BVP - Management and Clinical Care of Binocular Vision Disorders and Accommodation-Vergence Problems - Week 6

Question 1

What are some pieces of advice to give to patients given our changing visual demands (5)?

Answer 1

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

Question 2

List the overall sequential management plan for accommodative-vergence disorders (5).

Answer 2

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

Question 3

What is the principle behind the near stress model? If managing co-existing accommodative + vergence disorders, which should be treated first?

Answer 3

Most accommodation-vergence dysfunctions follow an aetiological path that is associated with near visual stress
Treat theaccommodative condition first

Question 4

What is uncorrected hyperopia a risk factor for?

Answer 4

The development of accommodative vergence problems

Question 5

Do all accommodative dysfunctions respond favourably to plus lenses? What system condition do plus lenses support (2)?

Answer 5

All accommodative dysfunctions should respond favourably to plus lenses
Plus lenses will support a system that is fatigued or overloaded

Question 6

What are minus additions typically used for? How does it work?

Answer 6

A treatment option for divergence excess or basic exophoria based on stimulating accommodation to drive convergence

Question 7

What are yoked prism additions typically used for? What conditions can it be useful for (2)?

Answer 7

Last resort option or as an adjunct to other treatments. Useful when postural defects in the distance such as divergence insufficiency and basic esophoria

Question 8

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?

Answer 8

Last resort option-takes image to eyes instead of eyes to image. More useful in acquired conditions in adult population, typically not children

Question 9

What is the most common lens treatment?

Answer 9

Near plus addition

Question 10

What three clinical findings can be used as a guide to determine the amount of plus? What is the typical range?

Answer 10

Accommodative lag
Magnitude of esophoria
AC/A ratio
+0.75 to +1.50

Question 11

What is the maximum power of minus addition lens to be prescribed for basic exophoria or exodeviation?

Answer 11

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

Question 12

What is the general guide for the use of yoked prism in exo and eso deviations?

Answer 12

No more than 2 ^ base up for exo deviations

No more than 2^ base down for eso deviations

Question 13

How do BU and BD affect the image position and distance?

Answer 13

Base up shifts image down and closer

Base down lifts image up and further away

Question 14

What is the general rule for the use of compensatory prisms?

Answer 14

To prescribe the minimal amount for desired shift or change in vergence that eliminates diplopia

Question 15

What principle can be applied when considering compensatory lenses?

Answer 15

Fixation disparity

Question 16

What is the goal of vision therapy?

Answer 16

To re-establish automated, effortless accommodative and vergence responses under any stimulus condition

Question 17

What is the first stage of vision therapy?

Answer 17

Monocular stage - work on each eye’s accommodation skills separately

Question 18

What is the second stage of vision therapy?

Answer 18

Biocular stage - introduce simultaneous viewing, diplopia awareness, anti supression

Question 19

What is the third stage of vision therapy?

Answer 19

Binocular stage - work on accommodation binocularly and introduce vergence demand
Introduce activities that work on both accommodation and vergence systems

Question 20

What is the fourth stage of vision therapy?

Answer 20

Proficiency stage - load the visual system to ensure skills are accomplished at a minimum attention capacity

Question 21

What is one of the most commonly presenting visual efficiency disorders?

Answer 21

Convergence insufficiency

Question 22

What is one of the most common causes of near visual asthenopic symptoms?

Answer 22

Convergence insufficiency

Question 23

Do compensatory BI prism glasses alleviate symptoms of convergence insufficiency?

Answer 23

No

Question 24

Are pencil pushups effective intreating convergence insufficiency?

Answer 24

No

Question 25

What is the gold standard for treating convergence insufficiency?

Answer 25

Office based vision therapy

Question 26

Define convergence excess.

Answer 26

A near deviation at least 3^ more esophoric relative to the distance

Question 27

What is the main therapy for accommodative insufficiency (2)?

Answer 27

Vision therapy then plus lenses

Question 28

What is the main therapy for ill-sustained accommodative (2)?

Answer 28

Vision therapy then plus lenses

Question 29

What is the main therapy for accommodative infacility (3)?

Answer 29

Plus lens then vision therapy

Correction of the underlying cause

Question 30

What is the main therapy for accommodative spasm?

Answer 30

Cycloplegic agents

Question 31

What is the main therapy for divergence excess (5)?

Answer 31

Passive vision therapy
Minus lenses
Prism
Active vision therapy
Surgery

Question 32

What is the main therapy for convergence insufficiency (2)?

Answer 32

Vision therapy

Prism

Question 33

What is the main therapy for basic esophoria (2)?

Answer 33

Vision therapy

Prism

Question 34

What is the main therapy for divergence insufficiency (2)?

Answer 34

Vision therapy

Prism

Question 35

What is the main therapy for convergence excess (3)?

Answer 35

Plus lenses
Vision therapy
Prism

Question 36

What is the main therapy for vertical phorias (2)?

Answer 36

Vision therapy

Prism

Question 37

What is the main therapy for fusional vergence dysfunction?

Answer 37

Vision therapy