BVP - Accommodation Convergence Dysfunction in Children - Week 1

Question 1

What does it mean to have good visual efficiency?

Answer 1

Clear and comfortable binocular vision for any visual task

Question 2

What percentage of school aged children suffer from an undetected visual problem?

Answer 2

25%

Question 3

What percentage of adults suffer from an accommodative and vergence dysfunction?

Answer 3

Accommodative - 6-12%
Vergence - 2-10%

Question 4

What percentage of school aged children have convergence insufficiency?

Answer 4

13%

Question 5

Is there an association between academic acores and accommodation-vergence dysfunction in children?

Answer 5

Yes

Question 6

List the minimum battery of tests for assessing BV (8).

Answer 6

Cover test
NPC
Stereopsis
NPA
Phoria
Accommodation facility
Vergence facility
MEM retinoscopy

Question 7

List 6 general management options in sequence for accommodative-vergence disorders and how if applicable.

Answer 7

Do nothing
Refractive error
-correct with glasses/CLs
Counsel
-advice
-educate
-review
Accommodation
-near add
Residual VE dysfunction
-lenses/VT or both
Unresolved
-compensatory prism or surgery

Question 8

Will blue filters help with digital eye strain?

Answer 8

There is little evidence at this time to support its use to minimise digital eye strain

Question 9

Can treatment for convergence insufficiency improve attention deficit symptoms or is there not enough evidence?

Answer 9

Yes

Question 10

Is vision therapy effective? Mention in terms of those doing accommodation/vergence exercises, placebo exercises, no exercises, and no exercises but maximum effort.

Answer 10

Vergence VT has the biggest improvement, followed by accommodation
No VT improved greatest just by exerting more effort
Placebo effect not significant

Question 11

Consider VT that separates convergence and accommodation exercises and those that exercise both concurrently. Which is more effective?

Answer 11

Separating them is more effective than concurrent exercising

Question 12

What are some of the main contributors to the efficacy of vision therapy (2)?

Answer 12

Clinician instructions
Patient effort

Question 13

What is the purpose of vision therapy?

Answer 13

To develop more efficient voluntary control of convergence and develop better reserves and facility of both accommodation and convergence

Question 14

When is prism usually given (for what deviation specifically)?

Answer 14

To compensate for exo deviation at near (using BI) when other options are not effective or practical

Question 15

In children, are BI prism glasses effective in alleviating symptoms, improving NPC, or fusional vergence vs a placebo Rx?

Answer 15

No, so they are not typically used in children

Question 16

Are pencil pushups effective in treating convergence insufficiency?

Answer 16

No

Question 17

What is the gold standard for vision therapy and in what condition is it the most effective approach for treatment?

Answer 17

Structured in-office vision therapy is the gold standard
Most effective approach to treat convergence insufficiency

Question 18

List four reasons why office-based vision therapy is so effective.

Answer 18

Program is tailored to the individual
The therapy techniques/procedures are explained so they are actually performed correctly
Optometrist can monitor progress and determine the best next step
Therapy program follows a plan based on a step-by-step approach

Question 19

List the structured management protocol for convergence excess (6).

Answer 19

Correct any refractive error
Educate and counsel (harmon working distance, breaks etc)
Plus near addition
Vision therapy
Prism
Referral

Question 20

List and describe the purpose of each of the four stages of vision therapy.

Answer 20

Monocular - equalise accommodative skills
Biocular - equalise and remove suppression
Binocular - increase facility and reserves binocularly
Proficiency - combine taks and load with distractions

Question 21

List three common vision therapy accommodation activities.

Answer 21

Ball bounce
Mental minus
Flippers at near

Question 22

List five vision therapy vergence activities.

Answer 22

Loose prism jump ductions (BI/BO distance/near)
Aperture rule at near
Brock string (distance/near)
Red-green/polarised tranyglyphs (near/distance)
Computer VT (HTS)