Accommodative Disorders Flashcards
Accommodation is a ______ skill
monocular skill; it contributes to clear SV
What is the goal of accommodative therapy
goal of therapy to have the pt understand where he is actually fixating and to accurately adjust accordingly until it is automatic; pt sits with both feet on the floor during testing
How to perform Hart Chart Near/ Far Rock
Distance: 10 ft Purpose: build flexibility of accommodation and increase pt awareness of relaxing and stimulating accommodation ; Method: This is MONOCULAR , Use a Hart Chart , pt patches an eye and holds a near chart at 40 cm , focus on top line of near chart then change focus and read first row of distance chart , go back and forth etc. ask pt how his eyes feel and which chart was easier ; eventually can do binocular ( distance chart is relaxing accommodation and near chart is stimulating it ) ; Modify: pt moves near card towards him until it blurs , then move card out until it blurs - then have pt perform test at the just clear distance
How do you perfom Hart Chart Near Far 70% test
more difficult test: Method: pt stands up with patch on and gets really far away from the wall chart as they can and still be able to read it ; we look for 70% accuracy -read 4 letters and need to miss 1 out of 4 or 70% ; pt still holds near chart close but still be able to see both charts . pt holds near chart in between their thumb and either the knuckle of the first, second or third knuckle ; ask them how do their eyes feel
How do you perform Hart Chart Tromboning
Distance: 10 ft Purpose: To build flexibility and enhance amplitude Method: MONOCULAR, pt reads near chart, they move the small Hart chart closer to the pt until the pt can no longer keep the first line clear , then they look at distance chart ( while moving the near card back out) and read the first line on the distance chart
How do you perform Hart Chart Walk Aways
Distance; 1 ft starting Purpose: To relax accommodation, good for pts who are Accommodative Excess ; Method: MONOCULAR, pt starts at 1 ft and reads the chart line by line; after read chart they tale a step back and reread, have them move back until it gets blurry , Next phase is to do with +1.00 lens , have the pt 12 inches away and then after reading of the entire chart , have the pt step back ( 3-4 ft) it should blur
How do you perform Look Hard/ Look Soft
Distance : 3 ft away Method: MONOCULAR, Pt looks at letter B in the center of the chart and stares at it ( check their awareness of other letters in the four corners and objects to the L and R of them ), pt then looks “ hard” at the letter as if they are burning a hole into the paper ( hold for 10 sec) , have them close their eyes and then look soft at the letter for 10 sec . Ask them how they feel afterwards Modify : if pt cant tell a difference use a +/- 5 lens have them look through both and ask what they see
How do you perform Kraskin Bifocal Rock
Distance: Harmons Distance Purpose: have the pt look at the target as clearly and quickly as possible , also to get the pt to experience what it feels like to look closer versus further away ; Method: MONOCULAR, pt stands harmons distance from marsden ball , give pt a -4 lens pt moves the lens infront of the eye until they see two balls , pt looks at ball through the lens for 8 sec then switches to the ball outside the lens for another 8 sec , do this for 2 mins per eye , ask pt which ball feels closer and how their eyes feel ( SILO - small in ( when they look inside of the lens the ball should appear smaller and closer to them ) ; next stage decrease lens power by +0.50 to 3.50 until the pt can no longer tell which ones is closer ; EXCELLENT technique for beginning stage of therapy
How to perform Mental Minus
Purpose: to make pt aware of what it feels like to stimulate and fix accommodation; Method: Monocular , we watch movement of the covered eye when doing the test, pt chooses a solid 3D object 6 ft away or more then using a -6 lens have them hold the lens 16-18 inches away from their eye in such a way they can see the target through the lens, pt moves lens in and out to their eye while looking at the target ( Which position do you see more things in the room -closer to the eye should be the answer ; when you move the lens closer to the eye which wasy does the target move- answer should be with the lens or toward you), have pt hold lens so they can see both images and ask “ which is smaller , the one in the lens or the real one - the one in the lens should be smaller , then ask which one seems closer to them - the one on the lens should ; then see if the pt can blur the image and make it clear again ( most important part) - Note: when using the minus lens the pupils should constrict as the lens comes closer to the eye , the eye under the occluder should converge as it clears the image
How to perform Lens Flippers ( MAR/BAR flippers monocular acc rock )
Purpose:enhance accommodative facility - instead of focusing on time like in an evaluation , you focus on accuracy and feeling tones of the flippers.
Method: flipper range from +/- 0.50 to +/- 2.50 , work up to +/-2.50, 20 cpm, use with R/G bar readers , polaroid bar readers etc to CONTROL FOR SUPPRESION
how to perform loose lens rock
Distance: 40 cm ; Purpose: normalize accommodative amp and facility ; method: MONOCULAR, print is at 40 cm, pt reads while alternating plus and minus lenses in front of the eye while just focusing on clearing the print , time is not a factor at this pt, start with +/- 1 . Once pt clears chart increase lens by 0.50D. The next phase is to clear the plus and minus as quickly as possible
How to perform lens sorting
Purpose: good to do at the beginning stages of therapy, to allow the pt to develop an awareness of the ability to relax and stimulate accommodation; Method: pt looks through plus and minus lenses and notes how their eyes feel , select minus lenses less than 1/2 their pts amp, place 6-8 plus and minus lenses on the table and pt sorts based on size change and how it makes their eyes feel
How to perform minus lens shift
distance: 5 ft ; purpose: ease pt into clearing minus lenses ; good for AI pts; Method: MONOCULAR, hold a -1.00 at arms length while looking at the chart, slowly move the lens inward - this stimulate accommodation - keep increasing power of lens until it reaches 1/2 pts amp
How to perform Biocular Loose Lens Rock ( Robbins Rock)
Purpose : Normalize accom. amp and facility without suppression Method: BIOCULAR, in a trial frame dissociate the pt with vertical prism : 6 PD , target is a single letter , then place a plus lens infront of one eye and a minus lens infront of the other , have the pt shift fixation and hence accommodation alternatively , ask the pt how their eyes feel
