Accommodative Theory & Programming Flashcards
What is the 1st line treatment for accommodative insufficiency/ill-sustained accommodation?
plus at near
Is VT a good option for accommodative insufficiency/ill-sustained accommodation?
yes, in combination with or following plus lenses
Which accommodative dysfunction is VT the least effective for?
accommodative spasm/excess
Which accommodative dysfunction is VT the most effective for?
accommodative infacility
What is the difference between accommodative spasm and excess?
excess is milder than a spasm
Why are plus lenses less useful in accommodative spasm/excess than in insufficiency/ill-sustained?
patients physiologically still over-accommodate just blur with plus lenses
What are three purposes of accommodative therapy?
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
What is the progression of accommodative therapy?
monocular –> bi-ocular –> binocular; make monocular skills equal b/w the eyes, make monocular skills meet norms in each eye (or at least close)
T/F accommodative skills should be in all VT programs
true
Change in accommodation –>
change in accommodative vergence and change in fusional vergence
T/F BV/accommodative/tracking conditions rarely occur in isolation
True
What does -1.00 OU do to the accommodative/vergence system?
stimulates accommodation, increases accommodative vergence, when target becomes double patient uses NFV to keep target single
What are accommodation improvement areas?
ability/accuracy, speed, range, stamina
What is ability/accuracy?
ability to have a normal accommodative response with different distances and different dioptric demands
What accommodative dysfunction is ability/accuracy particularly important for?
AE/spasm
How is ability/accuracy measured clinically?
lag testing, MEM and FCC
How do you train ability/accuracy?
emphasize the feeling of accommodation, look hard vs look soft
When should you emphasize accommodative ability/accuracy?
early in VT program
Patient needs to focus on ___ throughout the ability/accuracy accommodative procedures
clarity of vision
What are activities for ability/accuracy?
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
What is accommodative speed?
ability to stimulate or relax accommodation quickly
What accommodative dysfunction is speed improvement important for?
accommodative infacility
How is speed measured clinically?
facility testing +/- 2.00D and distance/near accommodative rock
How do you train speed?
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
When do you emphasize speed?
after accuracy, remember practice makes permanent
During speed, patient should focus on…
rapidity of accommodative response, patient should feel the effort
What is accommodative range?
ability to use the full amount of accommodation that is normal for the patient’s age
What accommodative dysfunction is range particularly important for?
AI
How is range measured clinically?
amplitude testing, push-up/pull-away or minus lens amplitude
How is range calculated?
Hofstetter’s formulae
What are two ways to train range?
using lenses and using distance
How does using lenses train accommodative range?
increase the amount of lens power, higher minus= more amp needed
Why do you need to consider the working distance for using lenses to train accommodative range?
high plus is problematic because the working distance moves toward the nose, maximum plus +3.00
How does using distance train accommodative range?
increase/decrease working distance because closer=more amp needed
Why should you be hesitant to change too much of accommodative range during a VT session?
too rapid often= poor maintenance of gains, the exception is when the activity needs to be easier
What are examples of accommodative range activities?
increase lens power in MAR/BAR/loose lens rock, increase distances during NFHC, increase range of powers during lens sortin
What is accommodative stamina?
the ability to maintain accommodative state over time
What accommodative dysfunction is stamina particularly important for?
AI/ill-sustained accommodation
T/F stamina is not measured directly in clinical setting
true, only indirectly
How is stamina indirectly measured in a clinical setting?
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?
How can you train accommodative stamina?
perform accommodative therapies for an extended period of time and increase accommodative demand throughout the therapy activity
How can you increase the accommodative demand throughout the therapy activity?
increase minus lens power, increase lens range, increase distance range
When should you emphasize stamina?
throughout the VT program
When should you emphasize range?
emphasize each week with changes
What are examples of increasing accommodative stamina?
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
What direction should you work in?
the direction of difficulty first (after determining current ability) aka focus on relaxing with AE/spasm and focus on stimulating with AI
Which comes first, accuracy or range?
accuracy
Which comes first, range or speed?
range, greater amps before greater facility
What do you need to emphasize during all accommodation therapy?
the FEELING of accommodation, hard when stimulating, soft when relaxing
What are examples of physiological feedback for look hard/soft?
shoulders scrunched, muscles tight, brow furrowed, etc
How do you know if the patient is fatiguing?
performance slows over time
Do you care about diplopia during accommodative tasks?
yes! Is the patient supposed to be double? (bi-ocular) or can you do anything to make the target single again?
What are the general accommodative feedback mechanisms?
feeling, fatigue, diplopia, suppression, SILO, and blur
With minus lenses, the patient should perceive…
small/in
With plus lenses, the patient should perceive…
large/out
What does blur tell you during accommodative therapy?
patient is over or under-using accommodation
How can you make accommodative therapy easier?
decrease range, increase print size, move the working distance further
How can you make accommodative therapy more challenging?
increase the range, decrease the print size, change the working distance
Therapy must be…
patient driven
How can you keep vision therapy patient driven?
have the patient hold targets and flip lenses when appropriate, emphasize the feeling of changes, and allow for success
You need to spread out your activities over the major visual skills for oculomotor and accommodative VT, those skills are…
accommodative, oculomotor, gross motor
What are the feedback mechanisms from the review points?
motor overflow, blur, diplopia, visual awareness
What is the order of accommodative improvement?
ability/accuracy –> speed –> range –> stamina
