Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Retinoscopy as a Screening Tool for Keratoconus

Al-Mahrouqi, Haitham, BMedSc (Hons), MB ChB*; Oraba, Saif Bani, MD; Al-Habsi, Shihab, MD; Mundemkattil, Noufal, MSc; Babu, Jithin, MSc; Panchatcharam, Sathiya M., MSc*; Al-Saidi, Rashid, MD, FEBO; Al-Raisi, Abdulatif, MD, FRCS§

doi: 10.1097/ICO.0000000000001843
Clinical Science

Purpose: To investigate the validity and reliability of retinoscopy in screening for keratoconus using the rotating Pentacam Scheimpflug camera as the gold standard comparison.

Methods: Patients between the ages of 10 and 30 years who were referred to the outpatient clinic with keratoconus, keratoconus suspect, reduced vision, eye discomfort or frequent change of glasses, or for refraction or refractive surgery, were screened by two independent and masked retinoscopists for the presence of scissoring reflex. Patients then underwent vision testing, slit lamp examination, and Pentacam imaging. A diagnosis of keratoconus by Pentacam was made if the final D index in the Belin and Ambrósio Display was ≥2.69. The results of retinoscopy and Pentacam examinations were compared to assess the validity and reliability of the test.

Results: A total of 123 patients (67 male patients and 45 female patients) with a mean age of 21 years ±5.6 (range 10–30 years) comprising 245 eyes were included. There were 87 eyes with keratoconus, and using the Amsler–Krumeich classification, 67.8%, 26.4%, 2.3%, and 3.4% of the eyes had stage I, II, III, and IV, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of retinoscopy were 97.7%, 79.9%, 70.8%, and 98.4%, respectively. The area under the curve was 0.88 (95% confidence interval, 0.83–0.92). There was excellent agreement between the 2 retinoscopists (Cohen's kappa value 0.84).

Conclusions: Retinoscopy appears to be a very sensitive and reliable test for detecting keratoconus including early disease. Such a test may be implemented in population-based screening programs for keratoconus.

*Oman Medical Specialty Board, Muscat, Oman;

Department of Ophthalmology, Ibra Hospital, Ministry of Health, Ibra, Oman;

Ophthalmology Centre, Ministry of Defence Hospital, Muscat, Oman; and

§Department of Ophthalmology, Al-Nahdha Hospital, Muscat, Oman.

Correspondence: Haitham Al-Mahrouqi, BMedSc (Hons), MB ChB, Oman Medical Specialty Board Way #4443, Bldg 18, Block 244, Plot 404, North Azaiba, Muscat, Sultanate of Oman (e-mail:

The authors have no funding or conflicts of interest to disclose.

Parts of this research were presented at the World Ophthalmology Congress, 16–19 June 2018 in Barcelona, Spain as an e-poster.

Received August 07, 2018

Accepted November 11, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.