (n=1202) was similar, however the interquartile range for EC was significantly smaller than for NC (0.37 vs. 0.49). VDD distributions were leptokurtic and positively skewed.
These data indicate that EC are more consistent and obtain smaller overall errors than NC in performing noncycloplegic retinoscopy. NC, however, may obtain results that are clinically useful with limited experience. The overall reliability of the technique for EC is about 0.40D.
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