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Visual Analysis 2 > Anomalies of Accommodation > Flashcards

Anomalies of Accommodation Flashcards

1
Q

It is the physiological insufficiency of accommodation leading to progressive fall in near vision due to increasing age, decrease elasticity of lens capsule & sclerosis of lens substance.

A

Presbyopia

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2
Q

It is the accommodation that is persistently higher than the normal expected due to excessive action of the ciliary muscles & flexibility of the lens.

A

Excessive Accommodation

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3
Q

Causes:
1. large amount of near work
2. deficient illumination
3. wearing of improper or ill fitted spectacle
4. physical or mental ill (hyperactive)
5. young hyperopes: frequently use this as a physiological adaptation to attain clear vision
6. young myopes: performing excessive near work uses this in association with excessive convergence

What type of accommodative anomaly?

A

Excessive Accommodation

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4
Q

• BI blur at near (17a) maybe low
• Fails the Binocular & monocular plus (+) accommodative facility (flipper)
• Low NRA
• Low MEM (lead of accommodation) & fused cross cyl (14b)
• Normal AOA (19)

What accommodative anomaly?

A

Excessive Accommodation

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5
Q

Treatment:
1. Correction of refractive error using wet refraction result
Cycloplegic drugs-paralyze the action of CM
2. Near work should be forbidden for a period

This is for what accommodative anomaly?

A

Excessive Accommodation

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6
Q

The accommodation is higher than normal expected due to involuntary control of the ciliary muscles & its amount may reach to 10.00D.

A

Spasm of Accommodation

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7
Q

Causes:
1. Drug induced spasm of accommodation like strong miotic drugs
2. Uncorrected hyperopes, astigmatic & myopes in children
3. excessive near work in unfavorable conditions like poor illumination, bad reading position, low energy, neurosis such as mental stress
4. iridocyclitis
5. lesion of brainstem such as encephalitis & meningitis
6. toxic reaction exogenous such as arsenic poisoning & smoking

What type of accommodative anomaly?

A

Spasm of Accommodation

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8
Q
  1. Px with this is associated with macropsia phenomenon
  2. Varying BOV due to induced pseudomyopia
  3. Asthenopia
  4. Headache specifically brow ache

What type of accommodative anomaly?

A

Spasm of Accommodation

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9
Q

Treatment:
1. complete paralysis of ciliary muscles with atropine for 4 weeks or more
2. correcting spectacle should be worn immediately when eyes are used again after period of cycloplegia
3. near work should be forbidden

This is for what type of accommodative anomaly?

A

Spasm of Accommodation

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10
Q

The accommodation is constantly below the lower limit of what may be expected for px’s age.

A

Accommodative Insufficiency / Insufficient Accommodation

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11
Q

• BO blur at near (16a) may be low
• Fails minus (-) binocular & monocularly accommodative facility (flipper)
• Low PRA
• High MEM & fused cross cyl (14b) / lag of accommodation
• Low AOA (19)
• Esophoria at near

What type of accommodative anomaly?

A

Insufficient Accommodation

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12
Q

Causes:
• 1. Premature sclerosis of the lens
• 2. Weak ciliary muscles due to muscular fatigue, anemia, stress, pregnancy & malnutrition

What type of accommodative anomaly?

A

Insufficient Accommodation

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13
Q

• Fatigue & irritable eyes while doing near work
• BOV at near
• Intermittent diplopia at near

What type of accommodative anomaly?

A

Insufficient Accommodation

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14
Q

Treatment:
• Spectacle correction & reading addition (weakest plus BCVA is given)
• If px has _______, full spherical correction is given
• Treatment of systemic cause

This is for what type of accommodative anomaly?

A

Insufficient Accommodation

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15
Q

Same as insufficient accommodation except that the deficiency is revealed after a period during which the accommodation has been active. AOA may appear normal but after some period there is decrease.

A

Ill-sustained Accommodation

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16
Q

Ill-sustained accommodation is also called __________.

A

Accommodative Fatigue

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17
Q

• BO blur at near (16a) may be low
• fails minus (-) binocular & monocular accommodative facility (flipper)
• Low PRA
• High MEM & fused cross cyl (14b)
• Normal AOA if administered just once, then decreases if repeated.
• Low AOA after some period of time

What type of accommodative anomaly?

A

Ill-sustained Accommodation / Accommodative Fatigue

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18
Q

Causes:
• Convalescence from illness
• Stage of general tiredness

What type of accommodative anomaly?

A

Ill-sustained Accommodation / Accommodative Fatigue

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19
Q

• Px complaints of feeling tired while doing near work
• Near point gradually recedes & near vision becomes blur
• Px complains of letters become blurred after reading for sometimes

What type of accommodative anomaly?

A

Ill-sustained Accommodation / Accommodative Fatigue

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20
Q

• Can be tested by RAF rule or VT#19
• 1. By RAF rule - measure accommodation repeatedly. Initially accommodation is sustained with considerable effort, it cannot be maintained over a period of time. Receded when repeatedly measured.

What type of accommodative anomaly?

A

Ill-sustained Accommodation / Accommodative Fatigue

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21
Q

Treatment
• Avoiding the near work during situation described in etiology
• Improve visual hygiene such as sufficient illumination & proper posture during study

This is for what type of accommodative anomaly?

A

Ill-sustained Accommodation / Accommodative Fatigue

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22
Q

This is a condition in which patients report difficulties in changing focus from a distant object to a near object and vice versa. Px changes from one state of accommodation to another with difficulty or sluggish.

A

Inertia of Accommodation / Accommodative Infacility

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23
Q

It is the ability of a px to rapidly change accommodation without changing vergence.

A

Accommodative Facility

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24
Q

It is useful in diagnosing binocular vision problems in symptomatic pxs whose phorias & visual acuities are normal.

A

Accommodative Facility

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25
Q

Can be tested by two methods:
• 1. near-far test
• 2. flipper lens test

A

Accommodative Facility

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26
Q
  1. determine flexibility of accommodative system
  2. rapidly alternatives viewing distance
    • Done under monocular & binocular conditions
    • Not appropriate for absolute presbyopia

What is this test?

A

Near-Far Test

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27
Q

Procedure:
• Place a series of 20/25 to 20/30 high contrast letters on wall 6M/20ft away
• Patient holds near VA chart at distance corresponding with
• Appropriate distance correction is worn
• Occlude one eye
• Tell px to switch focus back & fort between letters on the wall and near chart after making letters clear (this is done for 60 seconds)
• Procedure repeated for left eye for 60seconds
• Record number of cycle per minute • 1cycle=2 jumps (far to near)
• Expected results:
• Monocular:
– 15cycles per minute (minimum)
– 20 cycles per minute (average)
• Binocularly:
– 12cycles per minute (minimum)
– 16 cycles per minute (average)

What is this test?

A

Near-Far Test

28
Q

• Two plus and 2 minus lenses mounted in same holder
• Available powers
– +/- 0.50, 1.00,1.50,2.00,2.50 & 3.00
– +/- _____ is the best choice because it’s the max available lag

What is this test?

A

Flipper Lens Test; 2.00D

29
Q

The purpose of this test is:
• To determine the ability of accommodative system to respond to
lens created blur with a monocular stimulus presentation

A

Flipper Lens Test

30
Q

Procedure:
• Patient holds near point VA chart with 20/25 letters at 40cm
• Direct light from over head lamp
• Distance correction is worn
– Some procedure says –it can be combined with polaroid glasses (suppression check)
• OD is tested first
• Flipper lens placed in front of right eye (usually plus first)
• As soon as letters on acuity chart becomes clear, it is flipped to other side (minus side)
• As letter becomes clear with plus side flip back lens to minus
• Continue the procedure for 60 seconds
• The procedure repeated for left eye for 60 seconds

What is this test?

A

Flipper Lens Test

31
Q

Results:
• Young adults with polaroid glasses
• 11 cycles/minute monocular
• 8 cycles/minute binocular
• Children 8-12yrs old
• 7 cycles /minute monocular
• 5 cycles/minute binocular
• Recording & interpretation without polaroid glasses
• 1 cycle-clearance of minus to plus
• Monocularly
• Minimum = 12 cycles per minute
• Average =17 cycles per minute
• Binocularly
• Minimum =10 cycles per minute
• Average =13 cycles per minute

What is this test?

A

Flipper Lens Test

32
Q

Interpretation:
If there is decreased accommodative facility, px has _____________.
• Px’s complains of difficulty to focus for near activities after distance viewing or vice versa

This is for what type of accommodative anomaly?

A

Accommodative Infacility / Inertia of Accommodation

33
Q

Recommended therapy:
• Hart chart rock near-distance method or flipper lens

What type of accommodative anomaly?

A

Accommodative Infacility / Inertia of Accommodation

34
Q

• BO & BI blur (16a & 17a) at near maybe low
• Fails binocular & monocular +/- accommodative facility (flipper)
• Low NRA & PRA
• MEM is normal

What type of accommodative anomaly?

A

Accommodative Infacility / Inertia of Accommodation

35
Q

It is marked by reduced AOA due to drugs, head trauma & other factors.

A

Paresis of Accommodation

36
Q

Causes: excessive drugs & alcohol, head trauma, cerebral syphilis, infectious diseases like mumps, tonsillitis, herpes zoster & pneumonia

A

Paresis of Accommodation

37
Q

S/S: receding near point, dilated pupils, photophobia, do not want to read, asthenopia & headeache w/o ophthalmologic findings

A

Paresis of Accommodation

38
Q

No accommodation like the case of aphakia

A

Absence of Accommodation

39
Q

Intra Ocular Lens

A

Pseudophakia

40
Q

A type of accommodation that refers to the actual contraction of the lens measured in diopters.

A

Physical accommodation

41
Q

A type of accommodation that refers to the ciliary muscle contractions measured in myodiopters.

A

Physiological accommodation

42
Q

It is the ability of the optical system of the eye to increase its dioptric power so that parallel rays of light will be focused upon the retina. The adjustment of the eye for seeing at different distances: accomplished by changing the shape of the crystalline lens through action of the ciliary muscles, thus focusing a clear image on the retina.

A

Accommodation

43
Q

During accommodation, the radius of curvature is _____________.

A

increased

44
Q

During accommodation, the crystalline lens move ________ the cornea which causes the anterior chamber to be _________.

A

forward towards; shallow

45
Q

During accommodation, the equatorial diameter of the lens _________. From 10 mm to ____ mm.

A

decreases; 9.6 mm

46
Q

During accommodation, the thickness of the lens is ________, from 3.6mm to ____ mm, and it becomes more ________.

A

increased; 4 mm; biconvex

47
Q

During accommodation, the power of the lens is _________. From ___ D when relaxed to ___ D when stimulated.

A

increased; 19D to 33D

48
Q

During accommodation in case of aniridia (absence of iris), the equatorial diameter is _________.

A

decreased

49
Q

Hofstetter computation:

Minimum AOA

A

15 - 0.25 (px’s age)

50
Q

Hofstetter computation:

Average AOA

A

18.5 - 0.30 (px’s age)

51
Q

Hofstetter computation:

Maximum AOA

A

25 - 0.40 (px’s age)

52
Q

Etiology
• 1. decrease elasticity of the lens
• 2. hardening of the lens, stiffer and more plastic & sclerotic-like
• 3. lens size/volume increases which makes the lens capsule function less

A

Presbyopia

53
Q

First to become presbyopes are ______.

A

(1st) H - hyperope
(2nd) E - emmetrope
(3rd) M - myope

54
Q

Symptoms of _________:
1. vision at the customary near-work is blur or can be sustained only with excessive accommodative effort an dea
2. drowsiness after a short period of reading or near work.
3. reading materials must be held farther away or receding near point
4. occasionally, for early or incipient presbyopia, asthenopia related to attempt at excessive accommodative effort is reported. It may even lead to an accommodative spasm and pseudomyopia
5. transient diplopia and variable esophoria may be experienced as a result of the increased accommodative effort

A

Presbyopia

55
Q

What type of accommodative anomaly may lead to pseudomyopia?

A

Excessive Accommodation; Spasm of Accommodation; Presbyopia

56
Q

Symptoms
1. asthenopia and headache associated with near tasks
2. intermittent blurred distance vision
3. variable visual acuity
4. variable static & subjective findings
5. esophoria at near & possible at distance

A

Excess of Accommodation

57
Q

Symptoms
• 1. symptoms are very similar to those of presbyopia
• 2. BOV at near
• 3. discomfort and strain associated with.near tasks
• 4. fatigue associated with near point tasks
• 5. Difficulty with attention and concentration when reading
• 6. Intermittent diplopia at near

A

Insufficient Accommodation

58
Q

Symptoms
1. symptoms are very similar to accommodative insufficiency
2. BOV at near
3. discomfort and strain associated with near task
4. Fatigue associated with near point task
5. Difficulty with attention and concentration when reading

A

Ill-Sustained Accommodation / Accommodative Fatigue

59
Q

Symptoms
1. difficulty from distance to near and near to distance
2. asthenopia associated with near task
3. Difficulty with attention and concentration when reading
4. Intermittent blur associated with near tasks

A

Accommodative Infacility / Inertia

60
Q

Radius of curvature of the lens
* Relaxed - _____
* Stimulated - ____

A

10mm; 5.3mm

61
Q

How many mm is the displacement of the anterior crystalline lens going to the posterior of the cornea?

A

0.30 mm

62
Q

In what type of presbyopia is J9NR?

A

Absolute Presbyopia

63
Q

Developing or starting presbyopia; excessive accommodation

A

Incipient Presbyopia

64
Q

This occurs when you begin to notice more problems with near sight. Sometimes px can accommodate and sometimes cannot.

A

Functional Presbyopia

65
Q

cataract liquefies; better vision old cataracts

A

Senopia

66
Q

A test for px with matured cataract; examines if it is okay to remove the transparent media and determines BCVA at near when cataract is removed.

A

Potential or Super Pinhole

Visual Analysis 2 (2 decks)

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