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Z Strab, VT, & Amblyopia - Final > 3 - EF & ARC Therapy > Flashcards

3 - EF & ARC Therapy Flashcards

1
Q

Simultaneous prism CT

A

Estimated prism over deviated eye

Occluder over fixating eye

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2
Q

EF vs ARC

A

EF:

  • monocular
  • amblyopic eye using non-foveal pt
  • degrees or PDs

ARC:

  • binocular
  • fovea of fixating eye has same visual direction as non-foveal pt of non-fixating eye
  • PDs
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3
Q

4 types of retinal correspondence

A

Normal/NRC: H = S, A = 0

Anomalous/ARC: H ≠ S, A ≠ 0

Harmonious/HARC: H = A, S ≠ 0

Unharmonious/UHARC: H > A, H > S

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4
Q

EF vs ARC evaluations

A

EF: visuoscopy, HB, AI

ARC: W4D, Bagolini, Red Lens, Synoptophore, HB, AI
-looking for embeddedness (most natural/mild -> most artificial/deep)

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5
Q

Mild vs deeply embedded ARC

A

Mild:

  • 80%
  • moderate/large/variable angles
  • seen with Bagonlini only
  • no tx

Deep:

  • small, stable angle
  • early onset
  • rarely eliminated
  • present on 3-4 tests
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6
Q

Goals of tx (Flom’s criteria) - Functional cure

A
  • Clear, single BV
  • Stereo & normal vergences
  • Deviation 1% of the time, must have diplopia w/
  • May have prism (~5pd) to assist fusion
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7
Q

Goals of tx (Flom’s criteria) - Almost cure

A
  • clear single BV
  • some stereo
  • deviation 5%, must have diplopia w/
  • may have large amnt of prism to assist with fusion
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8
Q

Goals of tx (Flom’s criteria) - Moderate improvement

A
  • improvement in any 2 “above”
  • amblyopia is present
  • EF
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9
Q

Goals of tx (Flom’s criteria) - Some improvement

A

-improvement in only 1 thing

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10
Q

Goals of tx (Flom’s criteria) - No improvement

A

Microtropia

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11
Q

Prognosis for ARC better

A
  • exotropia
  • intermittent
  • large angle
  • older children
  • mildly embedded
  • Flom’s functional or almost cure
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12
Q

Prognosis for ARC worse

A
  • esotropia
  • constant
  • small angle
  • younger children
  • deeply embedded
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13
Q

*contraindication for ARC therapy

A

Horror fusionis

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14
Q

When do we use prism for strabismus

A

pts with NRC or to break ARC

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15
Q

4 techniques to reestablish NRC with cosmesis for ARC pts

A

Prism & disruptive techniques
Occlusion therapy
Vision therapy
Surgery

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16
Q

ARC tx: prism & disruptive techniques - purpose

A

Create instability of the angle

  • not sure of efficacy
  • poor compliance, discomfort/diplopia, time consuming
  • difficult to do all day due to constant diplopia & cosmesis
17
Q

ARC tx: prism & disruptive techniques - overcorrection

A

Works well w/ younger children to disrupt ARC by stimulating latent NRC localization

18
Q

ARC tx: prism & disruptive techniques - phases

A

1) overcorrect by ~15pd all day

2) after few months & when NRC is repeatedly seen on AT, needed power will be = to objective angle
- start VT
- prism can be gradually reduced
- if angle is still large, consider sx

19
Q

ARC tx: occlusion

A

Development of ARC prevented if occlude early enough

Occlude for amblyopia first

Total occlusion for 24 hrs, alternating days

Poor compliance

20
Q

ARC tx: occlusion - purpose

A

Disrupt ARC localization & prevent reinforcement

Break suppression

Tx amblyopia

21
Q

ARC tx: constant total occlusion

A

Children w/ constant strab that started before age 7

Be cautious in cases of intermittent strab - occlusion strab can result

22
Q

ARC tx: binasal occlusion

A

*Can be used in children with ET to prevent/tx any ARC

Beware with children that are active, have large head movements for fixation (“cheating” around the occlusion)

*Fixating/good eye has wider occlusion than bad eye

23
Q

ARC tx: VT

A

Anti-suppression, amblyoscopes, & stereoscopes can be used

Forces strabismic eye to fixate

Works on motor ranges as well

24
Q

ARC tx: surgery

A

May report NRC after sx, esp. those with mildly embedded ARC

Possible results: NRC, ARC, covariance, paradoxical UHARC

25
Q

ARC: other tx considerations - major amblyoscope

A
  • good closed-space instrument (less natural)
  • skills are transferred to open space
  • elicits bifoveal NRC localization by stimulating latent NRC
  • done in addition to constant total occlusion or prism (to disrupt ARC)
26
Q

ARC: other tx considerations - free-space skills

A

Binocular luster training

  • if pt reports a split field response (can’t fuse/appreciate luster), prognosis for tx is poor due to deep embeddedness
  • pt instructed to maintain luster while targets are introduced to the periphery, plus lenses introduced, etc.

Z Strab, VT, & Amblyopia - Final (7 decks)

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