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OD2 - Applied Clinical Training & Research Studies in Vision and Optometry > BVP - Assessment of Binocular Vision Disorders and Accommodation-Vergence Problems - Week 5 > Flashcards

BVP - Assessment of Binocular Vision Disorders and Accommodation-Vergence Problems - Week 5 Flashcards

1
Q

What is posture of accommodation?

A

How accurately the accommodative system focuses relative to where the visual stimulus is located

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2
Q

List two tests that assess posture of accommodation.

A

MEM retinoscopy

Binocular cross cyl

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3
Q

Is MEM retinoscopy subjective or objective?

A

Objective

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4
Q

What is the normal value for MEM retinoscopy? What is an abnormal finding (2)?

A

+0.25 to +0.50

Any minus finding or >+0.75 is abnormal

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5
Q

Is binocular cross cyl subjective or objective?

A

Subjective

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6
Q

List two disadvantages of binocular cross cyl.

A

Requires a phoropter

Proximal cues are lost and not a true representative of accommodation

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7
Q

What is the normal value for binocular cross cyl?

A

+0.50 ±0.50

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8
Q

What is amplitude of accommodation?

A

How much accommodation capacity the system has

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9
Q

List three tests for the amplitude of accommodation.

A

NPA
Refractor Head Near Point Rule
Minus lens to blur

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10
Q

What is the most widely used technique for amplitude of accommodation?

A

NPA

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11
Q

What is the minimum and normal values for NPA?

A

Minimum - 15 - age/4

Normal - 18 - age/3

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12
Q

Describe the reverse push up method. Does it over- or underestimate accommodation? Explain why.

A

Use a printed target, have the patient cover one eye, and bring the target close so that its blurry.
Slowly move the card outward until clearly seen and measure. Do this several times.
Will overestimate accommodation due to the magnification effect of bringing it close, improving acuity.

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13
Q

What is a disadvantage of RAF?

A

Requires the phoropter and proximal cues are lost.

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14
Q

Describe minus lens to blur. What are the expected values compared to the pushup method? Explain why.

A

Target is placed at 33cm, and minus lenses are added until the target blurs.
Expected values are generally less than with the pushup method by 2D
This is due to no magnification effect and some minification

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15
Q

What is accommodative facility?

A

How quickly and efficiently accommodation changes.

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16
Q

Can accommodative facility (using flippers) be done monocularly as well as binocularly?

A

Yesd

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17
Q

What should be noted when doing accommodative facility (also for vergence facility)?

A

Note if one side is noticeably slower/more difficult

18
Q

What is the normal value for accommodative facility?

A

±2.00D flippers should be 8cpm

19
Q

What is vergence posture (also heterophoria)?

A

How accurately the eyes are pointing to where the visual stimulus is located

20
Q

List 5 tests to assess vergence posture.

A 
Prentice card
Maddox rod
Von Graefe
Cover test
Maddox wing
21
Q

What is the preferred method for measuring phoria in children of school age?

A

Prentice card

22
Q

Explain how a maddox rod setup works.

A

It is made up of a series of grooves on a red filter. When light shines through, it will appear as a single red streak. The eyes will adopt a fusion free position

23
Q

Which is a more repeatable means of measuring phoria; Von Graefe or Maddox Rod?

A

Maddox Rod

24
Q

Is Von Graefe the preferred test for assessing phorias in children?

A

No

25
Q

What is an advantage the Maddox Wing has above all other methods? What is its disadvantage that has seen it become less commonly used?

A

Its advantage is that it can detect cyclodeviations

Its disadvantage is that it fails to adequately control accommodation when determining the phoria

26
Q

Is the cover test objective or subjective? What three components of a phoria can it assess?

A

Objective

Assesses presence, direction, and magnitude of a phoria

27
Q

What can be done to ensure accommodation is controlled during a cover test?

A

Ensure the target has detail and is engaging. It must be age appropriate.

28
Q

What is the Hirschberg test?

A

It evaluates the position of the corneal reflex relative to the pupil to determine the presence of any horizontal or vertical tropia.

29
Q

What is the Krimsky test?

A

It is the Hirschberg test, but with the addition of prisms to neutralise the tropia and determine its magnitude.
Prism is added until the corneal reflex overlaps with the centre of the pupil. The prism required is the magnitude.

30
Q

What is the amplitude of vergence?

A

How much capacity the vergence system has, and how much it can converge and diverge on demand

31
Q

What are two tests to assess the amplitude of vergence?

A

PRC (convergence)

NRC (divergence)

32
Q

What is vergence facility?

A

How quickly and efficiently the vergence system can change to uptake convergence or divergence on demand

33
Q

What prism flippers are generally used to measure vergence facility?

A

12^BO and 3^BI

34
Q

What is a normal break-recovery for NPC?

A

5-7

35
Q

What is the recommended break in children? What is an abnormal value?

A

<5cm

>5cm indicates BV issues

36
Q

In adults, what is deemed an abnormal break-recovery for NPC?

A

Anything over 10cm is abnormal

Suspicious if over 5cm

37
Q

What are the normal values for NRA and PRA?

A

NRA - +2.50D

PRA - -2.50D

38
Q

What does AC/A assess?

A

The effect of accommodation on vergence.

39
Q

What is the normal value for AC/A?

A

4^/1D ±2 SD

40
Q

What is the minimum battery of tests to yield good sensitivity and specificity for diagnosing non-strabismic binocular vision anomalies (NSBVAs)? What values for these tests would be anbormal?

A

NPC - >7.5cm
Monocular accommodative facility - <10cpm
D-N phoria (difference) >1.25^

41
Q

What is the minimum battery of tests to do on a routine basis (8)?

A 
Cover test
Stereopsis
NPC
NPA
Phoria D-N
Accommodation facility
Vergence facility
MEM retinoscopy

OD2 - Applied Clinical Training & Research Studies in Vision and Optometry (174 decks)

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