BVP - Management and Clinical Care of Binocular Vision Disorders and Accommodation-Vergence Problems - Week 6 Flashcards
What are some pieces of advice to give to patients given our changing visual demands (5)?
Limit amount of near tasks to 15-30 mins
Pace the amount of near work over time
Adopt a harmon working distance
Counsel on lighting
Encourage a balanced lifestyle
List the overall sequential management plan for accommodative-vergence disorders (5).
Manage slinically significant refractive error
Counsel patient if near workload is a modifiable risk factor
Manage accommodative problems where possible using lens additions
Consider vision therapy options where appropriate if the patient is a candidate and motivated
Comsider compensatory options such as prism or lens additions if other options are not suitable
What is the principle behind the near stress model? If managing co-existing accommodative + vergence disorders, which should be treated first?
Most accommodation-vergence dysfunctions follow an aetiological path that is associated with near visual stress
Treat theaccommodative condition first
What is uncorrected hyperopia a risk factor for?
The development of accommodative vergence problems
Do all accommodative dysfunctions respond favourably to plus lenses? What system condition do plus lenses support (2)?
All accommodative dysfunctions should respond favourably to plus lenses
Plus lenses will support a system that is fatigued or overloaded
What are minus additions typically used for? How does it work?
A treatment option for divergence excess or basic exophoria based on stimulating accommodation to drive convergence
What are yoked prism additions typically used for? What conditions can it be useful for (2)?
Last resort option or as an adjunct to other treatments. Useful when postural defects in the distance such as divergence insufficiency and basic esophoria
What are compensatory prism additions typically used for? What does it do to the image, in place of what? What population is it more useful in and what kind of conditions?
Last resort option-takes image to eyes instead of eyes to image. More useful in acquired conditions in adult population, typically not children
What is the most common lens treatment?
Near plus addition
What three clinical findings can be used as a guide to determine the amount of plus? What is the typical range?
Accommodative lag
Magnitude of esophoria
AC/A ratio
+0.75 to +1.50
What is the maximum power of minus addition lens to be prescribed for basic exophoria or exodeviation?
No more than -2.00 D addition recommended at distance and near in case of basic exo to stimulate accommodation and therefore accommodative convergence
No more than -2.00 addition in the distance for exo deviation to stimulate accommodation and therefore accommodative convergence and a near add at near to counter the distance addition
What is the general guide for the use of yoked prism in exo and eso deviations?
No more than 2 ^ base up for exo deviations
No more than 2^ base down for eso deviations
How do BU and BD affect the image position and distance?
Base up shifts image down and closer
Base down lifts image up and further away
What is the general rule for the use of compensatory prisms?
To prescribe the minimal amount for desired shift or change in vergence that eliminates diplopia
What principle can be applied when considering compensatory lenses?
Fixation disparity
