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Testing Accommodation: The Case for Nott Dynamic Retinoscopy in Orthoptic Assessments.

Sonia Toor1, Jessica E Francis2

  • 1School of Allied Health Professions, Pharmacy, Nursing and Midwifery, University of Sheffield, United Kingdom.

The British and Irish Orthoptic Journal
|May 4, 2026
PubMed
Summary

Nott dynamic retinoscopy offers a reliable, objective method for assessing accommodation, outperforming the subjective RAF Rule. This objective measurement is comparable to the gold standard Plusoptix, making it suitable for orthoptic assessments.

Keywords:
PlusoptixRAF Ruleaccommodationdynamic retinoscopy

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Area of Science:

  • Ophthalmology
  • Optometry
  • Vision Science

Background:

  • The RAF Rule is a common but error-prone subjective test for measuring accommodation.
  • Objective methods for assessing accommodation are needed for greater accuracy.

Purpose of the Study:

  • To compare Nott dynamic retinoscopy with the RAF Rule and the Plusoptix PowerRef III (gold standard) for measuring accommodation after close work.
  • To determine if Nott dynamic retinoscopy is a more suitable objective test for accommodation assessment.

Main Methods:

  • Accommodation was measured in 25 students before and after 30 minutes of close work.
  • Tests used included the RAF Rule, Nott dynamic retinoscopy, and the Plusoptix PowerRef III.
  • Nott dynamic retinoscopy assessed accommodative lead/lag, while the Plusoptix measured objective accommodation (slope and response).

Main Results:

  • Nott dynamic retinoscopy and the Plusoptix showed accommodative lag within normal limits, with no significant change after close work.
  • The binocular RAF Rule showed a significant decrease in accommodation amplitude after close work, unlike uniocular testing.
  • Measurement variations with the binocular RAF Rule highlight its subjective error potential.

Conclusions:

  • Nott dynamic retinoscopy is a reliable objective measure of accommodation, comparable to the gold standard Plusoptix.
  • The subjective RAF Rule demonstrates significant error potential, particularly in binocular testing.
  • Nott dynamic retinoscopy is recommended for orthoptic assessment of accommodation.