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Block 5 > Clincal: Accomodation Testing W Phoropter > Flashcards

Clincal: Accomodation Testing W Phoropter Flashcards

1
Q

Blurry images at near stimulates _____.

A

Accomodation

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2
Q

what is the near triad

A

Accommodation
Convergence
Constriction

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3
Q

Amplitude of accommodation is the

A

Total possible increase in power due to accommodation

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4
Q

The maximum amplitude is greatest in ____ and gradually decreases with ___.

A

Childhood, age

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5
Q

Most common accommodation issue

A

Presbyopia

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6
Q

What is presbyopia?

A

Gradual loss of accommodation

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7
Q

Average age of presbyopia onset

A

Early 40s

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8
Q

What changes happen to the lens hat cause presbyopia?

A

Lens becomes thicker, less elastic, more brittle with age

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9
Q

Symptoms of presbyopia:

A

-blurry near vision
-eye strain
-eye fatigue
-headaches
-hold stuff really far away to read it

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10
Q

How can we treat presbyopia?

A

Need separate optical correction for tasks
-ADD plus power
- bifocals, trifocals, progressive lens, readers
-contact lenses - multifocal, monovision

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11
Q

Non optical treatments fro presbyopia

A

Prescription eye drops (ex. Vuity, Qlosi)

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12
Q

What is an accommodative stimulus?

A

A stimulant that causes divergent rays to come into the eyes instead of parallel (focuses behind retina *)

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13
Q

Accommodation can be stimulated by either:

A

-a target closer than optical infinity
-minus lens

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14
Q

Near objects produce ____ rays

A

Divergence

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15
Q

How can we calculate how much a target causes a person to accommodate

A

1/ (distance of target in meters =0.0254 meters Diopters

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16
Q

Method using a near target to test accommodation

A

Push up and pull away method

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17
Q

Push up and pull away is monocular or binocular?

A

Monocular

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18
Q

Describe push up method

A

Pt focuses on a letter and is instructed to keep in clear. Slowly move the letters closer to the pt until the pt repots blue

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19
Q

Describe pull away method

A

Pull the fixation stick away form the patient until they report that the letter is clear

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20
Q

What do you do after measuring the points that the pt reports for push up or pull away method

A

Measure the distance and plug it into formula

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21
Q

Minus lenses: stimulus to accommodation = exact ____ ___ of the lens used

A

Dioptric power

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22
Q

Near target and minus lenses: combined method

A

You have a letter at a certain distance and use a minus lens

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23
Q

A single letter is placed at 50cm and the pt is looking at it through a -1.00 D lens. What is the total stimulus to accommodation

A

100/50cm =2 cm 2.00D(near target)
-1.00 D = 1.00D(minus lenses)
Total demand = 3.00D

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24
Q

Sheard’s minus lens to blur test

A

Meaures amplitude of accommodation using minus lenses and a near target

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25
Q

Sheard’s minus lens to blur test: monocular or binocular?

A

Monocular

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26
Q

Sheard’s minus lens to blur test: pt looks through ____ correction in the phoropter

A

Distance

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27
Q

Sheard’s minus lens to blur test: make sure you change the wings of the phoropter to ___

A

Near

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28
Q

Sheard’s minus lens to blur test: target

A

Vertical line of letters or block of letters, 20/30 in size at 40cm

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29
Q

Sheard’s minus lens to blur test: explanation of test to pt

A

I am going to make some changes. Try to keep the letters on the chart clear but let me know when they start to get blurry

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30
Q

Sheard’s minus lens to blur test: procedure

A
  1. Occlude eye
  2. Add minus, -0.25D at a time, until first sustained blur
    3.Ask patient to try to make it clear, if they can, continue to add -0.25D
  3. Pt can’t accommodate more
  4. Record the amount of minus sphere(absolute value) PLUS 2.50D* b/c its at 40cm
  5. Do other eye
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31
Q

What are two ways that give the expected monocular amplitude of accommodation for a person’s age?

A

-Donder’s table
-Hofsetter’s formula

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32
Q

Hofstetter’s formulas: max, average, min

A

Max: 25-.4(age)
Average: 18.5 - 0.3(age)
Min: 15-0.25( AGE)

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33
Q

Inaccuracy of accommodation can happen because

A

People do not always accommodate the exact amount expected based on don the stimulus

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34
Q

Lead of accommodation

A

The pt’s accommodative response is greater thane the accommodative demand

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35
Q

Lag of accommodation

A

The patient’s accommodation response is weaker than the accommodative demand

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36
Q

Three tests to test accommodative function:

A
  1. Fused cross-cylinder test(aka binocular cross-cylinder)
  2. Negative relative accommodation and positive relative accommodation
  3. And more ( learn later) whoops
37
Q

Accommodation testing is done after

A

The distance subjective refraction

38
Q

Accommodative testing proves date to calculate an

A

Alternative prescription for improved vision at near

39
Q

Uses for accommodative testing

A

-Presbyopia
-Latent hyperopes
-Other accommodative problems

40
Q

Near testing with the phoropter set up

A

-near point rod with the near card at 40cm
-set to near PD
-stand lamp if needed

41
Q

Fused cross cylinder (FCC) measures

A

A pt’s accommodative response while viewing a near target binocularly
*accuracy of accommodation

42
Q

Uses for FCC

A
  • determine a tentative add power
  • determine if patient is lead or lag
43
Q

FCC lighting

44
Q

FCC auxiliary knobs are set to

A

+/- 0.50 DC OU

45
Q

FCC target

A

Cross grid target on near card at 40cm

46
Q

The cross- cylinder on the auxiliary knobs splits the ____ and ____ line images on the cross grid

A

Horizontal and vertical

47
Q

FCC: if the parties accommodative response is accurate the horizontal and vertical liens will appear ___

A

Equally blurred

48
Q

FCC: if the patient reports the horizontal lines are sharper, they are

A

Under accommodating
Lag in accommodation

49
Q

FFC: patient reports the vertical lines are sharper, they are

A

Over-accommodating
Lead of accommodation

50
Q

FCC: instructions to pt

A

Which liens are shaper or more distinct? Those are going up and down or side to side

51
Q

FCC: If patient reports horizontal lines are clearer at start, you add

A

+0.25D binocularly and ask again

52
Q

FCC: You keep adding plus until the pt says what?

A

Reversal of their responses (not on equal!)

53
Q

FCC: if the patient starts the test with saying the vertical looks clearer, your first step is to

A

Dim the lights further

54
Q

FCC: if pt keeps saying vertical liens looks clearer, you’ll add

A

-0.25 D until they say horizontal or at -1.00D

55
Q

FCC: recording example

A

FCC: -0.50D lead of accommodation

56
Q

FCC: For presbyopia patients over the age of 50; add at least _____ to the phoropter before beginning in the test

57
Q

FCC excepted findings for young patients

A

+0.25D to +0.75D

58
Q

Negative relative accommodation and positive relative accommodation (NRA/PRA) test a pts ability to

A

Increase and decrease accommodation under binocular conditions and a fixed state of convergence

59
Q

NRA/PRA is monocular or binocular

60
Q

NRA/PRA uses:

A
  • refine a tentative ADD power
  • analyze a patient’s accommodative function
61
Q

NRA is always performed ____

A

First (before PRA)

62
Q

NRA uses ___ lenses to blur binoncularly

A

Plus
-relaxing accommodation

63
Q

PRA uses ___ lenses to blur binocularly

64
Q

NRA/PRA room illumination

A

Bight, stand lamp on na pointed at near car

65
Q

NRA/PRA: near card at __ with ___ letters

A

40 cm, 20/30 letters

66
Q

NRA/PRA: pre- presbyopia patients use ____ subjective refraction

67
Q

NRA/PRA: presbyopic patients use tentative ___ prescription from FCC

68
Q

NRA procedure

A
  1. Direct patient to look at 20/30 line on the near card and confirm that the letters are clear
  2. Add +0.25D at a time binocularly asking each time if the letters still appear clear or blurry
  3. Continue until the first sustained blur
  4. Note total amount of plus power added
69
Q

PRA procedure

A

After NRA:
1. Return to the initial power in the phoropter and confirm letters are clear again
2. Add -0.25D at a time bionocularly, following the same steps, until first sustained blur
3. Note total amount of minus added

70
Q

NRA/PRA recording

A

Record NRA first, then PRA
Record the net amount of plus

71
Q

NRA/PRA: Non-presbyopia expected findings

A

NRA: +2.00 (+/-0.50)
PRA: -2.37 (+/-1.00)

72
Q

NRA/PRA: presbyopes expected findings

A

Varies
NRA: the sum tentative add and NRA result should not exceed +2.50
NRA and PRA should be balanced (same absolute value)

73
Q

If the NRA is greater than PRA, it indicates the patients may need

74
Q

If the NRA is greater than PRA+2.50, the patients has ___ hyperopia or they are ______

A

Latent, over minuses

75
Q

If the PRA is less than -1.37D, the patient may have reduced _____ _ _____

A

Amplitude of accommodation

76
Q

If the PRA is greater than -3.37D, the patient is able to

A

Accommodate more than 3d and the true endpoint may be very high

77
Q

You choose a tentative add based on what three factors?

A

-age
-FCC result
- amplitude based

78
Q

Amplitude based for tentative add is based on the results of

A

Amplitude testing (push up, pull away, or minus lens to blur test

79
Q

Amplitude based uses the concept that patients should use ___ ____ ___ of their accommodative amplitude to view near targets

A

More than half of

80
Q

(NRA + PRA)/2+ ADD owner used =

81
Q

What is the estimated add for ages 40-42?

82
Q

What is the estimated add for ages 43-45?

83
Q

What is the estimated add for ages 46-47?

84
Q

What is the estimated add for ages 48-50?

85
Q

What is the estimated add for ages 51-52?

86
Q

What is the estimated add for ages 53-55?

87
Q

What is the estimated add for ages 56-57?

88
Q

What is the estimated add for ages 58-60?

Block 5 (46 decks)

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