5 - Anti-Suppression Therapy

Question 1

Anti-suppression therapy most used for which pts

Answer 1

Amblyopia & strabismic

Question 2

Awareness categories & equipment used

Answer 2

Mirrors - synoptophore & cheiroscope (superimposing images) Physiological diplopia - brock string Filters - R/G, polarized (suppression cues/checks - cant’ tilt head)

Question 3

Filters: Polarized R/G

Answer 3

Polarized - OS supp = partner’s R lens darkens (straight across) R/G Colored print: white background R sees G*, black background R sees R *where G lens over eye with more tendency to suppress Colored overlays: R sees thru R, suppression makes that bar black

Question 4

Anti-suppression specific guidelines

Answer 4

Structure environment so pt is least likely to suppress Measure depth/intensity before (W4D, Bagolini bar or striated) Choose room illumination to decr likelihood of suppression

Question 5

Altering stimuli: Target contrast Target focus Target illumination

Answer 5

Contrast: high (bright illum + dark room) Focus: clear target for suppressing eye, defocused for “good” eye Illumination: incr for suppressing eye, decr for “good” More effective to alter one, not both together E.g. R lens over suppressing eye to incr relative luminance -> more likely to overcome suppression* *R lens less likely to suppress, G more

Question 6

Altering stimuli: Conditions Target movement Flash the target Target size

Answer 6

Conditions: begin artificial* —> natural *R/G glasses Movement: makes suppression more difficult Flash: presents stimulus for time < latency to eliminate suppression (e.g. synoptophore) Size: start L periph —> small central 1st degree —> 2nd/3rd

Question 7

Anti-suppression coaching

Answer 7

“Look hard” thru suppressing eye “Look thru the dark lines” “Wake the eye up” Briefly cover “good” eye Tap/shake chart Wiggle fingers/tap temple by supp eye

Question 8

R/G flashlight tag

Answer 8

Younger kids Harder: incr speed & size of pursuits

Question 9

Verticle prism

Answer 9

Prism over “good” eye (avoid blurring suppressing eye) Harder: incr distance

Question 10

Cheiroscope

Answer 10

Start w/ suppressing eye drawing (hand movement avoids suppression) Deep suppression - use less detailed target Harder: switch eyes

Question 11

Mirror superimposition

Answer 11

45 degree angle Harder: incr target difficulty (2nd/3rd degree), smaller/more central

Question 12

Anaglyph drawing

Answer 12

G lens over suppressing eye - sees red crayon Harder: modify to games (tic-tac-toe)

Question 13

Face form

Answer 13

1) all red symbols - G lens over suppressing eye, pts who only suppress one eye 2) blue & red - pts who alternatively suppress or improve on 1

Question 14

R/G number search

Answer 14

R sees G Harder: slashes (vs circle)

Question 15

R/G playing cards

Answer 15

R card w/ black letters seen by R (like filter bars see thru R)

Question 16

Bar readers

Answer 16

R/G or polarized w/ BAR R sees thru R

Question 17

TV trainer

Answer 17

R sees thru R DE & DI may have to start close

Question 18

Vis-a-vis

Answer 18

Harder: incr distance (smaller, more central)

Question 19

R/G Hart & GTVT charts

Answer 19

Up to 20ft

Question 20

Anti-suppression flowchart

Answer 20