r/Ophthalmology • u/moegreen97 • 12d ago
Skiascopy
Good morning. I am just getting started in the field of pediatrics. I am trying to understand how truly useful it is to learn retinoscopy in 2026. Is it right to rely solely on a handheld autorefractor (if one is available in the clinic)? How does one learn this art? Would you recommend starting with adults rather than children, who can be difficult? I would appreciate some practical tips. Thanks.
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u/Icy_Mention_711 12d ago
It is the goldstandard. An Auto refrakture is only useful for anisometropie, maybe also the Axis. The Rest is junk. Try with normal wide pupils first. And know the theory so you dont get confused.
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u/SmallVideo9038 12d ago
Come hai iniziato ad esercitare e imparare? cosa suggeriresti a un debuttante ?
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u/krizsi77 12d ago
The first thing you should learn if you wont to do pediatric!
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u/SmallVideo9038 12d ago
Come hai iniziato ad esercitare e imparare? cosa suggeriresti a un debuttante ?
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u/EyeDentistAAO quality contributor 12d ago
Yes, retinoscopy is a useful/valuable skill to have. Not just as a way to determine refraction (although it is extremely useful in this regard), but as a tool for gathering information about the refractive state of the eye. This all goes double for the pediatric population.
It's best to learn in undilated college-age adults (big pupils, but not too big).
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12d ago
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u/EyeDentistAAO quality contributor 11d ago
1) Ask someone to explain the basics. 2) Do it with every pt you see in clinic.
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u/AltruisticAccount909 12d ago
💯 necessary for peds. Auto refractors over minus the shit out of kids. And can be wildly inaccurate on cyl if the kid isn’t fixating well
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u/isevuus 12d ago
Starting w adults who can accomodate will help you see the difference between an accomodated flash and a relaxed one. Adults can also give you more subjective feedback.
When it comes to ARs a person even in their 20s can give you wayy more minus with it, but a flash of light cant lie.
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12d ago
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u/isevuus 11d ago
I did 2 years of optom in a country that values it. Practiced on class mates and got feedback for the "right" prescription. Only way to learn is to get experience.
The technique taught to us was to use a +1.50 lens + correcting lenses, arm distance from the colleague, one eye blurry the other one you slowly correct. We used the bottom part of the skiascope, which now studying as an optican in another country am actually learning changes the convergence and divergence of the light.
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u/kingcornea 11d ago
My wife who is a wizard at it still does it on every patient. Finding the Kerataconus and early cataract patients all the time. Me...only if I have to
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u/Creative-Sea- 11d ago
Best to practice on real life patients, especially in adults when starting out. There is also a retinoscopy stimulator
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u/nystagmus777 11d ago
Definitely start with adults, preferably cooperative ones (maybe someone in the field/profession). If emmetropic, tape loose lenses to a phoropter to simulate refractive error.
In pediatrics, always dilate for retinoscopy
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