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Simultaneous Retinoscopy

Reply from: Zetsu
Date: 13 Apr 2008, 22:11
Simultaneous Retinoscopy

[...Simultaneous Retinoscopy

Much of my information about the eye has been obtained by means of
simultaneous retinoscopy.

The retinoscope Is an instrument used to measure the refraction of the
eye. It throws a beam of light into the pupil by reflection from a
mirror, the light being either outside the instrument--above and behind
the subject--or arranged within it by means of an electric battery. On
looking through the sight-hole one sees a larger or smaller part of
the pupil filled with light, which in normal human eyes is a reddish
yellow, because this is the color of the retina, but which is green in
a cat's eye, and might be white if the retina were diseased. Unless
the eye is exactly focussed at the point from which it is being
observed. one sees also a dark shadow at the edge of the pupil, and it
is the behavior of this shadow when the mirror is moved in various
directions which reveals the refractive condition of the eye. If the
instrument is used at a distance of six feet or more, and the shadow
moves in a direction opposite to the movement of the mirror, the eye
is myopic. If it moves in the same direction as the mirror, the eye is
either hypermetropic or normal; but in the case of hypermetropia the
movement is more pronounced than in that of normality, and an expert
can usually tell the difference between the two states merely by the
nature of the movement, In astigmatism the movement is different in
different meridians. To determine the degree of the error, or to
distinguish accurately between hypermetropia and normality, or between
the different kinds of astigmatism, it is usually necessary to place a
glass before the eye of the subject.

This exceedingly useful instrument has possibilities which have not
been generally realized by the medical profession. It is commonly
employed only under certain artificial conditions in a dark room; but
it is possible to use it under all sorts of normal and abnormal
conditions on the eyes both of human beings and of the lower animals.
I have used it in the daytime and at night; when the subjects were
comfortable and when they were excited; when they were trying to see
and when they were not; when they were lying and when they were
telling the truth. I have also used it, under varying conditions, on
the eyes of many cats, dogs, rabbits, birds, turtles, reptiles and
fish.

Most ophthalmologists depend upon the Snellen test card, supplemented
by trial lenses, to determine whether the vision is normal or not, and
to determine the degree of any abnormality that may exist. This is a
slow, awkward and unreliable method of testing the vision, and
absolutely unavailable for the study of the refraction of the lower
animals and that of human beings under the conditions of life. The
test card can be used only under certain favorable conditions, but the
retinoscope can be used anywhere. It is a little easier to use it in a
dim light than in a bright one, but it may be used in any light, even
with the strong light of the sun shining directly into the eye. It is
available whether the subject is at rest or in motion, asleep or
awake, or even under ether or chloroform. It is also available when
the observer is In motion. It has been used successfully when the
eyelids were partly closed, shutting off part of the area of the
pupil; when the pupil was dilated; also when it was contracted to a
pin-point; when the subject was reading fine print at six inches, or
at a greater distance; and when the eye was oscillating from side to
side, from above downward, or in other directions.

It takes a considerable time, varying from minutes to hours, to
measure the refraction with the Snellen test card and trial lenses.
With the retinoscope, however, the refraction can be determined in a
fraction of a second. With the Snellen test card and trial lenses it
would be impossible to get any Information about the refraction of a
baseball player at the moment he swings for the ball, at the moment he
strikes it, and at the moment after he strikes it. With the
retinoscope, however, it is quite easy to determine whether his vision
is normal, or whether he is myopic, hypermetropic, or astigmatic, when
he does these things; and if any errors of refraction are noted, one
can guess their degree pretty accurately by the rapidity of the
movement of the shadow.

With the Snellen test card and trial lenses conclusions must be drawn
from the patient's statements as to what he sees; but the patient
often becomes so worried and confused during the examination that he
does not know what he sees, or whether different glasses make his
sight better, or worse; and, moreover, visual acuity is not reliable
evidence of the state of the refraction. One patient with two diopters
of myopia may see twice as much as another with the same error of
refraction. The evidence of the test card is, in fact, entirely
subjective; that of the retinoscope is entirely objective. depending
in no way upon the statements of the patient.

By means of simultaneous retinoscopy it has been demonstrated that the
refraction of the eye is never constant; that all persons with errors
of refraction have, at frequent intervals during the day and night,
moments of normal vision when their myopia, hypermetropia, or
astigmatism, disappears completely; and that all persons, no matter
how good their sight may ordinarily be, have moments of imperfect
sight when they become myopic, hypermetropic, or astigmatic. It has
also been demonstrated that when the eye makes an effort to see, an
error of refraction is always produced, and that when it looks at
objects without effort, all errors of refraction disappear, no matter
how great their degree, or how long their duration. It has been
further demonstrated that when the eye strains to see distant objects
myopia is always produced in one or all meridians, and when it strains
to see near objects hypermetropia is always produced in one or all
meridians.

The examination of the eyes of persons while asleep, or under the
influence of ether or chloroform, has shown that the eye is rarely at
rest during sleep, or while the subject is unconscious from any cause.
Persons whose sight was normal while awake were found to have myopia,
hypermetropia and astigmatism when asleep, and if these errors were
present when they were awake, they were increased during sleep. This
explains why so many people are unable to see as well in the morning
as at other times, and why people waken with headaches and pain in the
eyes. Under ether or chloroform, errors of refraction are also
produced or increased, and when people are. sleepy they have
invariably been found to have errors of refraction.

Under conditions of mental or physical discomfort, such as pain,
cough, fever, discomfort from heat or cold, depression. anger, or
anxiety, errors of refraction are always produced in the normal eye,
or increased in the eye in which they already exist. In a dim plight.
inp a fog, or in the rain, the retinoscope may indicate no error of
refraction in eyes which ordinarily have normal sight; but a pilot on
a ship on a rainy night usually has an error of refraction, because he
is straining to see, and it is rare to find persons in positions of
responsibility under unfavorable conditions with normal vision.

In order to obtain reliable results with the retinoscope it must be
used at a distance of six feet or more from the subject. When used at
a distance of three feet or less, as it commonly is, the subject
becomes nervous and unconsciously strains, thus altering his
refraction...]

- Dr. W. H. Bates, October 1919

Reply from: Jan
Date: 13 Apr 2008, 22:32
Re: Simultaneous Retinoscopy

Zetsu schreef:
> [...Simultaneous Retinoscopy
>
> Much of my information about the eye has been obtained by means of
> simultaneous retinoscopy.

Yes, and?

Jan (normally Dutch spoken)

Reply from: Zetsu
Date: 13 Apr 2008, 22:30
Re: Simultaneous Retinoscopy

>Yes, and?

And, this lead to several significant discoveries.
Jan, I haven't seen you here for a long time.
What brings you back?


Reply from: Jan
Date: 13 Apr 2008, 22:58
Re: Simultaneous Retinoscopy

Zetsu schreef:
>> Yes, and?
>
> And, this lead to several significant discoveries.

Such as?

Jan (normally Dutch spoken)

Reply from: Zetsu
Date: 13 Apr 2008, 23:01
Re: Simultaneous Retinoscopy

They are described in The Book.

Reply from: Jan
Date: 14 Apr 2008, 00:01
Re: Simultaneous Retinoscopy

Zetsu schreef:
> They are described in The Book.

Peyton place?

Jan (normally Dutch spoken)




Reply from: Zetsu
Date: 13 Apr 2008, 23:59
Re: Simultaneous Retinoscopy

They are described in The Book.

Reply from: Jason Sperry
Date: 14 Apr 2008, 00:05
Re: Simultaneous Retinoscopy

LOL

JAN IS THE LAZIEST PERSON IN THE WORLD.

Reply from: Jan
Date: 14 Apr 2008, 19:42
Re: Simultaneous Retinoscopy

Jason Sperry schreef:
> LOL
>
> JAN IS THE LAZIEST PERSON IN THE WORLD.

Did we met?

Jan (normally Dutch spoken)

Reply from: Zetsu
Date: 14 Apr 2008, 19:45
Re: Simultaneous Retinoscopy

On 14 Apr, 18:42, Jan <nos...@nospam.nl> wrote:
> Jason Sperry schreef:
>
> > LOL
>
> > JAN IS THE LAZIEST PERSON IN THE WORLD.
>
> Did we met?
>
> Jan (normally Dutch spoken)

No, but we can infer that you are a slightly lazy person, since you
are asking many questions but not bothering to do some research and
find their answers yourself (by reading The Book).

Reply from: Mike Tyner
Date: 14 Apr 2008, 20:58
Re: Simultaneous Retinoscopy


"Zetsu" <absolutelyinvincible@hotmail . com > wrote

> No, but we can infer that you are a slightly lazy person, since you
> are asking many questions but not bothering to do some research and
> find their answers yourself (by reading The Book).

I've looked carefully through The Book and I never found exactly what Dr.
Bates meant by "simultaneous retinoscopy." He mentions the technique but
never actually explains how to do it, precisely how it is different from
conventional retinoscopy, nearpoint ret, or MEM.

He does mention that retinoscopy must be done from six feet, and that the
visual system always changes unpredictably when retinoscopy is done from the
more conventional 67 cm. (I can't see how this would be true for presbyopes.
I often think it an indication Dr. Bates was a bit of a smelly troll who
made young people nervous when he got close to them.)

At any rate, if you know how to do conventional retinoscopy, it makes you
scratch your head and wonder how he DID that. Nowhere in The Book does he
describe exactly how to do "simultaneous" retinoscopy. Knowing it's done
from 6 feet, and assuming his arms were not six feet long, we do know that
six-foot retinoscopy could not be very exact unless he employed an assistant
or had the patient move trial lenses in front of their eyes. Even then, it
would be 8-10 times more difficult to interpret the retinoscopic reflexes.

Now you may consider my points to be trite but I propose you will have at
least as many problems as I do, finding a comprehensive description of
"simultaneous" retinoscopy in The Book.

Feel free to prove me wrong by pointing out chapter and verse. That's how
it's done with other sacred Books like the Bible and the Koran.

I'm getting deja-vu; I know I've had this conversation before. But nobody
ever pointed out exactly how to do "simultaneous" retinoscopy.

With this Book, which you say is science and not religion, you _might_
decide that vagueness and arcane techniques that nobody can duplicate are
strong indications of charlatanry and pseudoscience. You might not decide
so, but that would be gullible and as you've said, you aren't gullible.

I have several retinoscopes and tons of experience with them. I can do
retinoscopy just about any way you want, except when you point vaguely and
say "like he did it, back there."

-MT



Reply from: otisbrown@embarqmail . com
Date: 14 Apr 2008, 21:08
Re: Simultaneous Retinoscopy


Dear Mike,

Thanks for the write-up.

The issue is truly that the person himself should be taught to
make these measurements.

And some of the history behind them.

But in concept. you could teach a person how to measure
the refractive STATE of the natural eye (under cycloplegic)
with a retinoscope.

These measurements tend to have a lot of errors in them, so
you must AVERAGE them to get good results.

Otis




On Apr 14, 2:58 pm, "Mike Tyner" <mty...@mindspring . com > wrote:
> "Zetsu" <absolutelyinvinci...@hotmail . com > wrote
>
> > No, but we can infer that you are a slightly lazy person, since you
> > are asking many questions but not bothering to do some research and
> > find their answers yourself (by reading The Book).
>
> I've looked carefully through The Book and I never found exactly what Dr.
> Bates meant by "simultaneous retinoscopy." He mentions the technique but
> never actually explains how to do it, precisely how it is different from
> conventional retinoscopy, nearpoint ret, or MEM.
>
> He does mention that retinoscopy must be done from six feet, and that the
> visual system always changes unpredictably when retinoscopy is done from t=
he
> more conventional 67 cm. (I can't see how this would be true for presbyope=
s.
> I often think it an indication Dr. Bates was a bit of a smelly troll who
> made young people nervous when he got close to them.)
>
> At any rate, if you know how to do conventional retinoscopy, it makes you
> scratch your head and wonder how he DID that. Nowhere in The Book does he
> describe exactly how to do "simultaneous" retinoscopy. Knowing it's done
> from 6 feet, and assuming his arms were not six feet long, we do know that=

> six-foot retinoscopy could not be very exact unless he employed an assista=
nt
> or had the patient move trial lenses in front of their eyes. Even then, it=

> would be 8-10 times more difficult to interpret the retinoscopic reflexes.=

>
> Now you may consider my points to be trite but I propose you will have at
> least as many problems as I do, finding a comprehensive description of
> "simultaneous" retinoscopy in The Book.
>
> Feel free to prove me wrong by pointing out chapter and verse. That's how
> it's done with other sacred Books like the Bible and the Koran.
>
> I'm getting deja-vu; I know I've had this conversation before. But nobody
> ever pointed out exactly how to do "simultaneous" retinoscopy.
>
> With this Book, which you say is science and not religion, you might
> decide that vagueness and arcane techniques that nobody can duplicate are
> strong indications of charlatanry and pseudoscience. You might not decide
> so, but that would be gullible and as you've said, you aren't gullible.
>
> I have several retinoscopes and tons of experience with them. I can do
> retinoscopy just about any way you want, except when you point vaguely and=

> say "like he did it, back there."
>
> -MT


Reply from: Mike Tyner
Date: 14 Apr 2008, 21:33
Re: Simultaneous Retinoscopy


<otisbrown@embarqmail . com > wrote

> The issue is truly that the person himself should be taught to
> make these measurements.

In which multiverse is that "truly an issue?"

I can measure my heart rhythm very precisely, averaging thousands of beats.
Does that keep my heart from growing too large? Does it prevent vessels from
occluding?

If one group of people measures their refraction precisely and another does
not, will one group grow nearsighted less than the other? Does it involve
the Heisenberg Uncertainty Principle?

Ever read Heinlein? I believe you live along a different time line, a
different ficton than the rest of us.

-MT



Reply from: Zetsu
Date: 15 Apr 2008, 14:22
Re: Simultaneous Retinoscopy

On 14 Apr, 19:58, "Mike Tyner" <mty...@mindspring . com > wrote:
> "Zetsu" <absolutelyinvinci...@hotmail . com > wrote
>
> > No, but we can infer that you are a slightly lazy person, since you
> > are asking many questions but not bothering to do some research and
> > find their answers yourself (by reading The Book).
>
> I've looked carefully through The Book and I never found exactly what Dr.
> Bates meant by "simultaneous retinoscopy."


Simultaneous means that Dr. Bates looks in the eye of the person being
examined at the same time while the same person looks at the eyechart,
i.e. while he uses his eyes for seeing.

>He does mention that retinoscopy must be done from six feet,

This is so that the subject is not made nervous.

>from 6 feet, and assuming his arms were not six feet long, we do know that
>six-foot retinoscopy could not be very exact unless he employed an assistant

Yes, probably he employed an assistant.

Reply from: Zetsu
Date: 15 Apr 2008, 14:40
Re: Simultaneous Retinoscopy

On 14 Apr, 19:58, "Mike Tyner" <mty...@mindspring . com > wrote:
> "Zetsu" <absolutelyinvinci...@hotmail . com > wrote
>
> He does mention that retinoscopy must be done from six feet, and that the
> visual system always changes unpredictably when retinoscopy is done from the
> more conventional 67 cm. (I can't see how this would be true for presbyopes.
> I often think it an indication Dr. Bates was a bit of a smelly troll who
> made young people nervous when he got close to them.)

Why no, quite the contrary! All the kids loved Dr. Bates! His presence
emanated an atmosphere of calm which would permeate into the children.

> At any rate, if you know how to do conventional retinoscopy, it makes you
> scratch your head and wonder how he DID that. Nowhere in The Book does he
> describe exactly how to do "simultaneous" retinoscopy. Knowing it's done
> from 6 feet, and assuming his arms were not six feet long, we do know that
> six-foot retinoscopy could not be very exact unless he employed an assistant
> or had the patient move trial lenses in front of their eyes. Even then, it
> would be 8-10 times more difficult to interpret the retinoscopic reflexes.

It is very unlikely that someone who made a hobby with the
retinoscope, using it for several decades to measure the refraction of
several thousands of subjects, was not highly proficient its use. It
is also a notable point that, after Dr. Bates cured himself of
presbyopia, he would most likely have secured a very keen level of
vision, and therefore would be able to perform feats with the
instrument that required great precision and skill, otherwise not
possible.


Pg.
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