Near Retinoscopy (Mohindra) Techniques

Questions and Answers

Which developmental milestone is typically assessed first in children?

Family medical history

Motor skills (correct)

Academic performance

Language development

What specific information is crucial when evaluating a child's academic history?

Occupational history of parents

Social interactions

Grade level and performance in subjects (correct)

Family goals and aspirations

In the context of eye medical history, which problem may indicate a serious concern?

Mild allergies to pollen

General academic difficulties

Specific eye turns or lazy eye (correct)

Remote visual needs

When considering medications for a child, which aspect is least important to document?

The child's favorite color Signup and view all the answers

What is an important aspect to understand in the goals set by the patient or parent?

Desire for better cosmesis or function Signup and view all the answers

Which type of allergy is most critical to investigate before prescribing medication?

Allergies to medications Signup and view all the answers

Which factor can influence a child's developmental milestones significantly?

Socioeconomic background of the family Signup and view all the answers

What is typically evaluated in a child's medical history related to vision?

History of binocular vision problems Signup and view all the answers

Which age-related assessment is generally essential during developmental evaluations?

Age of first steps versus crawling Signup and view all the answers

What factor is least likely to prompt the need for special classes or tutoring?

Excellence in mathematics Signup and view all the answers

What is the primary goal when probing the areas in the case history?

To help establish the diagnosis and develop the prognosis Signup and view all the answers

Which symptom is NOT related to the examination of eye turn or diplopia?

Patient's previous educational background Signup and view all the answers

When assessing the onset of symptoms, which aspect is NOT typically evaluated?

Nature of the patient's relationship status Signup and view all the answers

What type of therapy is typically investigated in the context of a patient's eye history?

Vision therapy Signup and view all the answers

Which factor is NOT considered in evaluating a patient's medical history?

The patient's favorite sport Signup and view all the answers

What aspect of the patient's symptoms may indicate a need for surgery?

Failure of previous treatments to improve condition Signup and view all the answers

Which of the following is NOT part of evaluating the patient's eye history?

Type of transportation used to get to appointments Signup and view all the answers

What does APGAR score assess in a patient's medical history?

Newborn's health status immediately after birth Signup and view all the answers

What kind of vision therapy focus is mentioned regarding patching?

To achieve specific therapy goals, such as pencil push-ups Signup and view all the answers

When discussing symptoms of double vision, what information is critical to gather?

The specific viewing direction causing issues Signup and view all the answers

What should be done to prepare the room for Near Retinoscopy?

Turn off all room lights and close the door. Signup and view all the answers

Why is cylindrical power not subtracted in the recording process for Near Retinoscopy?

Only spherical values are adjusted for accommodation. Signup and view all the answers

In which situation is Near Retinoscopy considered inappropriate?

Under cycloplegic conditions. Signup and view all the answers

What is a suggested method to engage a young child during the procedure?

Make sounds or sing songs to capture their attention. Signup and view all the answers

How is the net findings calculated from the gross findings in Near Retinoscopy?

By subtracting 1.25 from the sphere power. Signup and view all the answers

Which material is NOT required to perform Near Retinoscopy?

Pinhole occluder Signup and view all the answers

What age-related adjustment needs to be made for children under 2 years during Near Retinoscopy?

Subtract 0.75D from the sphere power. Signup and view all the answers

What is a common misconception regarding Near Retinoscopy procedure?

It can typically be performed with room lights on. Signup and view all the answers

According to the procedure, how should the primary meridians of the un-occluded eye be managed?

With lens bars to neutralize them. Signup and view all the answers

What is an important clinical pearl to remember when performing Near Retinoscopy?

Reduced acuity might indicate corneal distortion or other anomalies. Signup and view all the answers

What is the appropriate prism to use for a right esotropia with a deviation of 30 PD while scoping the left eye?

30 BO prism before the left eye Signup and view all the answers

In which situation is it recommended to perform retinoscopy out of the phoropter?

For young patients or those with special needs Signup and view all the answers

How should you adjust retinoscopy for a patient exhibiting a right hypertropia of 15 PD?

Use 15 BU prism before the right eye Signup and view all the answers

What is the suggested prism for a left exotropia with 30 PD while scoping the right eye?

30 BI prism over the right eye Signup and view all the answers

When scoping a patient with strabismic deviation, it is crucial to:

Use prism aligned with the direction of deviation Signup and view all the answers

Which of the following clinical pearls is not accurate for retinoscopy in strabismic patients?

Always perform out of the phoropter Signup and view all the answers

To successfully scope an exotropic patient, what must be taken into consideration?

The eye fixating the target must be determined Signup and view all the answers

Which combination of prisms should be used for a patient with a left hypertropia of 15 PD?

15 BU then 15 BD before the left eye Signup and view all the answers

Which psychopathological adjustment is necessary for strabismic patients during retinoscopy?

Consider baseline deviation degree and direction Signup and view all the answers

Study Notes

Near Retinoscopy (Mohindra) Overview

Useful for estimating refractive errors, particularly in young strabismic children.
Requires monocular testing conditions and is unsuitable under cycloplegic conditions.

Required Materials

Retinoscope, patch, and lens racks needed for the procedure.

Procedure Steps

Conduct testing without a phoropter; ensure the room is dark with only the retinoscope light visible.
Sit approximately 50 cm away from the patient, occlude one eye with a patch, and direct the patient’s attention to the retinoscope light.
Neutralize the primary meridians of the uncovered eye using lens bars, then repeat for the other eye.
This method tends to result in overminus findings.

Recording Results

Gross findings are noted on the optical cross, and then transposed into spherocylinder form.
Calculate net findings by subtracting -1.25D from the sphere power.

Example Gross to Net Findings

Gross: +4.00 DS transposes to Net: +2.00 - 1.00 x 180.
Gross: +2.75 DS transposes to Net: +0.75 - 1.00 x 180.

Clinical Pearls

For patients with reduced visual acuity, perform pinhole acuity testing to rule out various abnormalities.
Remember to turn off all lights to maintain proper focus on the retinoscope light.
Attract children's attention to the light with sounds or songs.
Adjust sphere value deductions based on the patient’s age; younger children have higher tonic accommodation.

Case History Importance

Essential for establishing diagnoses, prognosis, and preparation for patient/parent conferences.
Explore the chief complaint, symptoms, onset, patient eye history, and family medical history for comprehensive assessment.

Symptoms Evaluation

Assess patient awareness of eye turn direction, presence, and consistency of double vision.
Inquire if symptoms improve with head positioning or other adjustments.

Patient and Medical History

Document previous evaluations, treatments, compliance levels, and outcomes of therapies such as glasses, patching, vision therapy, or surgery.
Evaluate general health status and any past illnesses or hospitalizations, including prenatal and birth-related factors.

Assessing Refractive Status in Strabismus

Use near-retinoscopy to keep patients engaged with projected targets.
Employ prisms to align testing approach for different strabismic conditions (esotropia and exotropia) by using BO or BI prisms as necessary.

Deviations Handling

For esotropia, use BO prism on the fixating eye; for exotropia, use BI prism.
Address horizontal deviations with appropriate neutralizing prism adjustments for vertical deviations.

Final Note

Conduct retinoscopy in a manner suited to the patient's ability, especially for young or special needs individuals, to ensure accurate results.

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Description

Explore the Near Retinoscopy technique as outlined by Mohindra, ideally used for estimating refractive errors in young strabismic children. This quiz highlights essential materials, procedure steps, and the specific testing conditions for accurate assessment.