Accommodative Theory & Programming Flashcards

1
Q

What is the 1st line treatment for accommodative insufficiency/ill-sustained accommodation?

A

plus at near

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2
Q

Is VT a good option for accommodative insufficiency/ill-sustained accommodation?

A

yes, in combination with or following plus lenses

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3
Q

Which accommodative dysfunction is VT the least effective for?

A

accommodative spasm/excess

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4
Q

Which accommodative dysfunction is VT the most effective for?

A

accommodative infacility

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5
Q

What is the difference between accommodative spasm and excess?

A

excess is milder than a spasm

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6
Q

Why are plus lenses less useful in accommodative spasm/excess than in insufficiency/ill-sustained?

A

patients physiologically still over-accommodate just blur with plus lenses

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7
Q

What are three purposes of accommodative therapy?

A

improvement and enhancement of accommodative function, ability to identify objects at different distances under different dioptric demands, and increase range of function and allow for flexibility with other visual skills

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8
Q

What is the progression of accommodative therapy?

A

monocular –> bi-ocular –> binocular; make monocular skills equal b/w the eyes, make monocular skills meet norms in each eye (or at least close)

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9
Q

T/F accommodative skills should be in all VT programs

A

true

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10
Q

Change in accommodation –>

A

change in accommodative vergence and change in fusional vergence

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11
Q

T/F BV/accommodative/tracking conditions rarely occur in isolation

A

True

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12
Q

What does -1.00 OU do to the accommodative/vergence system?

A

stimulates accommodation, increases accommodative vergence, when target becomes double patient uses NFV to keep target single

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13
Q

What are accommodation improvement areas?

A

ability/accuracy, speed, range, stamina

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14
Q

What is ability/accuracy?

A

ability to have a normal accommodative response with different distances and different dioptric demands

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15
Q

What accommodative dysfunction is ability/accuracy particularly important for?

A

AE/spasm

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16
Q

How is ability/accuracy measured clinically?

A

lag testing, MEM and FCC

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17
Q

How do you train ability/accuracy?

A

emphasize the feeling of accommodation, look hard vs look soft

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18
Q

When should you emphasize accommodative ability/accuracy?

A

early in VT program

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19
Q

Patient needs to focus on ___ throughout the ability/accuracy accommodative procedures

A

clarity of vision

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20
Q

What are activities for ability/accuracy?

A

ability to… clear lenses during MAR/BAR loose lens rock, see letters clearly on the near and far Hart charts, clear and blur target during mental minus, sort lenses accurately by power using visual cues

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21
Q

What is accommodative speed?

A

ability to stimulate or relax accommodation quickly

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22
Q

What accommodative dysfunction is speed improvement important for?

A

accommodative infacility

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23
Q

How is speed measured clinically?

A

facility testing +/- 2.00D and distance/near accommodative rock

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24
Q

How do you train speed?

A

work on improvement in how fast patient can make the change; using lenses–change between plus and minus, increasing speed; using distance– change between near and far, increasing speed

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25
Q

When do you emphasize speed?

A

after accuracy, remember practice makes permanent

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26
Q

During speed, patient should focus on…

A

rapidity of accommodative response, patient should feel the effort

27
Q

What is accommodative range?

A

ability to use the full amount of accommodation that is normal for the patient’s age

28
Q

What accommodative dysfunction is range particularly important for?

A

AI

29
Q

How is range measured clinically?

A

amplitude testing, push-up/pull-away or minus lens amplitude

30
Q

How is range calculated?

A

Hofstetter’s formulae

31
Q

What are two ways to train range?

A

using lenses and using distance

32
Q

How does using lenses train accommodative range?

A

increase the amount of lens power, higher minus= more amp needed

33
Q

Why do you need to consider the working distance for using lenses to train accommodative range?

A

high plus is problematic because the working distance moves toward the nose, maximum plus +3.00

34
Q

How does using distance train accommodative range?

A

increase/decrease working distance because closer=more amp needed

35
Q

Why should you be hesitant to change too much of accommodative range during a VT session?

A

too rapid often= poor maintenance of gains, the exception is when the activity needs to be easier

36
Q

What are examples of accommodative range activities?

A

increase lens power in MAR/BAR/loose lens rock, increase distances during NFHC, increase range of powers during lens sortin

37
Q

What is accommodative stamina?

A

the ability to maintain accommodative state over time

38
Q

What accommodative dysfunction is stamina particularly important for?

A

AI/ill-sustained accommodation

39
Q

T/F stamina is not measured directly in clinical setting

A

true, only indirectly

40
Q

How is stamina indirectly measured in a clinical setting?

A

facility– does the patient fatigue over time, amplitude– does the amp change throughout the exam, near VA– does the near VA change throughout the exam?

41
Q

How can you train accommodative stamina?

A

perform accommodative therapies for an extended period of time and increase accommodative demand throughout the therapy activity

42
Q

How can you increase the accommodative demand throughout the therapy activity?

A

increase minus lens power, increase lens range, increase distance range

43
Q

When should you emphasize stamina?

A

throughout the VT program

44
Q

When should you emphasize range?

A

emphasize each week with changes

45
Q

What are examples of increasing accommodative stamina?

A

perform MAR for at least 5 minutes per eye, perform at least 10 cycles (blur-clear-blur) per lens on mental minus, complete entire chart multiple times with each eye on NFHC

46
Q

What direction should you work in?

A

the direction of difficulty first (after determining current ability) aka focus on relaxing with AE/spasm and focus on stimulating with AI

47
Q

Which comes first, accuracy or range?

A

accuracy

48
Q

Which comes first, range or speed?

A

range, greater amps before greater facility

49
Q

What do you need to emphasize during all accommodation therapy?

A

the FEELING of accommodation, hard when stimulating, soft when relaxing

50
Q

What are examples of physiological feedback for look hard/soft?

A

shoulders scrunched, muscles tight, brow furrowed, etc

51
Q

How do you know if the patient is fatiguing?

A

performance slows over time

52
Q

Do you care about diplopia during accommodative tasks?

A

yes! Is the patient supposed to be double? (bi-ocular) or can you do anything to make the target single again?

53
Q

What are the general accommodative feedback mechanisms?

A

feeling, fatigue, diplopia, suppression, SILO, and blur

54
Q

With minus lenses, the patient should perceive…

A

small/in

55
Q

With plus lenses, the patient should perceive…

A

large/out

56
Q

What does blur tell you during accommodative therapy?

A

patient is over or under-using accommodation

57
Q

How can you make accommodative therapy easier?

A

decrease range, increase print size, move the working distance further

58
Q

How can you make accommodative therapy more challenging?

A

increase the range, decrease the print size, change the working distance

59
Q

Therapy must be…

A

patient driven

60
Q

How can you keep vision therapy patient driven?

A

have the patient hold targets and flip lenses when appropriate, emphasize the feeling of changes, and allow for success

61
Q

You need to spread out your activities over the major visual skills for oculomotor and accommodative VT, those skills are…

A

accommodative, oculomotor, gross motor

62
Q

What are the feedback mechanisms from the review points?

A

motor overflow, blur, diplopia, visual awareness

63
Q

What is the order of accommodative improvement?

A

ability/accuracy –> speed –> range –> stamina