4 - Accommodative Therapy

Question 1

Accomm therapy is tx of choice for

Secondary tx for

Answer 1

Accommodative excess & infacility

Accomm insufficiency

Question 2

Accomm therapy sequence & goals

Answer 2

Monocular amps: Hofstetter’s
Monocular facility: +2.50/-6.00
Bi-ocular facility: +2.50/-6.00
Binocular facility: +2.50/-2.50

Question 3

Accomm therapy sequence & tests

Answer 3

Monocular amps: push-up
Monocular facility: lens sorting, N/F Hart, accomm flipper
Bi-ocular facility: loose prism & lens rock, minus lens & hart rock, red-red rock
Binocular facility: accomm flipper

Question 4

Push-Up

Answer 4

Accomm amps

Coaching: if blur = “look hard”, “tighten eyes”, “think about looking close”

Goals: normalize b/w both eyes, avg with Hofstetter’s (18.5-.3age)

Question 5

Lens sorting

Answer 5

MAR

Coaching: how the print looks thru each lens (mag/min) , kinesthetic awareness, understand they must tighten for (-), relax for (+)

Goals: develop awareness of how +/- change print & eye focusing, successfully sort +2.00 to -6.00 in 0.50 D increments

Question 6

N/F Hart Chart

Answer 6

MAR

Coaching: difficulty w/ N = “look hard”, “tighten eyes”
difficulty w/ D = “relax”, “look far away”

Goals: quickly (1-2 sec) clear & accurately change focus OD, OS equally, perform at 10-20ft & 3-4in

Modifications: easier = one line at a time
harder = one letter at a time

Question 7

Monocular flipper lens

Answer 7

MAR

Coaching: awareness questions, (+) relax, (-) look hard

Goals: rapid (15-20cpm), equal OD/OS, +2.50/-6.00
*eso and accomm excess generally don’t exceed -3.00

Question 8

Loose prism & lens rock

Answer 8

Bi-ocular rock

Procedure: small/N Hart @ 40cm
BD dissociating & (-) over OS, (+) over OD
Read half a line on top chart, half on bottom, etc.
Swap after several minutes

Coaching: awareness questions, (+) relax, (-) tighten

Goals: quickly/easily switch b/w +2.50/-6.00, ideally 15-20cpm minimum

Question 9

Minus lens & hart rock

Answer 9

Bi-ocular rock

Procedure: 2-3ft from large Hart
(-) lens 3-4cm in front of OD, 10BD dissciating over OS
Pt reads half a line on smaller chart (in - lens), half on larger, etc.
Switch lens after a few minutes

Coaching: difficulty finding small chart = momentarily occlude other eye or shake the lens
awareness questions, (+) relax, (-) look hard

Goals: quickly/accurately perform w/ -6.00 D OD, OS
*exo may exceed

Question 10

Red-red rock

Answer 10

Bi-ocular rock

Procedure: R/G glasses, red transparent slide @ 40cm
Matching white tiles w/ red letters given to pt
Lenses may be added to incr accomm demand
OD sees thru red slide, OS sees white tiles

Goals: 20cpm with +2.50/-6.00 flippers

Question 11

Binocular flipper lens

Answer 11

BAR

Coaching: awareness questions, (+) relax, (-) look hard
Diplopia = due to vergence system being influenced by change in accomm & fusion is lost —> may want to further work NFV/PFV skills (plus indirectly trains PFV, minus NFV)
Anti-suppression tools: R/G or polarized bar readers

Goals: 15-20cpm with +/- 2.50