Certified Ophthalmic Technician (COT) Test 2025 – 400 Free Practice Questions to Pass the Exam

A 'with' or 'against' reflex during retinoscopy helps determine the refractive error in a patient's eyes. When performing retinoscopy, a practitioner observes the movement of the light reflex in the pupil while introducing a series of lenses.

In the case of hyperopia, which is also known as farsightedness, the light reflex moves 'against' the direction of the light beam when the examiner uses a convex lens (plus power). This occurs because the rays of light focus behind the retina, indicating that additional plus power is needed to bring the focus forward onto the retina for clear vision. Conversely, if normal vision or myopia were present, the light reflex would more likely move 'with' the direction of light since the focusing of light rays aligns with the retina or in front of it, respectively.

Astigmatism could also present with different reflex movements based on the specific orientation of the corneal curvature, but the clear distinction of a 'with' or 'against' reflex is a characteristic identifying hyperopia versus other refractive errors. Thus, identifying hyperopia through the 'against' reflex is essential in determining the appropriate corrective lens needed for the patient.