Binocular and Accommodative Disorders Flashcards
How is binocular vision/strabismus classified?
direction of deviation, strabismus frequency of deviation, and eye affected
Constant strabismus will experience _______
fewer/no symptoms due to adaptation/suppression
Deviation at distance and near for strabismus is classified as
> /= 10 prism diopters
What are the anomalies of divergence?
divergence excess and divergence insufficiency
What is divergence excess?
exo D>N
What is divergence insufficiency?
eso D>N
What are the anomalies of convergence?
convergence excess and convergence insufficiency
What is convergence excess?
eso N>D
What is convergence insufficiency?
CI exo N>D
How many prism diopters are used for phoria with CI?
4+ prism diopters
A basic eso or exo is categorized as within…
10 prism diopters
Which divergence anomaly generally includes strabismus?
divergence excess
What are symptoms of binocular problems?
double vision, words move when reading, HA when reading, poor attention, avoids reading, words blur when reading, NONE
What is the focus of learning to read K-3?
focus is vocabulary dependent
What skills are involved in learning to read K-3?
letter knowledge and word recognition and recall
What is the format of learning to read K-3?
many pictures, few words on a page, large print, short periods of concentration
What are visual factors of learning to read K-3?
visual perceptual skills!, accommodation and binocular vision not as critical in this stage
What is the focus of reading to learn 4+?
comprehension, need to read fluently
What are the skills of reading to learn 4+?
context clues more important to recognize words, word analysis is more automatic, emphases on comprehension and speed
What is the format of reading to learn 4+?
longer reading assignments, fewer pictures, more words on a page chapter books, smaller print, longer periods of concentration
What are visual factors of reading to learn 4+?
accommodation and binocular vision, visual perceptual skills should be developed at this stage
What did the athletes study find?
worse NPC after concussion
What is the convergence insufficiency triad?
receded NPC*, XP’>XP, reduced PFV aka BO
What is an additional finding of convergence insufficiency?
low NRA
How does NRA work as a binocular test?
convergence is set, keep target clear and single, add + lenses, patient relaxes accommodation, decrease in accommodative convergence, patient convergences to keep single or reports diplopia
How does PRA work as a binocular test?
convergence is set, keep target clear and single, add - lenses, patient accommodates, accommodative convergence increases, patient diverges to keep single or reports diplopia
What is the tx for CI?
BI prism or vision therapy
What is Sheard’s used for?
not so much to Rx but more for the range
How is vergence calculated by sheard?
2/3 demand - 1/3 reserve
What is the compensating range as outlined by Sheard?
> /= 2X phoria
Phorias can vary based on….
time of day, testing
What does Sheard’s not consider?
recovery
What was the convergence insufficiency treatment trial finding?
most effective treatment for CI was office based therapy combined with home reinforcement activities (75% achieved improvement vs 43% at home)
What was the CITT-ART finding?
binocular/accommodative therapy does not improve reading… both treatment and placebo improved in reading but not to a significant degree
What was a critique of CITT ART?
exclusion of prism in glasses, uncorrected hyperopia if <2D
What three skills did the placebo CITT ART group practice with their therapy techniques?
fixation, attention, visual perception
What are association with CI?
autism, ADHD, concussions, lyme disease, Alzheimers, Parkinsons
What is a pseudo CI?
really an accomodative problem, present with CI signs (reduced NPC and PFV and XP’) may also demonstrate reduced amps and high lag
What is the treatment for a pseudo CI?
low plus glasses for near, VT
What testing is used for a pseudo CI?
NPC accommodative and non-accommodative, if PCI both will be equal if non-accommodative is more reduced then real CI
How do you change NPC to retest a PCI?
retest with low plus (+0.50 OU) and the NPC will improve if pseudo CI
What are characteristics of convergence excess?
reduced negative fusional vergence (BI), low PRA, high NRA
What is the treatment for convergence excess?
low plus for near, VT
What are symptoms of accommodative problems?
blurry near vision, eyes tear at near, near-far blur and far-near blur, fatigue when reading, HA when reading, close working distance
What are the two accommodative anomalies?
accommodative insufficiency and accommodative infacility
What is accommodative insufficiency?
difficulty stimulating accommodation
What is accommodative infacility?
difficulty changing accommodative response
What is a main symptom of accommodative insufficiency?
prolonged reading gets blurry
What are direct measures of accommodative insufficiency?
reduced amplitude of accommodation, high MEM?FCC because like +
What are indirect measures of accommodative insufficiency?
reduced PRA and high NRA because like +
What are the medical associations of accommodative insufficiency?
adhd stimulant meds and SSRIs
What are the condition associates of accommodative insufficiency?
down syndrome and cerebral palsy
What is not often tested in Peds?
accommodative infacility
How do you test accommodative infacility?
-2/+2 flippers, difficulty clearing monocularly is infacility
What is the 8-12 and 12+ expected cycles for monocular accommodative infacility?
7 cpm and 11 cpm respectively
What are indirect measures of accommodative infacility?
reduced PRA and NRA, difficulty clearing -2/+2 binocularly
What are the expected 8-12 and 12+ binocular cycles for accommodative infacility?
5 cpm and 10 cpm respectively
