ACCOMMODATIVE DISORDERS Flashcards
define accommodative insufficiency
Difficulty stimulating accommodation.
symptoms of accommodative insufficiency
- Blurry vision / HA / asthenopia / fatigue / reading issues / words moving on page – all issues will be at near
- Symptoms at the start of day and last the entire day.
signs of accommodative insufficiency
Primary Test:
* Amps: reduced (>2D from M.A.E)
* MAF: reduced, hard w/ - lenses
Secondary Test:
* NRA: normal
* PRA: reduced
* BAF: reduced, hard w/ - lenses
Tertiary Test:
* BCC/MEM: large lag, can’t stimulate accommodation.
difficulty clearing minus lenses b/c it induces accommodation & creates smaller image.
tx of accommodative insufficiency
Primary – SRx
* Hyperopes : relives some accommodative requirements.
* Myopes : may make it worse at first but should go away.
Secondary – SRx + ADD
* Easiest and highly beneficial
Tertiary – VT
* Highly successful –> aimed at increasing the flexability and speed of accommodation (begin monocularly then progress to binocular
define ill sustained accommodation
difficulty maintaining accommodation.
symptoms of ill sustained accommodation
- Blurry vision / HA / asthenopia / fatigue / reading issues / words moving on page – all issues will be at near.
- Symptoms occur at the end of day.
signs of ill sustained accommodation
Primary Test:
* Amps: normal (>2D from M.A.E)
* MAF: reduced, hard w/ - lenses twrds end of exam.
Secondary Test:
* NRA: normal
* PRA: normal
* BAF: reduced, hard w/ - lenses twrds end of exam.
Tertiary Test:
* BCC/MEM: normal or large lag
tx for ill sustained accommodation
Primary – SRx
* Hyperopes : relives some accommodative requirements.
* Myopes : may make it worse at first but should go away.
Secondary – SRx + ADD
* Easiest and highly beneficial
Tertiary – VT
* Highly successful –> aimed at increasing the flexability and speed of accommodation (begin monocularly then progress to binocular
define accommodative excess
accomm response exceeds accomm stimulus (doesn’t mean they have more accommodation).
symptoms of accommodative excess
- Blurry vision / HA / asthenopia / fatigue / reading issues / words moving on page – all issues will be at near.
- Symptoms start after prolonged near work.
commonly associated with convergence insufficiency secondary issue – uses extra accomm to strengthen convergence.
signs of accommodative excess
Primary Test:
* Amps: normal (>2D from M.A.E)
* MAF: reduced, hard w/ + lenses
Secondary Test:
* NRA: reduced
* PRA: normal
* BAF: reduced, hard w/ + lenses
Tertiary Test:
* BCC/MEM: lead, can’t relax accommodation.
difficulty clearing plus lenses b/c it relaxes accommodation.
tx for accommodative excess
Primary – SRx
* Hyperopes :consider partial Rx.
* Myopes : Do not over-minus!
Secondary – SRx + VT
* Not as successful
ADD is NOT beneficial b/c they have issue with plus lenses.
define accommodative infacility
ability to stimulate and relax accomm but cannot do it readily (inefficient accomm system).
symptoms of accommodative infacility
- Suck at any test that involves large dioptric jumps.
- Any task where target distance is quickly changed.
signs of accommodative infacility
Primary Test:
* Amps: normal (>2D from M.A.E)
* MAF: reduced, hard w/ -/+ lenses
Secondary Test:
* NRA: normal
* PRA: normal
* BAF: reduced, hard w/ -/+ lenses
Tertiary Test:
BCC/MEM: normal
difficulty flipping btwn both -/+ lenses b/c it requires quick adjustments.
tx for accommodative infacility
Primary – SRx
* Hyperopes : relives some accommodative requirements.
* Myopes : may make it worse at first but should go away.
Secondary – SRx + VT
* Highly successful
ADD is NOT beneficial b/c they are able to accomm
define streff non-malingering syndrome
condition that is psychological in etiology.
* Think STRESS for STREFF.
signs of streff
3 basic criteria:
* Refractive error of plano – (+1D).
* Reduced DVA w/o explained cause.
* No change in DVA w/ corrective lenses.
tx for streff
Primary – SRx + ADD
* Low-add can fix symptoms.
Secondary – psych referral
* If low-add doesn’t work.
