BVP - Accommodation Convergence Dysfunction in Children - Week 1 Flashcards
What does it mean to have good visual efficiency?
Clear and comfortable binocular vision for any visual task
What percentage of school aged children suffer from an undetected visual problem?
25%
What percentage of adults suffer from an accommodative and vergence dysfunction?
Accommodative - 6-12%
Vergence - 2-10%
What percentage of school aged children have convergence insufficiency?
13%
Is there an association between academic acores and accommodation-vergence dysfunction in children?
Yes
List the minimum battery of tests for assessing BV (8).
Cover test
NPC
Stereopsis
NPA
Phoria
Accommodation facility
Vergence facility
MEM retinoscopy
List 6 general management options in sequence for accommodative-vergence disorders and how if applicable.
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
Will blue filters help with digital eye strain?
There is little evidence at this time to support its use to minimise digital eye strain
Can treatment for convergence insufficiency improve attention deficit symptoms or is there not enough evidence?
Yes
Is vision therapy effective? Mention in terms of those doing accommodation/vergence exercises, placebo exercises, no exercises, and no exercises but maximum effort.
Vergence VT has the biggest improvement, followed by accommodation
No VT improved greatest just by exerting more effort
Placebo effect not significant
Consider VT that separates convergence and accommodation exercises and those that exercise both concurrently. Which is more effective?
Separating them is more effective than concurrent exercising
What are some of the main contributors to the efficacy of vision therapy (2)?
Clinician instructions
Patient effort
What is the purpose of vision therapy?
To develop more efficient voluntary control of convergence and develop better reserves and facility of both accommodation and convergence
When is prism usually given (for what deviation specifically)?
To compensate for exo deviation at near (using BI) when other options are not effective or practical
In children, are BI prism glasses effective in alleviating symptoms, improving NPC, or fusional vergence vs a placebo Rx?
No, so they are not typically used in children
Are pencil pushups effective in treating convergence insufficiency?
No
What is the gold standard for vision therapy and in what condition is it the most effective approach for treatment?
Structured in-office vision therapy is the gold standard
Most effective approach to treat convergence insufficiency
List four reasons why office-based vision therapy is so effective.
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
List the structured management protocol for convergence excess (6).
Correct any refractive error
Educate and counsel (harmon working distance, breaks etc)
Plus near addition
Vision therapy
Prism
Referral
List and describe the purpose of each of the four stages of vision therapy.
Monocular - equalise accommodative skills
Biocular - equalise and remove suppression
Binocular - increase facility and reserves binocularly
Proficiency - combine taks and load with distractions
List three common vision therapy accommodation activities.
Ball bounce
Mental minus
Flippers at near
List five vision therapy vergence activities.
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)
