hello and welcome to Optum materials I am Dr Noor and today we are going to learn one more important technique of retinoscopy which objectively evaluate the accommodative response we are going to learn about the monocular estimation method which is a near retinoscopy which measures the dynamic response of the accommodation so also known as a dynamic retinoscopy so before I move ahead and show you how this mem or manipulator estimation method is done if you are new to this Channel Please Subscribe the channel and click on the Bell icon to get the notification of all my upcoming videos foreign let me show you how this procedure is done you require a meme card but before that you can see this is a clip which needs to be attached to these your retinoscope and we have a couple of mem card so this card you can use and it is placed onto this retinoscope so let me attach this and now you can see this is the attachment patient has to read this at the distance of 40 centimeter and while examiness looks inside the patient's eye while neutralizing the reflector friends let me perform mem on my patients so first important thing is the room has to be normally illuminated you don't have to switch off light and second thing is it is performed at the 40 centimeter of distance for the adult and Harmon's distance worthy pediatric hormone distance is actually a distance from the elbow to this knuckle so this is the distance at which a person's read so I'm going to make her read this love so that I can neutralize The Reflex patient has to be fully corrected for the refractive error our patient is in Metro what I can see is with movement so I'll be neutralizing that in one Meridian usually we perform this semium in the horizontal Meridian by placing the streak vertically so I'm seeing with moments I'll quickly place the lens in front of the eye to neutralize it and I can utilize that with the plus 0.5 make sure that you are not keeping these lenses for longer period of time in front of the eye it can alter the accommodative response the expected range for the mem is plus 0.252 plus 0.50 with the standard deviation of plus 0.25 any values below penno or above 0.75 is suspicious for accommodative anomalies hope this video was informative to you please like share and subscribe the channel and comment your views in the comment section see you bye take care