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Retinoscopy Lecture (Video)

This video demonstrates how to perform loose-lens retinoscopy from start-to-finish. I’ve created a simple animatronic model to illustrate the technique. Normally, this is a hard technique to learn, but I think you’ll find this explanation pretty awesome … at least, if you need to learn this material!

length: 24:37 minutes

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Retinoscopy.m4v (195 MB)


(comments below)

Three Steps to Retinoscopy

1. Start with WITH motion
You need to the retina reflection to be “with” in all directions. If you see “against” motion in the beginning, you might need to hold up a -2.00, -4.00, or even a -10.00 lens in front of the eyes to get that “with” motion. Only then can you proceed without getting confused!!!

2. ADD power to neutralize reflex
Slowly add more power (plus power) until you neutralize the red-reflex. If you see “against” motion, you’ve gone too far. If the patient has astigmatism, you may get different powers for each axis … don’t worry. Just set the lenses aside so you can calculate the prescription later. Remember: the sphere power is your first lens, the cylinder power is the difference between the lenses. The axis is the angle your light beam ends up at (see example below)

3. SUBTRACT working distance at end
The last step is to subtract -1.50 from the sphere.

When the image is focused behind the retina, you see "with motion" as the reflection bounces off the retina.

When you use the perfect lens power, the reflection will be bright.

You add power until you neutralize the reflex. If you use too much power, like here, you see a "see-saw" movement of the light reflex. This is called "against" motion.

You subtract a working distance to compensate for your arm-length. For most people this is -1.50

The Final Prescription: -2.50 + 5.00 at 045


Nice vid., though I wish there were just a bit of discussion of what “working-distance” is all about (on the other hand, maybe that would just [needlessly] complicate this particular presentation).

Comment by I Am Name — November 3, 2010

I have to disgree about step 1 “srart with with motion” kids specealy hyperope tend to do accomodation during the retinoscopy test therfore it is better start with againts motion to make sure that the patient dosn’t be over corrected by the end of the retinoscopy test
well as u might guess I’M an optometrist from israel
thank u for the lactures

Comment by eyal — November 29, 2010

Editor: Agree to disagree. I still think its better to “start with with” as demonstrated in this video. All children have cycloplegic (dilated) refractions when performing retinoscopy to avoid the accomodation problem.

Also, I could argue that your method of “starting with against” has a tendancy to “over minus” them at the end if they have any residual accomodation working.

Optometrists (like yourself) like to work in minus, while ophthalmologists (like myself) like to work in plus. Its all a matter of preference, of course.

Comment by admin — December 13, 2010

i want to ask about cylinder lenses ,when we use it? in your examples the patient have astigmatism but you used spher lenses only ,why,,

Comment by wala' — December 21, 2010

Boa Tarde!
achei este video muito bom e gostaria de saber como adquiri-lo em português?

Comment by Marcos — January 3, 2011

very nice and prepare such type of other lectures

Comment by NAEEM — May 26, 2011

thank u 4 your lectures. could u please also prepare lectures for doing sphero-cylindrical retinoscopy as well as how to prescibe prism correction. it would be much appreciated by many ophthalmology residents like myself.

Comment by will — July 3, 2011

A very wonderful video. It made retinoscopy understandable and not scary. Ready to try it out now!!

Comment by sam — July 12, 2011

very good lecture. v soni

Comment by v soni — August 10, 2011

very nice video for retinoscopy

Comment by manikandan — October 27, 2011

wonderful,really very helpful , thnx

Comment by soufiane — November 23, 2011


Comment by imran pasha — December 13, 2011

wonderful,really very helpful , thnx;;;;;;;;;;;;

Comment by imran pasha — December 13, 2011

You are a didactic genius Dr. Root

Comment by Dr. WM Gerber — December 13, 2011

You are a didactic genius Dr Root

Comment by Dr. WM Gerber — December 13, 2011

excellant video…but should n’t we have to susbtract the value for cycloplegic we use…please let me know at my email.

Comment by dr pramod — January 31, 2012

I am very happy to see these the videos,but i couldnot understand that how you referact the stigmatisam or how you use the cylindrical lense.

Comment by tajammal hussain — February 6, 2012

vvery good vedio, but, could you pls explaain me the technique of myopic astiggmatism, eg -2,-1,180, +1, -1, 180….

Comment by Liyau — February 9, 2012

very good vedio. I am student optometry. do you can help me at search about miyopia

Comment by azad — February 23, 2012

its awesome..thank you so much..it was a great help..:)

Comment by megha — February 29, 2012

hello doctor,

Greetings from India. Thanks for the exhaustive explanation. very easy to understand ‘FINALLY’ .i will be looking forward to see many of your videos and lectures.
Thank you

Comment by Dr.Venkatesh — March 1, 2012

hello..i have questions:
how the distance between instrument and patient’s eye?
what object seen by patient? & how the distance?
the the last one how if i want to use minus cylinder, any different method?

Comment by me — June 3, 2012

excellent lecture i am passing on this site to my fellow techs. I have switched from a + cyl phoropter to – cyl, how do i find the astigmatic power now?

thank you

Rodney in Boston

Comment by rodney salvador — September 19, 2012

Thank you for this lectures>>>iwant from you to increased your
vedio about astigmatism.finally thank you.

Comment by mohmmade — December 6, 2012

非常感谢您的视频 所谓的工作距离就是眼距、就例如近视的患者 度数不够用的时候 把眼镜尽量靠近眼睛 看东西会清晰很多

Comment by 郭皓正 — March 12, 2013

Excellent video as always. I don’t think I’ve found a better ret video that describes spheres only. Bravo as usual!

Comment by david spence — April 21, 2013

It was a really educational video. I really got a better knowledge at retinascopy. Thank you so much.

Comment by Prabhamali — July 17, 2013

in case of kc how yo see

Comment by Thoufeer .KP — September 28, 2013

very easy and understandble

Comment by Nematullah Sial — September 29, 2013

excellent vidéo…

juste i want to ask you , how do the transposition ?


Comment by aras — October 8, 2013

Their vidz help me a lot for understanding many things obout ohpthalmology a speciallity that soon i want to doit.. thanks ..greeting from panama!!!

Comment by Dr· Carlos Guerra — October 15, 2013

very nice video…thank you

Comment by elshafie kamal — February 12, 2014

it’s very nice.thank u sir

Comment by nuwan — May 11, 2014

thanks,very nice

Comment by ARVIND RAUT — May 18, 2014

Very helpful. All my class-fellows prepared for our final Ophthalmology OSCE from this video. And Dr. Root, you are mad hot! ^_^

Comment by Moiz — June 11, 2014

great work,,,u r excellent teacher.may GOD bless u

Comment by samra — June 25, 2014

I’ve attempted for several years to learn retinoscopy. I’ve even had a workshop where I thought I finally understood the with and against, however that and no other means of learning ever stuck. It felt like learning calculus … having to memorize complex formulas to apply every step of the way. This is the first explanation/demonstration that flipped the switch on … and it be brightly lit rather than a flickering dimmer bulb that even moths weren’t attracted to. It finally makes complete sense. Sense enough that I’m wondering why it was so hard for me to get before. Thanks so much for putting this together! I’m taking my COT in 5 days and this was the last thing for me to learn … the only thing that has been holding me back for years!

Comment by Bristal — July 9, 2014

Hi Dr,

Firstly excellent video.
2ndly, what do u mean by writing down the
rx as “at [axis in degrees]”?

Is it the same as “X [axis in degrees]”

for example +0.50 +1.00 at 90 = +0.50 +1.00 X 90 ?

Thanks and keep up the awesome vids.

Comment by farhan — July 24, 2014

Thank you

Comment by Saso — September 5, 2014

very simple thank fr videos

Comment by asad — September 10, 2014

thank nd very simple

Comment by asad — September 10, 2014

Marvelous content, thank You !!

Comment by 即時比分nba — September 28, 2014

thank u lectures.good video

Comment by ajay — October 28, 2014

thanks very much , can I ask, please!
i did not understand how do we know the axis ?

Comment by ZAINA Bouzia — November 15, 2014

Thank you very much………its verys usefull…♡♥

Comment by Likhil — December 6, 2014

Nice video procedure made easy to understand…

Comment by Dr n varda — December 7, 2014

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