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D.S. Carlin, D.K. Wallace, J.D. Wright; An Evaluation of the Accuracy of Estimation Retinoscopy . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4316.
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Introduction: One of the daily challenges of a pediatric ophthalmology practice is retinoscopy of an uncooperative child. For those children who object most strongly to the placement of lenses in front of their eyes, it would be ideal to obtain an accurate estimate of refractive error without using lenses. One technique of estimation retinoscopy involves sliding the sleeve of the Copeland retinoscope downward until a neutral red reflex is achieved. The purpose of this study was to evaluate the accuracy of this technique by comparing it to results from standard cycloplegic retinoscopy in cooperative children. Methods: A Copeland retinoscope was calibrated using a schematic eye and 3 healthy adult volunteers who received cycloplegic eye drops. A scale was created adjacent to the sleeve of the retinoscope which allowed an estimate of refractive error based on the position of the top of the sleeve. Seventy eyes of 35 children had cycloplegic estimation retinoscopy done by one examiner who was blinded to refractive errors, and accuracy was defined as one diopter within the refractive error obtained by standard retinoscopy with loose lenses. Results: Estimation retinoscopy was accurate in: 34 of 37 eyes (92%) with spherical equivalence between –1.50 D and +1.50 D, 13 of 33 eyes (39%) with spherical equivalence between +1.75 D and +6.00 D, 12 of 13 eyes (92%) with cylindrical power between +1.00 D and +2.00 D, and 3 of 9 eyes (33%) with cylindrical power between +2.25 D and +5.00 D. None of 37 eyes with an estimated spherical equivalent less than +1.50 had an actual spherical equivalent greater than +4.25 D, and one of 26 eyes (4%) with an estimated cylinder power of +1.00 D or less had an actual cylinder power of greater than +2.25 D. Conclusions: The technique of estimation retinoscopy done by sliding the sleeve of the Copeland retinoscope downward is very sensitive for eyes with very mild myopia or hyperopia, but it has poor sensitivity for eyes with higher degrees of hyperopia or astigmatism. However, when this estimation technique indicates a spherical equivalent between –1.50 D and +1.50 D, with +1.00 D of cylinder power or less, the examiner can be assured that an amblyogenic refractive error is almost never present.
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