Accommodative Tests Flashcards
Probe bodies used in testing accommodation
Lenses (Plus or minus)
Probe body that stimulates accommodation
minus lens
Probe body that inhibits accommodation
Plus lens
Accommodative tests
19 - Amplitude of accommodation
20 - Positive Relative Accommodation
21 - Negative Relative Accommodation
14A - Dissociated/Unfused/Monocular Cross Cylinder Test
14B - Associated/Fused/Binocular Cross Cylinder Test
Probe body used in VT19 AOA
Lenses
Test distance used in VT19
13 inches (33 cm)
Test target used in VT19
0.62 or J3 of jaegers card
True or False
It is not necessary for VT19 and NPA to have almost the same result
False
The only test that uses different procedure in presbyope and non-presby
VT19
Endpoint of VT19
Total Blur Out
VT19 tests the ___________ stimulated accommodation.
Maximum
AOA normal expected result is based on
Hofstetter’s formula
Donder’s table
In a non presbyope, _____________ lenses is used to blur out target.
minus
Non presbyopia LIP during VT19
VT7 (Subjective Refraction)
Formula of AOA for non presbyope
TBO-VT7+2.5O
Formula in getting 2.50 used in AOA
Working distance - Average lag
Working distance: 40in/13in = 3.07
Average lag: 0.50
WD - AL = 2.50
A _________________ patient is given an addition of 2.50 because the AOA is still high
Non presbyope
As age increases, the AOA ___________
decreases
LIP of presbyope during VT19
TNC
_______ lens is used to inhibit or relax accommodation
Plus
Probe body used on presbyopia to totally blue out 0.62cm
Plus
Formula in getting AOA of presbyope patient
(TBO - VT7 Distance correction) -2.50
Test target of NPA
isolated J3 of Jaegers card
Unit of measurement used in NPA and NPC
cm
True or false
NPA result should be converted from cm to D
True
ANALYSIS OF NPA RESULTS
Mono and bino has almost the same result
normal
ANALYSIS OF NPA RESULTS
Low mono, high bino
Accommodative problem
If __________ result is lower than ________ and is lower than computed minimum Hofstetter’s Formula by 2D or more, there is an accommodative problem.
mono, bino
If mono result is lower than bino and is lower than computed _________ Hofstetter’s Formula by 2D or more, there is an accommodative problem.
minimum
If mono result is lower than bino and is lower than computed minimum Hofstetter’s Formula by __D or more, there is an accommodative problem.
2
If mono result is lower than bino and is lower than computed minimum Hofstetter’s Formula by 2d or more, there is an ______________.
accommodative problem
ANALYSIS OF NPA RESULTS
HIGH mono, LOW bino
Convergence problem
Accommodative Problems
Accommodative insufficiency
Accommodative excess
Accommodative spasm
Ill-sustained accommodation or Accommodative fatigue
Inertia of accommodation or Accommodative infacility
Paralysis of accommodation
Absence of accommodation
Convergence Problems
Convergence Excess
Convergence insufficiency
Divergence excess
Divergence insufficiancy
Basic esophoria
Basic exophoria
Accommodation is best tested ________________
Monocular
Convergence is best tested ________________
Binocular
Accommodative problem where accommodation is constantly below normal and 2D below minimum Hofstetter’s
Accommodative insufficiency
When results are higher than 2.00D or above compared to the maximum, and is constant, it is
ACCOMMODATIVE EXCESS
VT19 or NPA is decreasing upon conducting trials. The accommodative system of the eyes cannot maintain, and becomes fatigued
Ill-sustained accommodation
Also known as accommodative fatigue
ill-sustained accommodation
If the decrease of accommodation is at least 1D and above it is considered
ill-sustained
Average AOA is obtained through the Donder’s Table or Hofstetter’s Formula (18.5 - 0.3 x age) and if it is 10.00D greater or above than the average, it is
accommodative spasm
Average AOA is obtained through the Donder’s Table or Hofstetter’s Formula (____________) and if it is 10.00D greater or above than the average, it is accommodative spasm
18.5 - 0.3 x age
Average AOA is obtained through the ______________ or _____________ and if it is 10.00D greater or above than the average, it is accommodative spasm
Donder’s Table or Hofstetter’s Formula (18.5 - 0.3 x age)
Average AOA is obtained through the Donder’s Table or Hofstetter’s Formula (18.5 - 0.3 x age) and if it is ____________ greater or above than the average, it is accommodative spasm
10.00D
Only test used to check for accommodative infacility
Flipper test
Flipper test results are low whether on the plus or on minus there is
Accommodative infacility
Accommodative problem present when there is history of medications, systemic diseases. but if If the medication is removed or stopped and systemic disease is treated, the AOA will return to normal
Paralysis of accommodation
only condition contributing to ABSENCE OF ACCOMMODATION
aphakia
Condition where there is no crystalline lens
aphakia
True or False
If the patient is pseudophakic (has IOL), there is ACCOMMODATION
False
IOL only has prescription but it does not contract or relaxes
Name of VT#20
Positive Relative Accommodation
Operational name of PRA
Minus sphere to blur out at near on reduced 20/20 snellen
Significance of PRA
To determine the maximum amount of accommodation that can be stimulated
Accommodative test that indirectly measured the negative fusional vergence
Positive relative accommodation
Accommodative test that assesses anything with eso
Positive Relative Accommodation
Test distance of PRA
16 inches
Test target of PRA
RSTC 20/20
Endpoint of PRA
Blurring, first blur, slight blure
Normal expected for PRA
-2.00 to -2.25
PRA is not only an indication of px’s ability to stimulate accommodation but also a reflection of the status of _____________
negative fusional vergence
When the endpoint is reached in PRA, a differentiation of the causative factor can be made by __________________
occluding one eye
During PRA, f you cover one eye, whether right or left, and print gets clearer, the px has _____________________. The patient may have ____________________.
CONVERGENCE PROBLEM; DECOMPENSATED ESOPHORIA
If the target stays clear or the same blurring with both eyes, ___________ problem with accommodation or convergence.
no
If you cover one eye, and the blurring ___________, there is an ACCOMMODATIVE PROBLEM
worsens
If you cover one eye, and the blurring worsens, there is an _________________________
ACCOMMODATIVE PROBLEM
Indication of HIGH PRA
clinically insignificant because VT20 evaluates negative fusional vergence or VT17A in an indirect manner
Indication of LOW PRA
decompensated esophoria
accommodative insufficiency
ill-sustained accommodation
accommodative infacility
Name of VT21
Negative Relative Accommodation
Operational name for NRA
Plus sphere to blur out at near on reduced 20/20 snellen
Significance of NRA
To determine the maximum amount of accommodation that can be relaxed
NRA indirectly measures the
Positive fusional vergence
Assesses anything with exo
Negative relative accommodation
Type of probing used in NRA
inhibition
Test distance of NRA
16 inches
Test target of NRA
RSTC 20/20
Normal expected for NRA
+1.75 to +2.00D
___________ is a test to evaluate positive fusional vergence in an indirect manner.
NRA
The accommodative status of the px can be tested monocularly, by simply covering one eye if target gets clear- ______________ is at fault or __________
fusional vergence system; convergence problem
During NRA, if you cover one eye, whether right or left, and print gets ____________, the px has CONVERGENCE PROBLEM. The patient may have ___________.
clearer, DECOMPENSATED EXOPHORIA
If the target ____________________ with both eyes, no problem with accommodation or convergence.
stays clear or the same blurring
If you cover one eye, and the blurring worsens, there is _______________ PROBLEM.
ACCOMMODATIVE
HIGH NRA indicates
an over minus during VT7
LOW NRA indicates
Decompensated exophoria
Accommodative Excess
Accommodative Spasm
Accommodative Infacility
If a patient is _______________, it is normal that the PRA results will be low because they have difficulty accommodating or the ciliary muscles
presbyope
If a patient has incipient cataract, it is normal that PRA will be _____ because when the lens opacifies, it goes towards more ______.
high; minus
What is the operational name of VT19 if px is non presbyope?
MINUS LENS TO BLUR OUT 0.62 / J3
What is the spatial direction of the eye of VT19 if px is presbyope?
AWAY FROM THE PLANE OF REGARD
A 25 year old px VT7 is -3.50. Lens to blur out is -9.75. What is the AOA?
8.75D
What is the range of normal lag?
+0.25 to +0.75
NPA result of a 12 year old px over OD: 12.00D, OS: 12.50, OU: 9.50. What seems to be the problem of the px?
CONVERGENCE PROBLEM
What is the maximum AOA of a 37 year old px?
10.2 D
Results of NOA of a 20 yr old px is OD 8.75. OS is 9.25 OU is 10.50D. What is the condition of the px?
normal
A 15. year old px has VT19 of 8.75 repeatedly. What is the suspected condition of the px?
ACCOMMODATIVE INSUFFICIENCY
What is the test name of VT20?
POSITIVE RELATIVE ACCOMMODATION
What is 5e probe body of VT21?
PLUS LENS
During NPA, if px see that the target becomes clearer, what is the suspected result of MEM?
LEAD OF ACCOMMODATION
What is the suspected muscle imbalance if the ox PRA results reveal low PRA?
DECOMPENSATED ESOPHORIA.
Accommodative Tests
VT19, 20, 21, and also 14A and 14B
Chronological Order of Cross cylinder Test
14A - 15A - 14B - 15B
Maximum plus to equality of line target under dissociated line target thru cross cylinder
14A
What is measured during VT14A?
- The amount of accommodation free of convergence at 16 inches
- Measure of intensity & deterioration of the visual pattern
- Measure of degree of embedding of the visual problem
- Measure or recency of visual pattern
- Measure of anisometropia at near
a visual problem in which the px has fairly adjusted & achieved the best possible equilibrium in space
Embedded case
Embedded case is also known as
structured or organized
It is innate or within the eye of the patient already.
embedded
It is a visual problem making adjustments or adaptations in visual skills or visual performance to the need of the individual in the environment in which he lives
non-embedded
14A MEASURES _______________ PROBLEM.
EMBEDDED
According to Leo Manas, VT 14 A IS DONE _________ PRISM
WITH
Name of VT14A
Dissociated / Unfused / Monocular Cross Cylinder Test
LIP of 14A
1. Presbyope
2. Non- Presbyope
- Distance VT7
- VT7
TRUE OR FALSE
Put +/-0.50 always on VT14A , it doesn’t matter if you are using JCC or prism
false
If you use prisms, you can use the +/-0.50, but if not you can use the JCC.
Chronological order of illumination changes in 14A
- 20 ft candle (Room)
- 2 ft candle (Dim)
From vertical lines darker, you reduce the _______ until it becomes EQUAL.
plus
From horizontal lines darker, you reduce the _______ until it becomes EQUAL.
minus
Equal -> Add plus -> Vertical Darker -> Add _____ -> Equality
minus
Patient cannot identify if the vertical or horizontal is getting darker
unclassified
The eyes become confused if it is lag or lead of accommodation
unclassified
If the px reports that the horizontal/vertical lines are dark and no equality is achieved, you leave the recording as _____________.
blank
1st step to do if px sees inequality with VT 7
Add +0.25 Dsph
If even after adding +0.25 Dsph, px still see inequality, what is the next step?
Add minus cyl with axis at 90 to the darkest line until px reports equal
Procedure of 14 A (lag)
- Monoculary done, binocularly open
- Px says V & H lines are equal, VT7 is correct, turn off light (dim illumination or 2ft candle)
- Place JCC red dot @ 90
- Monocularly add + until vertical darker
- From vertical darker, add minus until equality.
- Record number of steps from vertical darker to equality
Procedure of 14 A (lead)
- Monoculary done, binocularly open
- Px says V & H lines are equal, VT7 is correct turn off light (dim illumination or 2ft candle)
- Place JCC red dot @ 90
- Monocularly add +, if px reports H darker, go back to initial
- From equality (initial) add minus until horizontal darker.
- From horizontal darker, add plus until equality.
- Record number of steps from horizontal darker to equality
In books, only 0.25 is added both on the sphere and the minus cylinder. If equality is not achieved with adding those, ______________________-.
YOU NEED TO RECHECK VT7
In pediatric patients, you record the number of clicks in_____ not LIP.
MEM
The equivalent accommodative effect at 16 inches should never be greater than _______. This value is the maximum allowable lag.
2.50D
Clinically the average value of this add is 0.50 to 0.75D (non presbyope) - this correction factor for the influence of convergence is called _____.
lag
In VT5, LIP is recorded but when you count the ___________ from gross of VT4 to VT5, it will be almost the same as 14A result.
number of clicks
what does a w/ movement from VT#4 to VT#5 means?
lag of accommodation
what does a v/s movement from VT#4 to VT#5 means?
lead of accommodation
5, 14A presbyope result:
Reading Add/TNC
When is #5, 14A result considered as the TNC of the patient?
Emmetropic presby
VT7 is LIP, and ask the patient to look at the near target, when it is with movement, it is towards plus and when it is against movement, it is toward minus.
MEM
T/F
VT5, VT14A, and MEM should coincide.
T
If VT14A is less plus than VT7 reading add (or VT7 reading add is higher than VT14A), _____ plus lens.
REJECT
Patient can still accommodate and accommodation is still stimulated. This is a complete rejection of plus lens application at near point. These are the ___________ px who complain of their glasses being too strong & yet have better than standard acuity at far.
hyperopic
Procedure is SAME as 13B but lens in place is the result of 14 a
15A
Base in prism to vertical alignment of dissociated line target thru 14a
15A
TESTS THAT USES CROSS GRID AS TEST TARGET
14 A
14 B
15 A
this test is Insignificant for non-presbyope but ignificant for presbyope because it is the INTERMEDIATE CORRECTION
14 B
Maximum plus to equality of line target under fused conditions thru cross cylinder
14B
Horizontal lines are dark
MINUS lenses are ADDED
LEAD OR LAG?
LEAD
PLUS lenses are ADDED
LAG
Maximum plus to equality of line target under fused conditions thru cross cylinders, control lenses 14B
15b
TEST TARGET FOR 15B
RSTC 20/20
ILLUM OF 15B
ROOM
ILLUM FOR 15 A
40 FT CANDLE
It determines the reading add for presbyopic patients.
5
14A
MEM
Objective measurement of anisometropia at near
VT5
NORMAL LAG (Physiological lag) :
+0.25 to +0.75
the ciliary muscles are slow to contract
LAG
Focusing system of the eye is under accommodating at abnormal level
LAG
fast and overstimulation or over contraction of the ciliary muscles
LEAD
If lag is higher than +0.75DS, the ff. Are the suspected condition:
Near esophoria
Accommodation dysfunction (insufficiency of accommodation or ill-sustained accommodation)
Under corrected hyperopia
Over corrected myopia
Higher plus diopters except if presbyope
FORMULA OF HOFSTETTER’S
1. MAX
2. AVE
3. MIN
- 25 - 0.4 (AGE)
- 18.5 - 0.3 (AGE)
- 15 - 0.25 (AGE)
If less than 2.00D from the minimum AOA according to Hostetter’s, that is _________________.
accommodative insufficiency
Also called accommodative fatigue
ILL-SUSTAINED ACC
Lower AOA as you perform trials for AOA
ill-sustained accommodation.
Can lead to pseudomyopia
LEAD OF ACCOMMODATION
If lead or excessive accommodation is present, the ff. Are the suspected condition:
Near exophoric
Spasm of accommodation / excessive accommodation
Under corrected myopia
2 diopters or more from the maximum is
ACC EXCESS
It is already ____________ because it is 10D greater than the normal amplitude
spasm of accommodation
