Eval Of Ocular Eye Movements 2 Flashcards
1
Q
NSUCO oculomotor test
A
Assess pursuits and saccades, direct observation test
2
Q
Substitutions on DEM
A
Cross out number with a slash if an error in naming. If there was an immediate correction, it can be accepted as correct
3
Q
Transposition (t) in DEM
A
Place an arrow where a number has been read out of sequence
4
Q
Omissions on DEM (o)
A
Circle the number if it is omitted
5
Q
Additions (a) on DEM
A
Places a cross when the extra number has been added or a number has been repeated
6
Q
Interpretation of DEM
A
Use the DEM examiners manueal to compare the patients values with expected age matched norm data
7
Q
Type I DEM
A
Average performance in all subtlest values
8
Q
Type II DEM
A
High horizaontal time, normal vertical time
-oculomotor dysfunction
9
Q
Type III DEM
A
High horizontal and vertical times, normal ratio
-difficulty in automaticity of number naming
10
Q
Type IV DEM
A
Horizontal time, vertical time, and ratio all abnormal
- deficiency in oculomotor skills and in automaticity
- combo of type II and III
11
Q
DEM ratio
A
Horizontal adjusted time/vertical adjusted time
12
Q
Adjusted horizontal time for DEM
A
Horizontal (C) x (80/(80-omissions +additions)
13
Q
Total vertical time in DEM
A
Add subset a and B
14
Q
if the diagnosis is
Average vertical time (47%)
High horizontal time (19%)
Abnormal ratio (9%)
DEM
A
Type II: high horizontal time, normal vertical time
-oculomotor function
15
Q
Purpose of king-devick test
A
Visual-verbal ocular motor assessment tool
- relies on rapid number naming
- assess saccadic eye movements
- assess neuro function
Can also be used for conclusion detection
16
Q
Set up king-devick test
A
Lenses: habitual at near
Normal illumination
Test distance: Harmon distance
17
Q
Procedure overview of king-devick test
A
- patient calls off a series of numbers as quickly as possible, NO finger or pointers
- compare response times and number of errors to table of expected values
18
Q
Demonstration card for king-devick test
A
- Note on the score sheet if the patient reports difficulty in reading at their age level
- call out the numbers on the card as quickly and carefully as possible
- point tot he upper left then the second left hand number, and the third number, etc
- instruct the patient to not use their finger to track the numbers
19
Q
Test card I in king devick test
A
- place card I in front of patient
- use a stopwatch to I’d time it takes to complete the card
- call out all the number so not he card as quickly as possible
- record the number of errors and record the time it took
20
Q
King devick test card II and III
A
- same procedure as test card I
- test card I: if greater than 50s, stop at test card I
- test card II: if total time of test card I and II is greater than 100s, stop at test card II
- of patient is less than or equal to 10yo and unable to complete test card III, take the sum of test cards I and II time and errors
21
Q
Errors in king-devick
A
Do not count the error if the patient quickly corrects the error
22
Q
Interpretation of king-devick test
A
Use the score sheet scoring guide to compare the patients values with expected age-matched normative data
23
Q
Purpose of groffman tracings
A
- Ocular motor assessment tool, assess pursuit eye movements
- detects reading disability
- requires little cognitive ability
24
Q
Set up for groffman
A
- habitual near correction
- normal room illumination
- test distance: Harmon distance
25
Procedure for groffman tracings
- hand the demo card to patient
- this is a test to see how quickly accurately you can follow a line using only your eyes. Look at the line that starts with the letter A. Follow it with your eyes.when it reaches another line (point to the first intersection), follow it straight ahead and do not turn off onto a line that crosses the line you are traveling on.
- now follow the lines starting at A with your eyes and tell me at what number it ends at the bottom of the page
- after the pt completes A, repeat for D and say, we are going to trace 5 more lines, your score will depend on accuracy and speed so work quickly, nut try not to make a mistake
- pt cannot use finger to trace line
26
Scoring for Groffman
- each letter is scored individually
- if the pt reached the incorrect number- "0" point for that letter
- if he or she reached the correct number but persisted in using his/her finger to trace the path- "0" points for that letter
- if he/she reached the correct number visually- points give according to the scale, based on time elapsed in seconds
- the individual scores for each letter are added and the total is compared to age matched normative data
27
Diagnosis for groffman
Use patients score comparison to age matched Norms to determine performance level
Also use observations during testing for diagnosis
Satisfactory rating with excessive head movement, body squirming and facial grimaces- oculomotor-motor coordination problem
28
NSUCO oculomotor test
- using red and white beads at 40cm
- saccades: look at red when i say red, look at white when i say white
- pursuits: watch the ball as it goes around. Don't ever take your eyes off the ball
29
What to observe in the NSUCO oculomotor test
Eye movement
Head movement
Body movement
30
Scoring the patient in NSUCO test
Ability
Accuracy
Head movement
Body movement
31
Saccades scoring in NSUCO oculomotor test: ability
1. No attempt made
2. Completes 2 round trips
3. Completes 3 round trips
4. Completes 4 round trips
5. Completes 5 round trips
32
Pursuits scoring in NSUCO oculomotor test: ability
1. No attempt is made to perform the task to 1/2 rotation
2. Completes 1/2 rotations but not one ful rotation
3. Completes 1 rotation but not 2
4. Completes 2 rotations in one direction but not 2 in the other
5. Completes 2 rotations in both directions
33
Saccades scoring in NSUCO oculomotor test: accuracy
1. Gross overshooting or undershooting is noted
2. Large to moderate overshooting or undershooting noted
3. Constant slight overshooting or undershooting noted
4. Intermittent slight overshooting or undershooting noted
5. No overshooting or undershooting noted
34
Pursuits scoring in NSUCO oculomotor test: accuracy
1. No attempt to follow the target to 10 refixations
2. Refiations 4-10x
3. Refixations 2-4x
4. Refixations 2 or less times
5. No refixations
35
Scoring head and body movements on NSUCO
1. Gross movement of head/body
2. Large to moderate movement of the head/body
3. Consistent slight movement of the head/body
4. Intermittent slight movement of the head/body
5. No movement of the head/body
36
Purpose of DEM test
Visual-verbal ocular motor assessment tool
-accounts for difficulties in naming numbers
To check on vision therapy progresses
37
Setup for DEM
- habitual near
- normal illumination
- Harmon distance
38
Procedure overview of DEM
-patient calls off a series of numbers as quickly as possible, no
39
Procedure overview for DEM
- patient called off a series of numbers as quickly as possible, no finger or pointers
- compare response times and numbers of errors to table of expected values
40
Pre=test for DEM
- to ensure child knows their numbers
- practice saying these numbers as fast as you can
- child must complete within 12 seconds
- do not administer DEM is child fails pre test
41
DEM subtext A and B
- tests vertical saccades
- testing 40 single digit numbers
- read as quickly and accurately as possible
- record time
42
Subtest C on DEM
- tests horizontal saccades
- 80 single digit numbers
- record time
43
Most common sign of a neuromuscular problem
Deviation of the visual axis (tropica or phoria)
44
Proper alignment needs good
Sensory and motor fusion
45
Abnormalities with sensory fusion can lead to
A disruption in motor fusion, then a deviation of the visual axes producing a tropia or phoria
46
A latent tendency for the eyes too deviate when fusion is broken
Phoiria
47
Needed for binocular fusion, to prevent diplopia and suppression
Fusion
48
What test picks up phoria
Alternating
49
Fusion can be disrupted/due to
Alternating cover test
Fatigue
Illness
Stress
50
Decompensating phoria
Had it before, coming out now
51
A manifest deviation of the eyes seen on unilateral cover test
Tropia (strabismus)
52
This results in amblyopia, diplopia and/or suppression
Tropia
53
Recording phoria or tropia
```
Without or with glasses
Distance or near
Amount of deviation
Type of phoria or tropia
Constant or intermittent (with freq)
Unilateral or alternating
```
54
Patient fixates with the other eye
Unilateral tropia
55
Fusion inadequate to keep aligned
Constant tropia
56
Fusion functions at some times, but not all times
Intermittent tropia
57
Patients having tropia and phoria
Remember that a patient could have a tropia at a certain distance and/or gaze, but a phoria at another distance and/or gaze
58
Deviation in one eye, in one gaze a only
Noncomittant
59
Cover test norm
Dist: 1XP (+/-2pd)
Near: 3XP (+/-3pd)
60
Neutralizing exo
BI
61
Neutralizing eso
BO
62
Neutralizing hypo
BU
63
Neutralizing hyper
BD
64
Neutralizing ortho
Verify by using BI and then BO
65
If both eyes have BU or BD and the value isn't split, the prism will produce
A version (conjugate eye movement)
Both eyes will move down and the problem didn't get treated
66
How do you treat someone with prism vertical
By splitting the vertical prism, the deviation is treated with the resultant and net binocular effect (the absolute sum of the prism)
8pd hyper
Rx 4BU OD with 4BD OS= 8BU OD, or 8BD OS
2BU OD with 3BD OS=5BU OD or 5BD OS
67
How do you split horizaonrtal prism
You have to keep the same base OU
8BO will be 4BO OD and 4BO OS
By doing this, the resultant amount of 8BO causes a vergence eye movement to move each eye out
68
What is BI and BO are RXed together
This will only reacte a version eye movement and not correct the deviation because they are yoked prisms and the effect will be canceled out in a version movement
69
This is an abnormal head posture (head tilt, turn, chin up or down)
Can have one or more of these together
Torticollis
70
Can be present in a variety of eye movement disorders. Requires early detection and correction of the cause
Torticollis
71
Prolonged torticollis
Prolonged could lead to permanent facial asymmetry and contracture of the neck muscles
72
A compensatory response to an ocular problem by a head tilt
Ocular torticollis
| -attempts to maintain binocularity and VA, or use of limited VF
73
Case history of torticollis
When did it start
| Need to eval to determine if an ocular problem is the cause
74
What tests would you perform and why for torticollis?
```
CT
EOM
Forced duction
Parks 3
Dolls head
Saccades
Pursuits
VA
Dilate, look at retina
Pupils
```
75
What do we want to rule out in torticollis
Nystagmus
| -the head tilt is being held at the null point where the nystagmus is 0
76
Abnormalities that can cause torticollis
- nystagmus (at null point for dampening) for better VA
- paretic strabismus
- refractive strabismus
- Supra nuclear disorders (gaze palsied, dorsal midbrain syndrome)
- AV pattern strabismus
- monocular blindness
- ptosis
- refractive error
- VF defect
77
Deviations are either ___ or ____
Comitant or noncomitant
78
Deviation size remains same (or within 5PD in all positions of gaze, implying no muscles are underacting or overacting
Comitant
79
Deviation size is different in different positions of gaze. Due to an over action or under action of one or multiple muscles
Non-comitant
80
How to you determine comitancy
CT is done in all positions of gaze. Non-comitant can be due to innervation problems (paralytic) or mechanical restrictions
81
Non comitancy can be caused by
Innervation problems or mechanical restriction
82
Comitancy and ____ play a role in neuromuscular abnormalities
Vergences
83
Anomalies of vergences
```
Convergence insufficiency (exo at near)
Convergence excess (eso at near)
Divergence insufficiency (eso at dist)
Divergence excess (exo at distance)
```
84
Accommodative eso tropia
Caused by overaccommodating
85
Vergences insufficiencies can affect
Tropias AND phorias
86
Sites OD lesions in neuromuscular problems
Supra nuclear
Nuclear
Infranuclear
Myotonic (at muscle)
87
Pathologies that can cause strabismus
Anomalies of the face or orbit due to hydrocephalus, craniostynosis, and other Crain official conditions
88
Time of onset of neuromuscular abnormalities
- congenital (birth to 6 months)
- acquired (after 6months of age)
- acute (trauma, tumor)
- longstanding
- consecutive (surgical overcorrection from fixing the first tropia)
89
HS for congenital neuromuscular deviations
Uncertain of onset, only intermittent diplopia and may be a symptomatic
90
He of acquired neuromuscular deviations
Diplopia; exact time of onset is known, symptomatic
91
Head posture of someone with a congenital neuromuscular deviations
Patient/family unaware of posture; some facial asymmetry may be possible; deviation may now be comitancy
92
Acquired neuromuscular deviations for head posture
Aware of head posture, needs to adopt intermittently because of symptoms, obvious
93
Comitancy of someone with a congenital neuromuscular deviations
May appears comitancy because of developed muscle sequalea, primary and secondary angle appear similar
94
Acquired neuromuscular deviations fusional amplitudes
Patient have large vertical fusional amplitude (>10PD)
95
Acquired neuromuscular deviations and suppression
Occurs in young children in the critical period, rare in adults
96
Congenital suppression in neuromuscular deviation
Often present
97
Congenital neuromuscular deviations and torsion
Rarely seen
98
Acquired neuromuscular deviations and torsion
Seen
99
Action of muscle or group of muscles completely eliminated ( no movement seen)
Paralysis
100
Action of muscle or muscles is impaired (some movement seen)
Paresis
101
General term for paralysis or paresis (since could be difficult to differentiate)
Palsy
102
What kind of deviations do palsied cause
Non-comitant deviations because of over action of under action of the involved muscles
103
When looking at a palsy, and there is a difficulty moving the eye in a certain direction, what should be considered
Mechanical restriction
104
Deviation in neurogenic
Marked deviation in primary
105
Mechanical deviation
Little deviation seen in primary
106
Diplopia in neurogenic
Diplopia same in different gazes
107
Diplopia in mechanical
Diplopia may reverse
108
Head posture in neurogenic
Head tilt seen with vertical palsies
109
Head posture in mechanical
Head tilt is rare, chin down or up may be seen for vertical deviations
110
Ocular movement in neurogenic
Movement on unctions>versions
111
Ocular movement in mechanical
Duction and version movements are equally limited
112
Fusion disrupted by sensory impairment
Trauma, disease
113
What could mechanical restrictions be caused by
Agenisis or abnormal insertion of the EOMs; abnormal adhesions at tissue or fibrosis of the muscles; tumor metasasis; sarcoidosis etc
114
What could an uncorrecrted hyperope get
Eso phoria
115
Hess Lancaster in neurogenic
Field of affected eye is smaller; but both fields are displaced according to the deviation
116
Less hancaster in mechanical
The fields are irregular and close to each other
117
Retraction of globe in neurogenic
None
118
Retraction of globe in mechanical
Retracts when turned in direction opposite the restriction
119
Pain on movement in neurogenic
None
120
Pain on movement in mechanical
Could be present
121
Forced duction in neurogenic
Able to move
122
Forced duction in mechanical
Limited movement
123
Tropia seen is fusion is
Not enough to overcome these abnormalities
124
Neurological abnormalities that can affect oculomotility
- brain stem abnormalities
- innervation anomalies resulting in paresis or paralysis
- neurological deficits such as birth injuries, cerebral palsy, development/special needs, retinopathy or prematurity
- vestibular abnormalities
- problems along visual pathway
- assault during gestation (smoking)
125
A patient may have a small pohioria but no symptoms why
Because the sensorimotor system is able to cope with the deviation
126
Why are vertical deviations likely to cause symptoms
Vertical fusional amplitudes are naturally limited
127
Poor fusion can be associated with
```
Fatigue
Asthenopia
HA (frontal)
Avoidance
Diplopia
Suppression
```
