Photorefraction of eyes: history and future prospects.

A brief history of photorefraction, i.e., the refraction of eyes by photography or computer image capture, is given. The method of photorefraction originated from an optical scheme for secret communication across the Berlin wall. This scheme used a lens whose focus about infinity was modulated by a movable reflecting surface. From this device, it was recognized that the vertebrate eye was such a reflector and that its double-pass pointspread could be used to compute its degree of defocus. Subsequently, a second, totally independent invention, more accurately termed "photoretinoscopy," used an eccentric light source and obtained retinoscopic-like images of the reflex in the pupil of the subject's eyes. Photoretinoscopy has become the preferred method of photorefraction and has been instantiated in a wide variety of devices used in vision screening and research. This has been greatly helped by the parallel development of computer and digital camera technology. It seems likely that photorefractive methods will continue to be refined and may eventually become ubiquitous in clinical practice.