BVP - Paediatric Accommodation Vergence Problems - Week 10

Question 1

List and define the three key facets of vision.

Answer 1

Visual integrity
-eye health and visual acuity
Visual efficiency
-clear and comfortable vision
Visual information processing
-understanding and analysing what we see

Question 2

What percentage of school-aged children suffer from an undetected visual problem?

Answer 2

25%

Question 3

By what age should every child have an eye exam?

Answer 3

By age 3

Question 4

What VA is required for distance and near to meet classroom visual demands?

Answer 4

D - 6/12

N - 6/30

Question 5

What accommodative range and facility is required for distance and near to meet classroom visual demands?

Answer 5

Range - ~8D

Facility - 11 cycles/min

Question 6

What vergence reserve and facility is required for distance and near to meet classroom visual demands?

Answer 6

Reserve - 17^break

Facility - 14 cycles/min

Question 7

What is the recommended duration of near work before having a break?

Answer 7

~30 mins then a break

Question 8

Does vision for the purposes of classroom demands have more to do with visual acuity or visual efficiency?

Answer 8

More to do with visual efficiency and less to do with VA

Question 9

What are hyperopes of school age more likely to manifest (accommodatively) compared to emmetropes/myopes?

Answer 9

Accommodative lag

Question 10

Treating hyperopes before what age results in better perceptual skills compared to those treated after that age?

Answer 10

Treatment before age 4 results in superior outcomes

Question 11

What is fatigue/stress/prolonged near work a risk factor for in children (4)?

Answer 11

Accommodative insufficiency/excess

Convergence insufficiency/excess

Question 12

What accommodative-vergence dysfunctions is there a genetic predisposition for (4)?

Answer 12

Convergence insufficiency/excess
Divergence excess
Divergence insufficiency

Question 13

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

Answer 13

Convergence excess
Basic esophoria
Accommodative insufficiency

Question 14

What is down syndrome, cerebral palsy, and fragile x syndrome a risk factor for (2)?

Answer 14

Accommodative insufficiency

Convergence excess

Question 15

What is diabetes, myasthenia gravis and antidepressant medications a risk factor for (2)?

Answer 15

Accommodative insufficiency/excess

Question 16

What is trauma/graves disease/parkinsons disease a risk factor for (2)?

Answer 16

Accommodative spasm

Convergence insufficiency

Question 17

List 8 components for the minimum battery of tests.

Answer 17

Cover test
NPC
Stereopsis
Phoria including AC/A
NPA/NPC
Accommodative facility
Vergence facility
MEM retinoscopy
Adjust to suite age and cognitive skills of the child

Question 18

What are 5 management considerations with accommodative/vergence problems in children?

Answer 18

Think about why the patient has the condition - risk factors
Think about management in terms of what goal you are trying to accomplish
Communicate the management plan - parental and patient action is essential
Relate the diagnosis back to how it is affecting the patient individually
Discuss the consequences of no treatment

Question 19

What can uncorrected hyperopia in children lead to (vergence problem)?

Answer 19

Convergence excess

Question 20

List six ways to treat convergence excess and explain each.

Answer 20

Correct refractive error
-if hyperopia, push plus to ensure no unnecessary accommodation
Educate and counsel
-counsel to find ways to reduce risk of near visual stress
Plus near addition
-to further support accommodation and reduce near esophoria
Vision therapy
-to develop more efficient voluntary control of accommodation
Prism
-to compensate for eso deviation at near, when other options are not effective or practical
Referral
-for medical opinion if sudden onset or trauma/illness

Question 21

How can plus at near help with convergence excess?

Answer 21

It will support a fatigued or overloaded system by reducing accommodative demand, reducing esophoria at near.

Question 22

When should vision therapy for convergence excess be considered?

Answer 22

If other means do not resolve symptoms

Question 23

When is prism for convergence excess typically used?

Answer 23

When other options are not effective or practical and can’t achieve an acceptable result with plus and/or VT

Question 24

When is referral considered for convergence excess (2)?

Answer 24

For medical opinion if onset is sudden, or if recent illness or trauma suspected

Question 25

What is the most commonly presently BV disorder in children?

Answer 25

Convergence insufficiency

Question 26

What is the most successful mode of delivery for vision therapy?

Answer 26

In-office

Question 27

List six ways to treat convergence insufficiency and explain each.

Answer 27

Correct refractive error
-should always be the first treatment optionaccommodation
Educate and counsel
-counsel to find ways to reduce risk of near visual stress
Plus near addition
-to further support accommodation
Vision therapy
-to develop more efficient voluntary control of accommodation
Prism
-to compensate for exo deviation at near, when other options are not effective or practical
Referral
-for medical opinion if sudden onset or trauma/illness