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BOARDS2: Accomomdative/Vergence/Oculomotor > BV disorders > Flashcards

BV disorders Flashcards

1
Q

What is the patient’s most likely diagnosis?

CC: eyes tire easily, esp when reading for a long time

CT
D: 2xp
N: 1-XP

SUBJ: plano OU

VonGraefe
D: 3xp, no vertical
N: 10xp, no vertical

vergences
D: BI X/8/5, BO 10/20/10
N: BI 13/20/12, BO 15/19/9

NPC: 7cm, 9cm through a +2.00D lens
Amp: 11.50D
NRA/PRA: +1.50/-2.50D

A

convergence insufficiency

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2
Q

what mergence range value should be examined to determine if this patient can compensate for the large XP ay near?

CC: eyes tire easily, esp when reading for a long time

CT
D: 2xp
N: 1-XP

SUBJ: plano OU

VonGraefe
D: 3xp, no vertical
N: 10xp, no vertical

vergences
D: BI X/8/5, BO 10/20/10
N: BI 13/20/12, BO 15/19/9

NPC: 7cm, 9cm through a +2.00D lens
Amp: 11.50D
NRA/PRA: +1.50/-2.50D

A

BO near blur

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3
Q

what is the total amount go prism required to treat this patient according to Sheard’s criterion?

CC: eyes tire easily, esp when reading for a long time

CT
D: 2xp
N: 1-XP

SUBJ: plano OU

VonGraefe
D: 3xp, no vertical
N: 10xp, no vertical

vergences
D: BI X/8/5, BO 10/20/10
N: BI 13/20/12, BO 15/19/9

NPC: 7cm, 9cm through a +2.00D lens
Amp: 11.50D
NRA/PRA: +1.50/-2.50D

A

S=2/3D-1/3R
D=phoria
R=compensating fusional vergence

2/3(10)-1/3(15)
1.66

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4
Q

what magnitude of prism should be RXed for this patient based on Percivals criterion?

CC: eyes tire easily, esp when reading for a long time

CT
D: 2xp
N: 1-XP

SUBJ: plano OU

VonGraefe
D: 3xp, no vertical
N: 10xp, no vertical

vergences
D: BI X/8/5, BO 10/20/10
N: BI 13/20/12, BO 15/19/9

NPC: 7cm, 9cm through a +2.00D lens
Amp: 11.50D
NRA/PRA: +1.50/-2.50D

A

no prism needed

P=1/3G-2/3L
1/3(15)-2/3(13)=-3.66

percivals states that the smaller fusional mergence reserve should be at least half of the greater fusional vergence

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5
Q

what is the most common BV issue?

A

CI

present in 3-5% of the population.

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6
Q

CI characteristics

A 
XP greater at near 
low AC/A
receded NPC
normal accommodation
low NRA
low BO vergence ranges
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7
Q

NPC

A

measures the ability of the eyes to converge while maintaining fusion. A near target is brought towards the patient until he reports diplopia or the clinician notes an eye deviation. This distance is recorded in cm. The target is then moved away from the patient until it appears single again
-if the patient has borderline findings or the OD is highly suspicious of a problem, test using a penlight to RG glasses to dissociate the eyes. This will cause a fragile BV system to become more receded

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8
Q

normal NPC

A

5cm break and 7cm recovery

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9
Q

pseudoconvergence insufficiency

A

occurs when a patient has sufficient accommodation, resulting in a decreased convergence. A patient with pseudo CI will also have a receded NPC that improves with the addition of plus lenses

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10
Q

diff between pseudo CI and CI

A

a pt with true CI will have difficulty converging the eyes through plus lenses because accommodation will be more relaxed, resulting in less convergence. In contrast, a pseudo CI will have an improved NPC with plus lenses because the plus lenses compensate for the patients insufficient accommodation

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11
Q

XP will have problems with what fusional vergence

A

PFV

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12
Q

normal CT@D

A

1EP-3xp

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13
Q

normal CT@N

A

ortho-6xp

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14
Q

normal AC/A

A

4/1

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15
Q

normal distance smooth BI ranges

A

x/7/4

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16
Q

normal distance smooth BO ranges

A

9/19/10

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17
Q

normal near smooth BI ranges

A

13/21/13

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18
Q

normal near smooth BO ranges

A

17/21/11

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19
Q

normal vergence facility

A

15cpm

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20
Q

normal NPC

A

5cm break/7cm recovery

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21
Q

normal monocular accommodative facility

A

11cpm

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22
Q

normal binocular accommodative facility

A

8cpm

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23
Q

min amp of accommodation

A

15-0.25(age)

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24
Q

avg amp of accommodation

A

18.5-.30(age)

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25
Q

normal lag of accommodation (MEM/FCC)

A

+0.25D to +0.75D

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26
Q

normal NRA/PRA

A

+2.50/-2.50

27
Q

Sheard’s criterion works best for

A

exo

28
Q

CITT

A

efficacy of office based VT vs home based VT with pencil push ups vs pencil push ups alone vs placebo office. At 12 weeks, office based VT was the only treatment that resolved symptoms.

29
Q

various techniques of office or home based VT for NPC and PFV

A 
brock string 
pencil push ups 
vectograms 
computer orthoptics 
hart chart
aperture rule
30
Q

treatment fo CI

A

VT

if no improvement, RX prism based on Sheards

31
Q

treatment for convergence excess

A

plus lenses at near followed by VT or prism as needed

32
Q

treatment for divergence insufficiency

A

BO prism at distance followed by VT; refer if neuro in etiology

33
Q

treatment for divergence excess

A

VT, prism, or minus lenses

34
Q

treatment for basic XP

A

BI prism, VT

35
Q

treatment for basic EP

A

BO prism, VT

36
Q

treatment for vertical imbalance

A

Prism

37
Q

insufficiency problems and AC/A

A

have low AC/A ratios

38
Q

excess problems and AC/A

A

high

39
Q

treating someone with low AC/A

A

does not respond well to treatment with lenses. lenses are really good for people with high AC/A ratio

40
Q

general management steps for non strab BV anomalies or accommodative issues include the following

A
  1. optical correction of ametropia
  2. spherical lens power changes
  3. prism
  4. occlusion
  5. VT (amblyopia, suppression, ARC, sensory motor function)
  6. surgery (rare)
41
Q

to increase fusional vergence ranges

A

either accommodation or vergence need to be held constant while the other is varied

42
Q

what should you treat before treating fusional vergences

A

amblyopia or deep suppression

43
Q

VT should initially start how?

A

require the patient to work in the direction that is most difficult, eventually both directions will be trained

44
Q

with non strab BV problems, what order do you work the targets?

A

begin with third degree targets, then second, then first, working with peripheral stereopsis before working on central stereopsis

45
Q

should you work on ranges or amplitudes?

A

begin working on amp ranges, followed by facility of fusional vergence or the accommodative response

46
Q

what are the two main ways vergences can be trained

A

smooth (sliding) or phasic (jumping)

47
Q

antisuppresion therapy

A

suppression can be broken with increased illumination, movement of the target, increased contrast to the suppressed eye, or blurring the target in the non suppressed eye

48
Q

anaglyphs and polaroid filters

A

tranaglyphs, bar readers, vectograms, computer orthoptics (liquid crystal system)

  • these devices increase the amp and velocity and decrease the latency of PFV and NFV
  • each eye sees different parts of the same target to resemble normal seeing conditions
  • best for the treatment of shallow to moderate suppression
49
Q

lenses, prisms, and mirrors

A

lenses change accommodation and vergence demand, while prisms and mirrors change the direction of light
-used for anti suppression therapy, fusional vergence, accommodation, and ocular motility treatment

50
Q

septums/apertures

A

include the aperture slide and the Remy separator

  • these devices increase the amplitude and velocity and decrease the latency of PFV and NFV
  • each eye sees different parts of the same target
  • Best used for the treatment of shallow to moderate suppression: typically reserved for use after anaglyphs/polaroid filters and lenses/prisms/mirrors
51
Q

paper, pencil, misc tasks

A

life saver cards, Brock string, hart chart, tracing, barrel card, three dot card
-these devices are used to train accommodation, vergence, accurate eye movements, and decrease suppression

52
Q

stereoscopes

A

Brewster, Wheatstone, haploscope, and cheiroscope

  • increase the amp and velocity and decrease the latency of PFV and NFV
  • these devices divide the visual space into two areas that are visible for each eye
  • they contain 1st, 2nd, and 3rd degree targets to treat shallow, moderate, and deep suppression (although not first line therapy)
53
Q

after images, entoptic phenomenon, and electrophysiologic techniques

A

Maxwell Spot, haidenger brushes

54
Q

VT for ocular motor dysfunction (saccades and pursuits)

A

VT exercises should work first on accuracy and then on speed. The patient should work on large eye movements first before working on small, fine eye movements. Begin with monocular therapy, then move to binocular therapy until the eyes are equal in their movements. The patient should not be allowed to move his head during the exercise (unless necessary). The following techniques can be used: hart chart, visual tracing, computer vergences, random dot stereograms, letter and symbol tracing

55
Q

hart card

A
  • for distance/near monocular accommodative rock: place one card in the patient’s hand and the other on the wall across the room. The patient should read the top line of the near card aloud and then the second line of the distance chart out loud. Continue to alternate between N and D
  • for saccadic therapy: Place distance card 5-10 ft from patient. Occlude one eye and have patient read out letters from various non-adjacent columns
56
Q

brock string

A

this is a long string with different colored beads attached. It should be tied to a door knob at one end and the other end should be held at the patient’s nose. the patient will experience physiological diplopia of one bead when looking at the other beads. The patient should be able to fuse all the beads and jump back and forth between them

57
Q

lifesaver card

A

this card has 3 sets of two circles side by side that increase in their separation as you go up the card. The patient is asked to fuse the circles and hold for 10s and then jump up to the next targets and repeat. the card should be kept in clear focus the entire time

58
Q

SILO

A

small in large out. while maintaining fusion, if the convergence demand increases, the object being fixated will appear to become smaller and move closer. On the other hand, if divergence demand increases, the object will appear larger and move out. This phenomenon can serve as a method of feedback for the patient while doing VT

59
Q

BIM/BOP

A

base in minus and base out plus. this means that BI and minus (and BO and plus) have a similar effect on the difficulty of the task for the patient

60
Q

localization

A

used in convergence therapy with devices such as tranaglyphs and vectograms; the patient points to where he perceives the images to be fused

61
Q

Chiastopic fusion

A

the patients visual axes are crossed relative to the fixation distance of the target

62
Q

orthopic fusion

A

the patient’s visual axes are uncrossed relative to the fixation distance of the target

63
Q

biocular task

A

both eyes are used for the task, but central fusion is not possible

BOARDS2: Accomomdative/Vergence/Oculomotor (4 decks)

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