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Pediatrics > Binocular and Accommodative Disorders > Flashcards

Binocular and Accommodative Disorders Flashcards

1
Q

How is binocular vision/strabismus classified?

A

direction of deviation, strabismus frequency of deviation, and eye affected

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2
Q

Constant strabismus will experience _______

A

fewer/no symptoms due to adaptation/suppression

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3
Q

Deviation at distance and near for strabismus is classified as

A

> /= 10 prism diopters

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4
Q

What are the anomalies of divergence?

A

divergence excess and divergence insufficiency

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5
Q

What is divergence excess?

A

exo D>N

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6
Q

What is divergence insufficiency?

A

eso D>N

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7
Q

What are the anomalies of convergence?

A

convergence excess and convergence insufficiency

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8
Q

What is convergence excess?

A

eso N>D

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9
Q

What is convergence insufficiency?

A

CI exo N>D

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10
Q

How many prism diopters are used for phoria with CI?

A

4+ prism diopters

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11
Q

A basic eso or exo is categorized as within…

A

10 prism diopters

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12
Q

Which divergence anomaly generally includes strabismus?

A

divergence excess

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13
Q

What are symptoms of binocular problems?

A

double vision, words move when reading, HA when reading, poor attention, avoids reading, words blur when reading, NONE

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14
Q

What is the focus of learning to read K-3?

A

focus is vocabulary dependent

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15
Q

What skills are involved in learning to read K-3?

A

letter knowledge and word recognition and recall

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16
Q

What is the format of learning to read K-3?

A

many pictures, few words on a page, large print, short periods of concentration

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17
Q

What are visual factors of learning to read K-3?

A

visual perceptual skills!, accommodation and binocular vision not as critical in this stage

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18
Q

What is the focus of reading to learn 4+?

A

comprehension, need to read fluently

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19
Q

What are the skills of reading to learn 4+?

A

context clues more important to recognize words, word analysis is more automatic, emphases on comprehension and speed

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20
Q

What is the format of reading to learn 4+?

A

longer reading assignments, fewer pictures, more words on a page chapter books, smaller print, longer periods of concentration

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21
Q

What are visual factors of reading to learn 4+?

A

accommodation and binocular vision, visual perceptual skills should be developed at this stage

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22
Q

What did the athletes study find?

A

worse NPC after concussion

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23
Q

What is the convergence insufficiency triad?

A

receded NPC*, XP’>XP, reduced PFV aka BO

24
Q

What is an additional finding of convergence insufficiency?

A

low NRA

25
Q

How does NRA work as a binocular test?

A

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

26
Q

How does PRA work as a binocular test?

A

convergence is set, keep target clear and single, add - lenses, patient accommodates, accommodative convergence increases, patient diverges to keep single or reports diplopia

27
Q

What is the tx for CI?

A

BI prism or vision therapy

28
Q

What is Sheard’s used for?

A

not so much to Rx but more for the range

29
Q

How is vergence calculated by sheard?

A

2/3 demand - 1/3 reserve

30
Q

What is the compensating range as outlined by Sheard?

A

> /= 2X phoria

31
Q

Phorias can vary based on….

A

time of day, testing

32
Q

What does Sheard’s not consider?

A

recovery

33
Q

What was the convergence insufficiency treatment trial finding?

A

most effective treatment for CI was office based therapy combined with home reinforcement activities (75% achieved improvement vs 43% at home)

34
Q

What was the CITT-ART finding?

A

binocular/accommodative therapy does not improve reading… both treatment and placebo improved in reading but not to a significant degree

35
Q

What was a critique of CITT ART?

A

exclusion of prism in glasses, uncorrected hyperopia if <2D

36
Q

What three skills did the placebo CITT ART group practice with their therapy techniques?

A

fixation, attention, visual perception

37
Q

What are association with CI?

A

autism, ADHD, concussions, lyme disease, Alzheimers, Parkinsons

38
Q

What is a pseudo CI?

A

really an accomodative problem, present with CI signs (reduced NPC and PFV and XP’) may also demonstrate reduced amps and high lag

39
Q

What is the treatment for a pseudo CI?

A

low plus glasses for near, VT

40
Q

What testing is used for a pseudo CI?

A

NPC accommodative and non-accommodative, if PCI both will be equal if non-accommodative is more reduced then real CI

41
Q

How do you change NPC to retest a PCI?

A

retest with low plus (+0.50 OU) and the NPC will improve if pseudo CI

42
Q

What are characteristics of convergence excess?

A

reduced negative fusional vergence (BI), low PRA, high NRA

43
Q

What is the treatment for convergence excess?

A

low plus for near, VT

44
Q

What are symptoms of accommodative problems?

A

blurry near vision, eyes tear at near, near-far blur and far-near blur, fatigue when reading, HA when reading, close working distance

45
Q

What are the two accommodative anomalies?

A

accommodative insufficiency and accommodative infacility

46
Q

What is accommodative insufficiency?

A

difficulty stimulating accommodation

47
Q

What is accommodative infacility?

A

difficulty changing accommodative response

48
Q

What is a main symptom of accommodative insufficiency?

A

prolonged reading gets blurry

49
Q

What are direct measures of accommodative insufficiency?

A

reduced amplitude of accommodation, high MEM?FCC because like +

50
Q

What are indirect measures of accommodative insufficiency?

A

reduced PRA and high NRA because like +

51
Q

What are the medical associations of accommodative insufficiency?

A

adhd stimulant meds and SSRIs

52
Q

What are the condition associates of accommodative insufficiency?

A

down syndrome and cerebral palsy

53
Q

What is not often tested in Peds?

A

accommodative infacility

54
Q

How do you test accommodative infacility?

A

-2/+2 flippers, difficulty clearing monocularly is infacility

55
Q

What is the 8-12 and 12+ expected cycles for monocular accommodative infacility?

A

7 cpm and 11 cpm respectively

56
Q

What are indirect measures of accommodative infacility?

A

reduced PRA and NRA, difficulty clearing -2/+2 binocularly

57
Q

What are the expected 8-12 and 12+ binocular cycles for accommodative infacility?

A

5 cpm and 10 cpm respectively

Pediatrics (22 decks)

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