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Musa M, Enaholo E, Bale BI, Salati C, Spadea L, Zeppieri M. Retinoscopes: Past and present. World J Methodol 2024; 14:91497. [DOI: 10.5662/wjm.v14.i3.91497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/14/2024] [Accepted: 05/29/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Retinoscopy is arguably the most important method in the eye clinic for diagnosing and managing refractive errors. Advantages of retinoscopy include its non-invasive nature, ability to assess patients of all ages, and usefulness in patients with limited cooperation or communication skills.
AIM To discuss the history of retinoscopes and examine current literature on the subject.
METHODS A search was conducted on the PubMed and with the reference citation analysis (https://www.referencecitationanalysis.com) database using the term “Retinoscopy,” with a range restricted to the last 10 years (2013-2023). The search string algorithm was: "Retinoscopy" (MeSH Terms) OR "Retinoscopy" (All Fields) OR "Retinoscopes" (All Fields) AND [(All Fields) AND 2013: 2023 (pdat)].
RESULTS This systematic review included a total of 286 records. Publications reviewed iterations of the retinoscope into autorefractors, infrared photo retinoscope, television retinoscopy, and the Wifi enabled digital retinoscope.
CONCLUSION The retinoscope has evolved significantly since its discovery, with a significant improvement in its diagnostic capabilities. While it has advantages such as non-invasiveness and broad applicability, limitations exist, and the need for skilled interpretation remains. With ongoing research, including the integration of artificial intelligence, retinoscopy is expected to continue advancing and playing a vital role in eye care.
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Affiliation(s)
- Mutali Musa
- Department of Optometry, University of Benin, Benin 300283, Nigeria
- Department of Ophthalmology, Africa Eye Laser Centre, Benin 300105, Nigeria
| | - Ehimare Enaholo
- Department of Ophthalmology, Africa Eye Laser Centre, Benin 300105, Nigeria
- Department of Ophthalmology, Centre for Sight Africa, Nkpor 434101, Nigeria
| | | | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, "Sapienza" University of Rome, Rome 00142, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
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Schaafsma JD, Arnold RW. Pre-Cycloplegic Exam Benefit of Photoscreening and Accommodation-Relaxing Skiascopy. Clin Ophthalmol 2024; 18:833-846. [PMID: 38504935 PMCID: PMC10950080 DOI: 10.2147/opth.s454430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/21/2024] [Indexed: 03/21/2024] Open
Abstract
Background Seeking a quick way to estimate refractions for challenging pediatric patients, we studied two non-contact methods with particular attention to accuracy and level of stress in uncovering cycloplegic hyperopia. Methods Newly referred and follow-up pediatric eye patients had timed school bus accommodation-relaxing skiascopy (SBARS) and Plusoptix A12 (Px) photoscreener testing before cyclopentolate 1% confirmatory examinations. The ABCD ellipsoid univariate method based on relative blur and vector components was used to compare dry sphero-cylinder refraction estimates with cycloplegic. Receiver operating characteristic (ROC) curves were used to determine screening value. Results Three compared refractions were attempted in 191 racially diverse children of whom 100 were age 0.2-3.9 years and 91 were 4 to 14 years. Plusoptix failed to yield a result in 21 and an additional 21 were interpreted as an excess sphere. Median spherical equivalent did not differ between Px and SBARS for 149 with Px readings but in hyperopic patients, Plusoptix uncovered 27% less hyperopia. The ellipsoid for SBARS of 0.8 was better than 2.4 for Plusoptix (Mann-Whitney p<0.001). Plusoptix was fastest (3-15 seconds) followed by SBARS (15-30 seconds) compared to 30-45 minutes for cycloplegic exam. Conclusion Non-contact quick refractive methods enhanced confirmatory cycloplegic pediatric exam in high-risk pediatric patients.
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Affiliation(s)
| | - Robert W Arnold
- Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USA
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Arnold R, Angi M. Multifaceted Amblyopia Screening with blinq, 2WIN, and PDI Check. Clin Ophthalmol 2022; 16:411-421. [PMID: 35210746 PMCID: PMC8858021 DOI: 10.2147/opth.s349638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/11/2022] [Indexed: 12/25/2022] Open
Abstract
Background Novel devices target different facets of amblyopia risk factors (ARFs). Through birefringence, the Rebion blinq assesses binocular foveation. The Adaptica 2WIN is a multiradial infrared photorefractor that also estimates ocular alignment. PDI Check is a forced-choice, dynamic near-vision game for the autostereoscopic Nintendo 3DS. Methods New and returning patients to a pediatric ophthalmology clinic had concomitant confirmatory exams after all three vision screens had been validated with ROC curves, Bland–Altman plots, and Alaska Blind Child Discovery ellipsoid grades. Exam outcomes were classified by ARF visual acuity, strabismus, binocularity, and refractive errors following the 2021 AAPOS guidelines and Bosque–Hunter rubric for the blinq. Results A total of 202 ethnically diverse students aged 10±4 (4–19) years, 33% treatment-naïve, had a high (58%) prevalence of ARFs. Linear logMAR visual acuity, intereye differences, stereo and three-cone color correlated well between PDI Check and exams. Mean score on the 2WIN matched sphero-cylinder exam with ellipsoid scoring was 2.1±1.5. For AAPOS 2021 refractive plus strabismus, sensitivity/specificity for PDI Check was 68%/59%, 2WIN 72%/95%, and blinq 87%/32%. For the amblyopia or strabismus rubric, PDI Check was 79%/68%, 2WIN 56%/65%, and blinq 94%/37%. Conclusion Each device had advantages and disadvantages in screening this cohort of older, high-prevalence students, many of whom had already been treated. Validation methods should cover more than just refraction, as the new 2021 AAPOS guidelines do. ![]()
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Affiliation(s)
- Robert Arnold
- Alaska Blind Child Discovery, Alaska Children’s Eye and Strabismus, Anchorage, Alaska, 99508, USA
- Correspondence: Robert Arnold, Alaska Blind Child Discovery, Alaska Children’s Eye and Strabismus, Office 280, 3500 Latouche Street, Anchorage, Alaska99508, Tel +1-907 561-1917, Fax +1907 563-5373, Email
| | - Mario Angi
- Senior Scientist, Department of Ophthalmology, University of Padua, Padua, Padua Province, Italy
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Arnold R, Silbert D, Modjesky H. Instrument Referral Criteria for PlusoptiX, SPOT and 2WIN Targeting 2021 AAPOS Guidelines. Clin Ophthalmol 2022; 16:489-505. [PMID: 35250260 PMCID: PMC8893268 DOI: 10.2147/opth.s342666] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/04/2022] [Indexed: 12/27/2022] Open
Abstract
Background Methods Results Conclusion ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/cPqIFE1_Eqo
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Affiliation(s)
- Robert Arnold
- Alaska Blind Child Discovery, Alaska Children’s Eye & Strabismus, Anchorage, Alaska, USA
- Correspondence: Robert Arnold, Alaska Blind Child Discovery, Alaska Children’s Eye & Strabismus, 3500 Latouche #280, Anchorage, Alaska, 99508, USA, Tel +1 907 561-1917, Fax +1 907 563-5373, Email
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Mahlen T, Arnold RW. Pediatric Non-Refractive Vision Screening with EyeSwift, PDI Check and Blinq: Non-Refractive Vision Screening with Two Binocular Video Games and Birefringent Scanning. Clin Ophthalmol 2022; 16:375-384. [PMID: 35177896 PMCID: PMC8846608 DOI: 10.2147/opth.s344751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this paper is to validate three recent non-refractive devices that target sensory and/or strabismus risk factors for amblyopia. EyeSwift® with eye tracking and PDI Check on autostereoscopic Nintendo 3DS are video games that estimate acuity, binocularity and color. The Rebion blinq assesses foveation by birefringence. Methods Students were consented to be screened by each device as if by a school nurse before confirmatory examination with optimized, refined refraction. Results were compared with correlation and Bland Altman plots while screening ability was compared with 2021 AAPOS Guidelines and the strabismus-amblyopia rubric proposed by David Hunter. Results A total of 77 ethnically diverse students, aged 11±4 (4–19) years had a 77% prevalence of 2021 risk factors. Near visual acuity, inter-eye difference and stereopsis correlated significantly (p<0.01) for the EyeSwift® (r2 0.14, 0.06 and 0.45) and PDI Check (r2 0.23, 0.22 and 0.32). The sensitivity/specificity to target 2021-AAPOS: Hunter-rubric for EyeSwift® was 82%/56%: 74%/62%, for PDI Check was 75/64%: 69%/69% and for blinq 75/48%: 82%/39%. Sensitivity/specificity for the seven color-deficient students was 86%/84% for EyeSwift® and 100%/81% for PDI Check. Screening time was 96±19 s for PDI Check and 375±102 s for EyeSwift but less than 25 s for blinq. Conclusion Reliable near visual acuity, stereo and color testing were obtained from the two binocular and touch screen devices often with minimal coaching of the student. The blinq rapidly gives an estimate of whether both eyes are steadily fixing, and the ProVersion predicted 100% which eye is deviated or amblyopic. Non-refractive validation metrics were beneficial. ![]()
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Affiliation(s)
- Tsaina Mahlen
- Pacific Northwest University College of Osteopathic Medicine, Yakima, WA, USA
| | - Robert W Arnold
- Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USA
- Correspondence: Robert W Arnold Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, 3500 Latouche #280, Anchorage, AK, 99508, USATel +1 907 561-1917Fax +1 907 563-5373 Email
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Arnold RW, Martin SJ, Beveridge JR, Arnold AW, Arnold SL, Beveridge NR, Smith KA. Ellipsoid Spectacle Comparison of Plusoptix, Retinomax and 2WIN Autorefractors. Clin Ophthalmol 2021; 15:3637-3648. [PMID: 34511869 PMCID: PMC8415895 DOI: 10.2147/opth.s326680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/11/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Handheld devices can automatically give an estimate of refraction. The established method for refraction comparison using spherical equivalent (M) and J0, J45 vector transformations by Bland-Altman analysis is too complex for non-eye doctors involved with vision screening and remote vision clinics. Therefore, a simpler comparison technique was developed. METHODS Based on the spectacle limit to resolve grade A 1 logMAR, B 3 logMAR and C 6 logMAR blur, J0, J45, and M are combined into the Alaska Blind Child Discovery (ABCD) composite ellipsoid GRADE system. Pediatric eye patients had confirmatory examination after dry refraction with three portable autorefractors: Plusoptix, 2WIN and Retinomax. The refractions were then compared using both Bland-Altman and ABCD composite. Performance to detect AAPOS amblyopia risk factors was also assessed. RESULTS A total of 202 children, mean age seven years, 28% high spectacle need and 43% AAPOS 2013 amblyopia risk factors showed high correlation with cycloplegic refraction (intraclass correlation 0.49 to 0.90) for sphere, J0 and J45 spectacle components. Plusoptix had more (10%) inconclusives due to patients out-of-range. The Retinomax was unable to screen some younger children and was less reliable for sphere but gave more precise astigmatism estimates. The proportion of autorefractions expected to give GRADE A/B high-need patients acuity improvement to 20/40 would be 41% for Plusoptix, 39% for 2WIN and 65% for Retinomax. Sensitivity/specificity for amblyopia risk factor detection was 80%/83% for Plusoptix, 72%/88% for 2WIN and 84%/73% for Retinomax. CONCLUSION The simplified spectacle comparison resembled Bland-Altman and could assist lay vision screeners and non-eye doctors attempting remote spectacle donation worldwide.
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Affiliation(s)
- Robert W Arnold
- Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, 99508, USA
| | | | | | | | | | | | - Kyle A Smith
- Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, 99508, USA
- Accurate Vision, Anchorage, AK, USA
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Keffalos M, Martin S, Arnold R. Drive-by Photoscreening: Plusoptix, 2WIN and Blinq Amblyopia Detection During the COVID-19 Pandemic. Clin Ophthalmol 2021; 15:775-782. [PMID: 33654376 PMCID: PMC7914108 DOI: 10.2147/opth.s300871] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/03/2021] [Indexed: 12/26/2022] Open
Abstract
Background Community photoscreening for amblyopia had successfully been adopted by many communities, however many clinics curtailed screening as a result of the COVID-19 pandemic. We modified three conventional devices and tested them for outdoor, drive-by socially distanced photoscreening and refraction. Methods External frames that provide luminance control and focus distance were fashioned for plusoptiX S12 (Nuremberg, Germany), Adaptica 2WIN in Kaleidos case (Padova, Italy) and the Rebion blinq (Boston, USA). Children were screened by each device and then Retinomax (Righton, Japan) before AAPOS guideline validation. Results Eighty-eight children average age 8±7 years had precise refraction and alignment from which 69% AAPOS 2003 risk factors were determined. The sensitivity/specificity/inconclusive rate for plusoptiX was 85%/96%/16%, for 2WIN 79%/89%/5% and for blinq 43%/74%/8%. Blinq improved to 54%/70% when screening for amblyopia ± strabismus. Bland Altman analysis of spherical equivalent showed plusoptiX and 2WIN with less over-minus than Retinomax and J0 and J45 vectors highly reliable for astigmatism determination. Conclusion The infrared photorefractors in modified cases reliably screened amblyopia risk factors and refraction. The birefringent scanner provided drive-by results but less reliably with wire-frame opaque case than without the case in a dimly lit room. Modified drive-by photoscreeners could help reduce amblyopia and provide socially distanced refraction during an extended pandemic.
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Levitt AH, Martin SJ, Arnold RW. Performance of Glow Fixation GoCheck Kids and 2WIN Photoscreeners and Retinomax to Uncover Hyperopia. Clin Ophthalmol 2020; 14:2237-2244. [PMID: 32982148 PMCID: PMC7500080 DOI: 10.2147/opth.s256991] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/07/2020] [Indexed: 12/27/2022] Open
Abstract
Background A low-detail, glowing fixation device was added to GoCheck Kids (GCK) photoscreener in the hope of unmasking hyperopia and amblyopia risk factors (ARF). Methods Pediatric eye patients were screened by GCK and 2WIN photoscreeners, and Retinomax autorefractor before being compared to AAPOS ARFs. Results Screening was attempted by 131 children who then had school bus accommodation-relaxing skiascopy (SBA-RS) before cycloplegic examination. By 2013 AAPOS uniform guidelines, sensitivity/specificity for GCK was 87%/68%, for 2WIN 87%/71% and for Retinomax 79%/68%. Detection of amblyopia had sensitivity/specificity by GCK of 78%/63%, for 2WIN 79%/65% and for Retinomax 77%/68%. Inconclusive screens were seven for GCK, six for 2WIN and 13 for Retinomax. Mean hyperopia for GCK (+2.49±0.74 D) was similar to cycloplegic refraction (+2.93±0.72 D) and SBA-RS (+2.80±0.82 D) while GCK was slightly more than Retinomax (+1.59±0.93 D, p=0.13) but significantly more than 2WIN (+1.02±0.49 D, p<0.01). Conclusion GCK, 2WIN and Retinomax had similar validity detecting uniform amblyopia risk factors and amblyopia itself. The nondetailed glow fixation device allowed GCK to uncover substantial hyperopia while the detailed flashing fixation devices on 2WIN and Retinomax seemed to stimulate accommodation in some hyperopic children. Clinical Trials Registry NCT04297969. Data Access: http://www.abcd-vision.org/references/GCK%20glow%202WIN%20deidentify.pdf. Précis A glow fixation device on a smart phone photoscreener allowed robust detection of hyperopia.
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Affiliation(s)
- Alexa H Levitt
- Human and Organizational Development, Vanderbilt University, Nashville, TN, USA
| | - Samuel J Martin
- Research Department, Alaska Blind Child Discovery, Anchorage, AK, USA
| | - Robert W Arnold
- Alaska Blind Child Discovery, Alaska Children's EYE & Strabismus, Anchorage, AK, USA
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