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Binocular Dysfunction > Exam 1 Material > Flashcards

Exam 1 Material Flashcards

1
Q

What are the 3 requirements for binocular vision?

A
  1. Corrected refractive error
  2. Motor fusion
  3. Sensory fusion
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2
Q

What drop is used for a “damp” refraction?

A

Tropicamide

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3
Q

What drop is used for a “wet” refraction?

A

Cycloplegic drop

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4
Q

What is mohindra?

A

Near point retinoscopy used for infants
Monocular, in a dark room
Infant looks at light
1.25 D working distance

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5
Q

What kind of blur would a moderate hyperope experience?

A

Near point blur

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6
Q

What kind of blur would a moderate myope experience?

A

Distance blur

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7
Q

What is heterophoria?

A

Natural deviated resting position of dissociated eyes

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8
Q

What is fusional vergence demand?

A

Amount of motor fusion needed to compensate for phoria that is present

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9
Q

What type of convergence errors are esophoria and exophoria?

A

ESOphoria - OVER convergence when dissociated

EXOphoria - UNDER convergence when dissociated

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10
Q

What type of fusional vergence compensates for ESOphoria?

A

NFV

Negative Fusional Vergence

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11
Q

What type of fusional vergence compensates for EXOphoria?

A

PFV

Positive Fusional Vergence

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12
Q

What is the term for eyes that have normal alignment under dissociated conditions?

A

Orthophoria

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13
Q

What 3 symptoms does poor motor fusion create?

A
  1. Diplopia
  2. Fatigue
  3. Blur
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14
Q

In terms of accommodation, what helps with an eso deviation?

A

Relaxing accommodation

Plus lenses

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15
Q

In terms of accommodation, what helps with an EXO deviation?

A

Stimulating accommodation

Minus lenses

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16
Q

What allows for the foundation of stereopsis?

A

Two eyes with two different visual directions

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17
Q

What are the Big 6 of the binocular exam?

A
  1. Refractive Error
  2. Phoria
  3. Accommodation
  4. Vergence
  5. Oculomotor skills
  6. Fusion
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18
Q

What equipment can be used to screen and check if the patients tentative Rx is appropriate?

A

+/- 2.00D Flipper

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19
Q

What is the scale that gives a functional number for cover test, rather than just the magnitude of deviation?

A

Mayo Control Scale for XT

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20
Q

What is the expected AC/A ratio if near is relatively more EXO (>5 prism diopters) than distance?
Low or high?

A

Low AC/A

This is me

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21
Q

What is the expected AC/A ratio if near is relatively more ESO (>5 prism diopters) than distance?
Low or high?

A

High AC/A

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22
Q

What is the difference between comitant and non-comitant phoria?

A

Comitant: Constant phoria in all positions of gaze

Non-Comitant: Phoria changes with position of gaze

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23
Q

If a patient is more ESO at near while performing kinetic cover test, is their expected AC/A high or low?

A

High AC/A

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24
Q

Is the “Push-up” or “Pull-away” test better for patients that don’t understand the concept of blur?

A

“Pull-away” test

Instruct patient to say when line is clear

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25
Q

What is the MINIMUM expected accommodative amplitude of a patient as described by Hoffsteter’s formula?

A 
15 minus (0.25 x patient age)
Example: 20 year old
15 - (0.25x20) = 15-5 = 10D
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26
Q

At what distance should MEM retinoscopy be performed?

A

At reading distance for the patient

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27
Q

What does it mean to have accommodative lag?

A

Patient is using LESS accommodation than necessary

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28
Q

What does it mean to have accommodative lead?

A

Patient is using MORE accommodation than necessary

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29
Q

If a patient views the HORIZONTAL lines as darker in Binocular Cross Cylinder testing:
What is happening with accommodation?
What corrective lenses should be used?

A

Accommodative LAG

Plus lenses

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30
Q

If a patient views the VERTICAL lines as darker in Binocular Cross Cylinder testing:
What is happening with accommodation?
What corrective lenses should be used?

A

Accommodative LEAD

Minus lenses

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31
Q

Is accommodative LAG or accommodative LEAD the expected normal value?

A

Accommodative LAG

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32
Q

What should be used as a suppression check for accommodative facility testing?

A

Red/Green Bar Readers

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33
Q

How long should accommodative facility be tested?

A

One minute

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34
Q

What is an example of a “smooth” vergence range measurement?

A

Risley prism

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35
Q

What is an example of a “step” vergence range measurement?

A

Prism bar

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36
Q

What are 3 examples of oculomotor skills to test?

A
  1. Fixation
  2. Saccades
  3. Pursuits
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37
Q

What does Worth 4 dot testing measure?

A

Presence and/or size of scotoma

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38
Q

What is a requirement for a global stereopsis test?

A

Must be bifoveal

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39
Q

What is the absence of fusion?

A

Suppression

No depth perception

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40
Q

What is an example of a patient where prescribing the full Rx would negatively impact posture?

A

Uncorrected hyperope w/ significant exo posture

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41
Q

What are 2 important considerations for performing static retinoscopy on pediatric patients?

A
  1. Bracket

2. Be fast and precise

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42
Q

Mohindra is typically performed monocularly. What is an example of where it would be performed binocularly?

A

Infants

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43
Q

What is a common error of autorefractor readings?

A

Over-minusing of patients

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44
Q

When is an autorefractor useful for rechecking a prescription?

A

After cycloplegic drops

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45
Q

When is a handheld autorefractor useful?

A

Wheelchair bound patients

Young or small patients

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46
Q

Why is a cycloplegic refraction used?

A

To control accommodation

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47
Q

What are the 3 most common cycloplegic agents?

A
  1. Atropine
  2. Cyclopentolate
  3. Tropicamide
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48
Q

What is the most potent cycloplegic agent and how long does it last?

A

Atropine

1 week

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49
Q

How long do the effects of cyclopentolate last?

A

24 hours

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50
Q

For about how long do the effects of tropicamide last?

A

4-6 hours

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51
Q

How much residual accommodation is left when using tropicamide?

A

About 5 diopters

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52
Q

How much residual accommodation is left when using cyclopentolate?

A

0.75 diopters

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53
Q

What type of drug is cyclopentolate and what is its action?

A

Anticholinergic

Inhibits iris sphincter and ciliary muscle

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54
Q

What is pseudomyopia caused by?

A

Spasm of the ciliary muscle

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55
Q

What should dosage of cyclopentolate be for patients under 1 year old?
Over 1 year old?

A

Under 1 - 0.5% cyclopentolate

Over 1 - 1.0% cyclopentolate - 2 drops 5 mins apart

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56
Q

What are some adverse reactions to cyclopentolate to be aware of?

A

Blur, photophobia (expected)
Increased IOP if angle closes
Seizures, behavior change, cardiac problems

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57
Q

What are 5 types of patients to monitor closely if cyclopentolate is used?

A
  1. New patient
  2. Previous adverse reaction
  3. Frail cardiovascular system
  4. Compromised CNS (Down’s, TBI, etc…)
  5. Narrow anterior chamber angle
58
Q

What does a binocular refraction allow for greater control of?

A

Accommodation

Also, more accurate endpoint for cylinder axis

59
Q

What are 3 techniques of refraction that do not require blur balance as an additional step?

A
  1. Septums (infinity balance)
  2. Polarized slides (vectographic)
  3. Fogging (Humphriss)
60
Q

What is true of most hyperopic infants?

A

They will stay hyperopic, but the extent will lessen

61
Q

What is true of most myopic infants?

A

They will become hyperopic and then proceed into myopic during the school age years

62
Q

Are hyperopes or myopes at higher risk of developing amblyopia?

A

Hyperopes

63
Q

When should you prescribe lenses for hyperopes?

A

Greater than +2.00D at any age

64
Q

What should you prescribe lenses for myopes?

A

Greater than -3.00D for 1-3 year olds

Greater than -1.00D for all over 3 years old

65
Q

When should you prescribe lenses for astigmats?

A

Greater than -1.25D of cyl

66
Q

What is the goal of case analysis?

A

Evaluate all exam data to make a diagnosis

67
Q

What is very important for all BV patients?

A

Management of symptoms

68
Q

What are the 3 steps of the integrative analysis approach?

A
  1. Compare tests to tables of expected findings
  2. Group findings that deviate from expected results
  3. Identify the syndrome
69
Q

What specific norms are we using for this class?

A

Morgan’s norms

70
Q

What syndromes are associated with LOW AC/A?

A

Insufficiencies

convergence and divergence

71
Q

What syndromes are associated with HIGH AC/A?

A

Excess

convergence and divergence

72
Q

What is the near triad?

A

Convergence
Accommodation
Miosis

73
Q

What is the formula for calculated AC/A?

A 
PD + (NFD)(Hn-Hf)
NFD = Near Fixation Distance in meters
Hn = Near Phoria
Hf = Distance Phoria
All eso is plus
All exo is minus
74
Q

Where is gradient AC/A performed?

A

At near

75
Q

What is CA/C ratio?

A

Convergence Accommodation/ Convergence

76
Q

What are direct tests for PFV and NFV?

A

Smooth and step BO and BI ranges

77
Q

What will all direct tests of accommodation be?

A

Monocular

78
Q

Are convergence problems near or distance problems?

A

NEAR problems

79
Q

Are divergence problems near or distance problems?

A

DISTANCE problems

80
Q

What is the definition of fixation disparity?

A

Small angle of misalignment of the eyes under binocular conditions

81
Q

What is required to be occurring for fixation disparity to be present?

A

Fusion

82
Q

In order for fusion to be present, where must the amount of inaccuracy be within?

A

Panum’s Fusional Area

83
Q

Where in Panum’s Fusional Area are patients more likely to experience symptoms with fixation disparity?

A

Near the edges of Panum’s Fusional Area

Results from larger magnitude fixation disparity

84
Q

What type of fixation disparity is a patient with esophoria likely to have?

A

Eso fixation disparity

85
Q

What is a ‘slang’ term for fixation disparity as related to the visual system?

A

“ready position”

86
Q

What are 5 examples of methods/equipment that measure fixation disparity?

A
  1. Mallet Box
  2. Disparometer
  3. Borish Card
  4. Wesson Card
  5. Saladin Card
87
Q

What is a very precise method of measuring fixation disparity?

A

Disparometer

88
Q

What 3 things must all measuring methods of fixation disparity provide?

A
  1. Binocular fusion lock
  2. Two monocular nonius lines
  3. Natural conditions (not dissociated)
89
Q

What does the x-axis of a fixation disparity curve measure?

A

Prism amount in prism diopters

90
Q

What does the y-axis of a fixation disparity curve measure?

A

Magnitude of fixation disparity in arc minutes

91
Q

What is the x-intercept of a fixation disparity curve and what are its units?

A

Associated phoria

prism diopters

92
Q

What is the y-intercept of a fixation disparity curve and what are its units?

A

Magnitude of fixation disparity

arc minutes

93
Q

What is significant about the associated phoria?

A

The amount of prism diopters needed to reduce the fixation disparity to ZERO

94
Q

Where is the slope for a fixation disparity curve observed?

A

Between 3 BO and 3 BI

95
Q

What does a steeply sloped fixation disparity curve signal?

A

Poor ability to adapt to prism

96
Q

What does a fixation disparity curve with a flat slope signal?

A

Good ability to adapt to prism

97
Q

What type of curve do most patients show with a fixation disparity curve?

A

Type 1

98
Q

What does a type 2 curve look like and what does it signify?

A

Looks like an L
Poor adaptation to BI prism
Esophoria usually present

99
Q

What does a type 3 curve look like and what does it signify?

A

Looks like a 7
Poor adaptation to BO prism
Exophoria usually present

100
Q

What does a type 4 curve look like and what does it signify?

A

Looks like a Z

Poor sensory or motor fusion

101
Q

What 2 things are a fixation disparity curve useful for?

A
  1. May help uncover a BV problem not found with other tests (symptomatic patient without signs)
  2. Monitoring vision therapy progress
102
Q

What are the 4 steps in the order of evaluation?

A
  1. Comprehensive Eye Exam
  2. Binocular Vision Follow Up
  3. Treatment Decision
  4. Follow Up/ Monitor
103
Q

What is the main goal for treatment of accommodative and non-strabismic disorders?

A

Overcoming symptoms

104
Q

What are the 2 main BV symptom surveys?

A
  1. Convergence Insufficiency Symptom Survey

2. COVD QOL Survey

105
Q

What is the purpose of a symptom survey?

A

Can be used to show measurable decreases in symptoms

106
Q

What is extremely important in the prevention of amblyopia or strabismus?

A

Early detection

107
Q

In order from least invasive to most invasive, what are the 6 parts of the sequential management approach for amblyopia?

A
  1. Optical correction of ametropia
  2. Added lenses
  3. Prism
  4. Occlusion
  5. Vision therapy
  6. Surgery
108
Q

Is there an age limit on treatment of amblyopia?

A

NO

Example - Stereo Sue

109
Q

When does rapid emmetropization occur?

A

Infancy

very noticeable between 3 and 9 months

110
Q

When is it always important to prescribe a myopic Rx?

A

When patient has significant refractive error

When patient is an exotrope (especially when intermittent)

111
Q

What should you be careful with when prescribing plus lenses?

A

Don’t want to make the patient exo

112
Q

What is an important consideration when prescribing astigmatic correction?

A

Astigmatism should be deemed stable before prescribing for it

113
Q

During what span of life are larger amounts of astigmatism common?

A

Less than 3 years old

114
Q

What types of astigmatism are more stable?

A

With the Rule

Oblique

115
Q

What amount of anisometropia presents a large risk for amblyopia?

A

Greater than 3 diopters at 1 year old

116
Q

Where should the bifocal line be measured for on a 3-5 year old patient?

A

Pupil center

117
Q

Where should the bifocal line be measured for on a 6-7 year old patient?

A

Lower pupil

118
Q

For any patient older than 8 years of age, where should the bifocal line be measured?

A

Lower lid margin

119
Q

What amount of prism should you prescribe for any given patient?

A

The least amount needed to come to the desired result.

120
Q

How does Sheard suggest the Compensational Fusional Vergence should relate to the phoria of a patient?

A

CFV should be twice the phoria

121
Q

What is the formula for Sheard’s Criterion?

A

Prism needed = (2/3 phoria) - (1/3 CFV)

122
Q

How should prescribed prism be split between eyes?

A

Half and half

Example 4 BI total would be 2 BI OD and 2 BI OS

123
Q

For what type of phoria is the 1:1 rule mostly used for?

A

ESOphoria

124
Q

What does the 1:1 Rule state?

A

Recovery is greater than or equal to the phoria

or the patient may have symptoms

125
Q

What amount of vertical prism is clinically significant?

A

0.50 prism diopters

126
Q

Should prescribed prism allow for fusion all the time?

A

Should allow for fusion MOST of the time

Remember, Rx the least amount possible for relief of symptoms

127
Q

How long should patching occur in cases of moderate amblyopia?

A

2 hours a day

128
Q

How long should patching occur in cases of severe amblyopia?

A

6 hours a day

129
Q

What is the long term goal of vision therapy?

A 
To develop normal:
Sensory fusion
Motor fusion
Accommodative skills
Oculomotor control
130
Q

What amount of horizontal deviation may warrant surgical intervention?

A

Greater than 30 prism diopters

131
Q

What is the Relative Point Value with respect to add determination?

A

The difference in dioptric power from the patient’s BVA (therefore BVA=0)

132
Q

What is the formula for balancing the NRA and PRA to determine the add for a patient?

A

(NRA+PRA)/2 + RPV

133
Q

Should NRA be a positive or negative value?

A

Positive

134
Q

Should PRA be a positive or negative value?

A

Negative

135
Q

How does a high AC/A impact PRA?

A

High AC/A lowers the potential PRA with all else the same

136
Q

When training BI values, what vergence direction is being trained?

A

Divergence

137
Q

When training BO values, what vergence direction is being trained?

A

Convergence

138
Q

What kind of lenses make divergence more difficult?

A

Minus lenses

139
Q

What kind of lenses make convergence more difficult?

A

Plus lenses

140
Q

What is the normal AC/A ratio based on Morgan’s Norms?

A

4/1

Binocular Dysfunction (2 decks)

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