There are some potential adverse reactions, side effects and legal issues in the use of cycloplegic drugs. Alternatives to using drugs have been suggested. One such method is near fixation retinoscopy-often referred to as the Mohindra technique. This relies on the fact that young children are likely to be attracted to a retinoscope light in a darkened room. To keep the infant attentive it has been suggested that feeding them can help; feeding also helps to relax the accommodation and widens the palpebral aperture. Noncycloplegic retinoscopy can be used when frequent follow up is necessary, when the child is extremely anxious about instillation of cycloplegic agents and when the child has had or is at risk of an adverse reaction to cycloplegic drugs
Because of errors arising from working off the visual axis and spherical aberration during retinoscopy, before a prescription can be issued the results obtained need to be refined during subjective refraction. The Jackson cross-cylinder is used to refine the correction for astigmatism.
Following retinoscopy and subjective refraction, binocular balancing is used to ensure that the accommodation is balanced in each eye. It corrects any extra hyperopia that may become manifest when the patient becomes binocular. Binocular balancing ensures that accommodation is balanced between th...
Accommodation relaxes in binocular single vision and therefore binocular addition may not be necessary as balancing with monocular fogging may have already relaxed accommodation maximally. However, binocular addition can be used as a final check to ensure that the accommodation is completely rela...
