Dynamic Retinoscopy

J Med Sci 2003;23(6):329-332
http://jms.ndmctsgh.edu.tw/2306329.pdf
Copyright © 2003 JMS
Clinical Tool Aid in Diagnostic and Therapeutic Dilemmas
Involving Hypermetropic Amblyopia--Dynamic Retinoscopy
Received: December 3, 2002; Revised: June 13, 2003;
Accepted: June 18, 2003.
* Corresponding author: Po-Liang Chen, Department of
Ophthalmology, Tri-Service General Hospital, 325, Cheng-
Kung Road Section 2, Taipei 114, Taiwan, Republic of
China. Tel: +886-2-87927163; Fax: +886-2-87927164; email:
chenboli@gcn.net.tw
Po-Liang Chen * , Dao-Chun Hsi, Joa-Jing Fu, and Ping-I Chou
Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center,
Taipei, Taiwan, Republic of China
Po-Liang Chen, et al.
Background: Dynamic retinoscopy is a well-described but often overlooked technique that allows rapid assessment of
accommodative ability. We want to evaluate the application of dynamic retinoscopy in hypermetropic children with or
without amblyopia. Methods: From Jan. 1999 to Jan. 2001, 60 eyes of 40 patients were enrolled in this study. Patients were
selected based on the hyperopic refractive error (ranged from +0.25D to +5.00D, mean+2.73D) according to their medical
records. The average age was 6.7 years, ranged from 4 to 11 years. Dynamic retinoscopy was performed on 28 eyes with
amblyopia and 32 eyes without amblyopia then the results of dynamic retinoscopy were recorded. Results: All nonamblyopic
eyes (53.3%) showed the “rapid, complete, steady” normal response. On the other hand, all the amblyopic eyes
(46.7%) revealed abnormal responses, “incomplete” (35.7%), “asymmetric” (35.7%) and “unsteady” (14.4%) were the most
of all. Conclusions: In our study, all subjects with good accommodative ability will not develop amblyopia even with
moderate-to-high degree of hyperopia. On the other hand, subjects with poor accommodative response will have high risk
of developing amblyopia even with mild degree of hyperopia. Therefore this clinical tool can be used as a convenient and rapid
guide providing critical data about accommodative ability that can help us solve diagnostic or therapeutic dilemmas involving
hyperopic amblyopia, especially in preverbal children.
Key words: accommodation, dynamic retinoscopy, hyperopic amblyopia
INTRODUCTION
Hyperopia is a common refractive error of children 1 and
usually do not cause visual problem in mild degree of
hyperopia. But with moderate-to-high degree of hyperopia,
the risk of developing amblyopia and strabismus become
increased. Anisometropia and isoametropia are the second
and third common cause of amblyopia 2 , hyperopia takes an
important part in both forms. Accommodative responses
play a critical role in the determination of occurrence of
hyperopic amblyopia 3,4 .
There are many kinds of method to evaluate children’s
visual status like visual acuity test, stereopsis test,
autorefraction, VEP, and photoscreener. In children whose
visual acuity can be determined, hyperopic amblyopia is
easy to diagnose and subsequent treatment can be well
established. But in preverbal kids with suspicious degree
of hyperopia, the diagnosis of amblyopia is quite difficult
and the need of treatment is also puzzling both to doctors
and parents. Besides, we also cannot know how these
children accommodate in their real-life situations. So we
introduced the well-known but less used tool: dynamic
retinscopy to solve the dilemma. In order to evaluate the
application of dynamic retinoscopy in hyperopic children
with or without amblyopia, a retrospective study was done.
MATERIALS AND METHODS
From Jan. 1999 to Jan. 2001, 60 eyes of 40 patients were
enrolled in this study. Patients were selected based on the
hyperopic refractive error according to their medical
records. The mean age was 6.7 years ranged from 4 to 11
years. The ratio of female to male was 2:1. Depending on
with amblyopia or not, they were categorized into 2 groups
(Table 1). All patients received complete eye examination
including slit lamp, ophthalomoscopy, cover test, manifest
refraction, cycloplegic refraction and visual acuity (Snellen
chart). Exclusion criteria consisted of astigmatism over
1D, strabismus, abnormal eye finding, uncooperative and
age less than 4 years old (Table 2).
329

Dynamic retinoscopy detecting hyperopic amblyopia
Table 1 Characteristics of the patients
Sex
Male
Female
Age (year, mean SD)
Refraction error
(diopter, mean SD)
Amblyopia (No)
0-+1D
>+1-+2D
>+2-+3D
>+3-+4D
>+4D
Total
Table 2 Exclusion criteria
Astigmatism 1D
Strabismus
Abnormal eye finding (Nystagmus, Congenital cataract, Coloboma of the optic
nerve, other systemic associated anomalies)
Age

complete, steady” normal response. On the other hand, all
amblyopic eyes (46.7%) revealed abnormal responses;
“incomplete” (35.7%), “asymmetric” (35.7%), and “unsteady”
(14.4%) were the most of all (Table 3). “Incomplete”
means that the neutralization only can be seen if
moving near target backward. “Unsteady” means that
neutralization only can be seen for a short period of time.
“Asymmetric” means that one eye achieves the neutralization
response but another eye cannot accomplish the
response. In view of relationship between power degree of
hyperopia and various abnormal responses, “incomplete”
response correspond to the highest mean power degree of
hyperopia (4.15D) followed by “asymmetric” (3.675D),
“unsteady” (2.75D) and “sluggish” (2.25D) responses.
When compared with mean refractive error of all patients
(2.73D) by using unpaired t test, “incomplete” and “asymmetric”
have more significant statistical difference than
other responses (P

Dynamic retinoscopy detecting hyperopic amblyopia
ity cannot be determined like preverbal children, mild
mental retardation, and Down syndrome. We also learn
that it can be used as a reliable and quick screening tool for
potentially amblyopiagenic refractive error of hyperopia.
After this study in our clinical practice, we used this tool to
help us make decision in treating children with hyperopic
error that would produce amblyopia in preverbal children.
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