BVP - Paediatric Accommodation Vergence Problems - Week 10 Flashcards
List and define the three key facets of vision.
Visual integrity -eye health and visual acuity Visual efficiency -clear and comfortable vision Visual information processing -understanding and analysing what we see
What percentage of school-aged children suffer from an undetected visual problem?
25%
By what age should every child have an eye exam?
By age 3
What VA is required for distance and near to meet classroom visual demands?
D - 6/12
N - 6/30
What accommodative range and facility is required for distance and near to meet classroom visual demands?
Range - ~8D
Facility - 11 cycles/min
What vergence reserve and facility is required for distance and near to meet classroom visual demands?
Reserve - 17^break
Facility - 14 cycles/min
What is the recommended duration of near work before having a break?
~30 mins then a break
Does vision for the purposes of classroom demands have more to do with visual acuity or visual efficiency?
More to do with visual efficiency and less to do with VA
What are hyperopes of school age more likely to manifest (accommodatively) compared to emmetropes/myopes?
Accommodative lag
Treating hyperopes before what age results in better perceptual skills compared to those treated after that age?
Treatment before age 4 results in superior outcomes
What is fatigue/stress/prolonged near work a risk factor for in children (4)?
Accommodative insufficiency/excess
Convergence insufficiency/excess
What accommodative-vergence dysfunctions is there a genetic predisposition for (4)?
Convergence insufficiency/excess
Divergence excess
Divergence insufficiency
What is uncorrected refractive error a risk factor for (3)?
Convergence excess
Basic esophoria
Accommodative insufficiency
What is down syndrome, cerebral palsy, and fragile x syndrome a risk factor for (2)?
Accommodative insufficiency
Convergence excess
What is diabetes, myasthenia gravis and antidepressant medications a risk factor for (2)?
Accommodative insufficiency/excess
What is trauma/graves disease/parkinsons disease a risk factor for (2)?
Accommodative spasm
Convergence insufficiency
List 8 components for the minimum battery of tests.
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
What are 5 management considerations with accommodative/vergence problems in children?
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
What can uncorrected hyperopia in children lead to (vergence problem)?
Convergence excess
List six ways to treat convergence excess and explain each.
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
How can plus at near help with convergence excess?
It will support a fatigued or overloaded system by reducing accommodative demand, reducing esophoria at near.
When should vision therapy for convergence excess be considered?
If other means do not resolve symptoms
When is prism for convergence excess typically used?
When other options are not effective or practical and can’t achieve an acceptable result with plus and/or VT
When is referral considered for convergence excess (2)?
For medical opinion if onset is sudden, or if recent illness or trauma suspected
