Purpose
To evaluate the detection of AMD by a retinoscopic technique. Pupillary streaks produced using a calibrated streak retinoscope (Fig. 1) and parallel light vary in reflectance with the pigment and health of the retinal pigment epithelium (RPE). The brightness of the reflected pupillary streak was evaluated using a reflectance scale of #5 to #1, with #5 describing a bright streak decreasing to #2, a faint streak, and #1, no visible streak reflex.
Methods
This was a retrospective study of patients seen in a general ophthalmology practice. Patients with healthy streaks and those with conditions which interfere with retinoscopic streaks were excluded. Patients with depressed streaks, 1-3, and/or abnormal fundus exams were referred to retinal specialists. Patient’s ages ranged 27-93; 25% of the patients had previous diagnoses of AMD, 83% had negative personal or family history of AMD and 98% were Caucasian with 64% female. <br /> <br /> The parallel retinoscopic technique (Fig. 2) was performed after the preliminary ophthalmic examination and a subjective refraction. Slide locks maintained the calibration alignment of the thumb slide of the retinoscope. Pupils were dilated for fundus exams.
Results
Of the 124 eyes with depressed 1-3 streaks, 96% were subsequently diagnosed with AMD by a retinal specialist, i.e. there was a high correlation between abnormal retinoscopic streaks and AMD. Of the 44 eyes previously diagnosed with AMD, 100% had depressed streaks. Of eyes not previously diagnosed with AMD but with depressed streaks, 86% were confirmed to have AMD by the retinal specialist.
Conclusions
This study demonstrates that retinoscopy can detect early and late AMD. Macular pigment is the common element in retinoscopy and AMD. Current evidence suggests that a decrease in the RPE function may contribute to the onset and progression of AMD. This retinoscopic technique may be a useful tool for monitoring the progression and response of AMD to various therapeutic interventions, evaluating patients with AMD scheduled for cataract surgery and improving one’s skills in recognizing early AMD pigment changes. Eye physicians are trained in retinoscopy making inexpensive mass screenings for AMD possible. Early detection could greatly benefit research, patients and society.