BVP - Diagnosis of Binocular Vision Disorders and Accommodation-Vergence Problems - Week 6

Question 1

What are five approaches to making a diagnosis?

Answer 1

Graphical analysis
Morgan’s normative analysis
Fixation disparity
Analytic analysis
Integrative analysis

Question 2

Is graphical analysis practiced clinically? Explain why.

Answer 2

No, it is cumbersome and time consuming

Question 3

What does graphical analysis not take into consideration?

Answer 3

Doesnt take into account all elements of testing

Question 4

What is morgan’s normative analysis? Is it commonly used?

Answer 4

Tests grouped after data is compared with morgan’s table of expected finsingds and trends determined
Not commonly used

Question 5

What is fixation disparity? How is it carried out? Is it used clinically? Explain why.

Answer 5

Fixation disparity is the small misalignment of the eye under binocular conditions from exact bi-foveal fixation
Prism required to emilinate fixation disparity is plotted
Not practical clinically as it is time consuming

Question 6

When is fixation disparity of use?

Answer 6

Only of use if prism is being considered in the management plan

Question 7

What is the OEP analytic analysis? Where is all the testing based? Is it commonly used?

Answer 7

Uses the OEP model 21 point test system
Testing is all phoropter based
Not commonly used in practice

Question 8

What is the most widely used diagnostic approach clinically?

Answer 8

Integrative analysis approach

Question 9

Explain the integrative analysis approach (4).

Answer 9

Compares individual test results against expected values published
Identifies any patterns or characteristic signs of dysfunction
Integrates this with the patient’s history and needs
Narrows the possible diagnoses

Question 10

What are the three steps in carrying out an intergrative analysis approach?

Answer 10

Compare test findings to the normal values
Group the findings outside the normal range
Identify possible diagnoses based on the pattern

Question 11

What can fatigue/stress/prolonged near work be a risk factor for (4)?

Answer 11

Accommodative insufficiency
Accommodative excess
Convergence insufficiency
Convergence excess

Question 12

What can genetic predispositions be a risk factor for (4)?

Answer 12

Convergence insufficiency
Convergence excess
Divergence insufficiency
Divergence excess

Question 13

What can uncorrected refractive error be a risk factor for (3)?

Answer 13

Convergence excess
Basic esophoria
Accommodative insufficiency

Question 14

What can systemic diseases like diabetes, myasthenia gravis, and parkinsons disease be a risk factor for (4)?

Answer 14

Accommodative insufficiency
Accommodative excess
Binocularity problems (EOM)
Vergence disorders

Question 15

What can trauma be a risk factor for (2)?

Answer 15

Accommodative spasm
Convergence insufficiency

Question 16

Do myopic contact lens wearers have poorer or better accommodation and vergence function compared to spectacle wearers? Should these functions be assessed with both contact lenses (if they wear them) and spectacles, or is this unnecessary?

Answer 16

Generally poorer
They should be assessed with both contact lenses and spectacles

Question 17

Can test results be considered in isolation?

Answer 17

They mean little in isolation and should be put together

Question 18

List four diagnostic patterns of convergence insufficiency.

Answer 18

Exophoria - D < N
Low AC/A ratio
Reduced NPC
Reduced fusional convergence

Question 19

List four diagnostic patterns of divergence excess.

Answer 19

Exophoria - D > N
High AC/A ratio
High tonic exophoria
Large exophoria/tropia at distance

Question 20

List two diagnostic patterns of basic exophoria.

Answer 20

Exophoria - D = N
Normal AC/A ratio

Question 21

List two diagnostic patterns of convergence excess.

Answer 21

Esophoria - D < N
High AC/A ratio

Question 22

List three diagnostic patterns of divergence insufficiency.

Answer 22

Esophoria - D > N
Low AC/A ratio
High tonic esophoria

Question 23

List two diagnostic patterns of basic esophoria.

Answer 23

Esophoria N = D
Normal AC/A ratio

Question 24

List three diagnostic patterns of vergence insufficiency.

Answer 24

Normal AC/A ratio
Restricted fusional vergence amplitude
Steep fixation disparity curve

Question 25

List two diagnostic patterns of vertical phorias.

Answer 25

Comitant deviations
Noncomitant deviations

Question 26

What nerve palsy can result in vertical phorias?

Answer 26

4th nerve