2. BV II - Assessment Flashcards
What questions should we ask during history for BV workups?
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...? If yes,...? -
...? Do you...? -
...? If yes,.... -
...? -
...? -
...?
What questions should we ask during history for BV workups?
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Do your eyes bother you? If yes,how often and when? -
How do your eyes bother you? Do youexperience eyestrain, fatigue, headaches, sleepiness? -
Do you ever get headaches? If yes,follow LOFTSEA. -
How long can you read comfortably? -
When you read, does the print ever blur, double, or move around? -
Do you experience car or motion sickness?
What is posture of accommodation?
How accurately the accommodative system is working relative to the visual system.
Monocular Estimate Method (MEM)
It is an ... measure of ....
It is a form of ... where the retinoscope is held at ....
Normal values are ... +- ...DS, so ... to ...DS.
Monocular Estimate Method (MEM)
It is an objective measure of accommodative posture.
It is a form of dynamic retinoscopy where the retinoscope is held at the patient's normal reading distance.
Normal values are +0.50 +- 0.25DS, so plano to +0.75DS.
Binocular cross cylinder
It is a ... measure of ....
Using the ... in the phoropter, the target is set at ...cm from the patient and the ... is placed in front of each eye or add ...DC in front of each eye where the ....
If the horizontal lines are clearer, ... until either ... or ....
Normal values are ... +- ...DS, so ... to ...DS.
Binocular cross cylinder
It is a subjective measure of accommodative posture.
Using the near chart in the phoropter, the target is set at 40cm from the patient and the +-0.50 cross cyl is placed in front of each eye or add -0.50DC in front of each eye where the negative align vertically.
If the horizontal lines are clearer, add more plus lenses until either vertical and horizontal lines are equally clear or there is reversal.
Normal values are +0.50 +- 0.50DS, so plano to +1.00DS.
What is amplitude of accommodation?
How much accommodative capacity the eye has.
Why is accommodative amplitude measured monocularly?
To remove the vergence aspect, otherwise this would be a test of relative accommodation.
Near Point of Accommodation (NPA)
It is a ... measure of ....
Covering one eye, move a target that is ... than ... on the PD ruler. Move the target towards the patient’s eye until .... Record the distance from eye and convert to diopters.
Normal amplitude is ... and minimum amplitude is ....
Near Point of Accommodation (NPA)
It is a subjective measure of accommodative amplitude.
Covering one eye, move a target that is one line better than the smallest legible line on the PD ruler. Move the target towards the patient’s eye until there is sustained blur. Record the distance from eye and convert to diopters.
Normal amplitude is 18-1/3(age) and minimum amplitude is 15-1/4(age).
RAF rule
It is a ... measure of ....
It is the same method as ..., just with a different target.
RAF rule
It is a subjective measure of accommodative amplitude.
It is the same method as NPA, just with a different target.
Minus lens to blur
It is a ... measure of ....
The same target as NPA is used, however the target is set at ...cm away from the target. Then ... are added until the patient ....
Normal values are ... than NPA.
This difference can be attributed to ... due to not pushing the target forward.
Minus lens to blur
It is a subjective measure of accommodative amplitude.
The same target as NPA is used, however the target is set at 40cm away from the target. Then negative lenses are added until the patient cannot clear the lens.
Normal values are 2D less than NPA.
This difference can be attributed to the loss of the magnification due to not pushing the target forward.
What is accommodative facility?
How quickly and efficiently accommodation can be changed.
Near accommodative flippers.
It is a ... measure of ....
The target is ... and is set ...cm away from the patient. The patient is first shown the ... flippers and then the ... flippers and asked if they can clear them both. If they cannot, repeat with the ... flippers.
Continuously, for ..., the patient is asked to clear the target. Note down if ....
Normative values for the ... flippers are ...cpm.
Near accommodative flippers.
It is a subjective measure of accommodative facility.
The target is the diamond of letters on the rear of the Phoria card and is set 40cm away from the patient. The patient is first shown the +2D flippers and then the -2D flippers and asked if they can clear them both. If they cannot, repeat with the +-1D flippers.
Continuously, for 1 minute, the patient is asked to clear the target. Note down if either positive or negative is harder to clear.
Normative values for the +-2D flippers are 8cpm.
When do you test accommodative facility monocularly?
When there is a known vergence problem.
What is vergence posture/heterophoria?
How accurately the eyes are pointing relative to a visual stimulus.
Prentice card/Howell Phoria card
It is a ... measure of ....
A ... is placed in front of the patient’s ... to induce .... If no ... is observed, use ....
Ensuring that the patient ..., ask the patient what ... and ... the top arrow is pointing to.
Blue indicates ... and yellow indicates ..., where the ... indicates severity.
Prentice card/Howell Phoria card
It is a subjective measure of vergence posture.
A 6BDprism is placed in front of the patient’s right eye to induce diplopia. If no diplopia is observed, use a stronger prism.
Ensuring that the patient sees both images equally clearly, ask the patient what number and colour the top arrow is pointing to.
Blue indicates exophoria and yellow indicates esophoria, where the number indicates severity.
During Maddox Rod, if the patient sees the line to the left of the light, this indicates ... and if the line is to the right, this indicates ... (provided that the MR is in front of the ... eye).
This is the same for Von Graefe except the image formed with the eye with the prism is either left or right.
During Maddox Rod, if the patient sees the line to the left of the light, this indicates exophoria and if the line is to the right, this indicates esophoria (provided that the MR is in front of the right eye).
This is the same for Von Graefe except the image formed with the eye with the prism is either left or right.
What is amplitude/range of vergence?
How much capacity the vergence system has.
Negative and Positive Relative Convergence (NRC/PRC)
They are ... measures of ... and ....
For NRC, ... prism is added until the patient’s vision ... and then ... and then removed until vision .... The target is ... and is set ...cm from the patient.
The opposite prism is used for PRC.
Normative values for NRC are ... at near and ... for distance. For PRC, normative values are ... for both distance and near.
Negative and Positive Relative Convergence (NRC/PRC)
They are subjective measures of vergence range/amplitude and fusional reserves.
For NRC, BI prism is added until the patient’s vision blurs and then breaks sustainly and then removed until vision re-fuses. The target is the diamond of letters on the back of the Phoria card and is set 40cm from the patient.
The opposite prism is used for PRC.
Normative values for NRC are 10/16/10 at near and -/6/4 for distance. For PRC, normative values are 10/16/10 for both distance and near.
What is vergence facility?
How quickly and efficiently the vergence system can converge and diverge to maintain clear vision.
Vergence flippers (12BO/4BI)
It is a ... measure of ....
The target is ... and is set ...cm away from the patient. The patient is first shown the ... flippers and then the ... flippers and asked if they can clear them both.
Continuously, for ..., the patient is asked to clear the target. Note down if ....
Normative values are ...cpm.
Vergence flippers (12BO/4BI)
It is a subjective measure of vergence facility.
The target is the diamond of letters on the rear of the Phoria card and is set 40cm away from the patient. The patient is first shown the BI flippers and then the BO flippers and asked if they can clear them both.
Continuously, for 1 minute, the patient is asked to clear the target. Note down if either BI or BO is harder to clear.
Normative values are 15cpm.
Near Point of Convergence (NPC)
It is a ... and ... measure.
Move a target that is ... than ... on the PD ruler. Move the target towards the patient’s eye until .... Record the distance from .... Then ... and record the ... distance from the eye.
In adults, abnormal values are ...cm but ...cm is suspicious.
In children, abnormal values are ...cm.
Near Point of Convergence (NPC)
It is a subjective and objective measure.
Move a target that is one line better than the smallest legible line on the PD ruler. Move the target towards the patient’s eye until there is sustained diplopia. Record the distance from eye. Then move the ruler back until vision is single and record the recovery distance from the eye.
In adults, abnormal values are >10cm but >5cm is suspicious.
In children, abnormal values are >5cm.
Negative and Positive Relative Accommodation (NRA/PRA)
It is a ... measure of ... in the presence of ....
The target is the ... on the phoropter RAF rule, set ...cm from the patient. In NRA, ... lenses are added until ... and the opposite for PRA.
Normative values are ...D and ...D for NRA and PRA, respectively.
Negative and Positive Relative Accommodation (NRA/PRA)
It is a subjective measure of accommodative function in the presence of vergence.
The target is the N8 letters on the phoropter RAF rule, set 40cm from the patient. In NRA, positive lenses are added until sustained blur and the opposite for PRA.
Normative values are >+2.50D and >-2.50D for NRA and PRA, respectively.
AC/A
It is a ... measure of ... under ....
The target is the ... held ...cm from the patient. ... is assessed with ..., ..., ..., ..., and then ... lenses held in front of the eyes alongside the ....
Normative values for AC/A are ... +- ....
AC/A
It is a subjective measure of vergence system under accommodative change.
The target is the Phoria card held 33cm from the patient. Vergence posture is assessed with +2, 1, 0, -1, and then -2 lenses held in front of the eyes alongside the prism.
Normative values for AC/A are 4 +- 2 prism/D.
