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Exam One Flashcards

1
Q

whats the therapy for functional oculomotor dysfunction

A

begin with fixation , move to saccades and then pursuits ; move from monocular to biocular to binocular ; orientation of body must be normal -> good gross motor and fine motor coordianation; good understanding of laterality ; eye tracking used to find and fixate target ( precursor to accommodation and binocularity)

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2
Q

this skill in VT is visual information processing ; ability to use visual cognitive skills for extracting and organizing visual information ; ability to take visual information and integrate it with information for other senses

A

perceptual function ( visual information processing)

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3
Q

what did the pediatric eye disease investigator group say for severe amblyopia

A

VA 20/100-20/400; patching for 6 hours a day with at least one hour of near activities

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4
Q

what do we work on in phase 2 of VT

A

biocular / antisuppresion accommodation activities biocular / antisuppresion eye tracking activiites anti suppression / basic fusion

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5
Q

which is considered harder pursuits

A

Rotator T’s , Rotator O’s ( dpeneding on size)

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6
Q

this bv disorder is reduced PFV and NFV; normal ACA; normal phoria at distance and near; reduced vergence facilities

A

fusional vergence dysfunction

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7
Q

some characteristics of this dysfunction include poor body coordination leading to poor eye coordination , developmental delays , clumsiness, abnormal developmental milestones, reversals, possible poor laterality

A

developmental oculomotor dysfunction-( these pts will fail the “ ability “ part under NSUCO ; excessive body movement - higher level skill)

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8
Q

what do we work on in phase 3 of VT

A

binocular accomodation act. binocular eye tracking act. fusion therapy act.

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9
Q

this is when you cannot stimulate accommodation ; Amps are below lower limit expected for age ; affects pre-presbyopes ; one of the most common types of accommodative dysfunction

A

accommodative insufficiency

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10
Q

by what age, should a child be able to maintain fixation of a target for 10 sec; can be affected by motivation

A

3 YO

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11
Q

what are the three important components of eye movements in reading

A

saccades ( average saccade is 8-9 characters ), fixations ( occurs b/w saccades average duration 200-250 ms), and regressions ( in skilled readers this occurs 10-20% of time )

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12
Q

these bino vision disorders will present with exo at near greater than distance ; reduced PFV ; reduced ability to stimulate accommodation ( low mono amps, high MEMs, slow on minus side of facility monocularly )

A

pSeudo CI

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13
Q

on the DEM what does the vertical Z score indicate

A

RAN ( automaticity) - how quickly they call out the numbers

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14
Q

which accommodative disorder mainly associ with pseudomyopia

A

accommodative excess

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15
Q

with binocularity and accommodation what are we working on

A

accommodation: improvement of accuracy, speed, range, and stamina ; goes from monocular to biocular to binocular binocularity - anti suppression to physiological diplopia to fusional vergence , improvement in posture , facility, and amplitude

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16
Q

this is a subclass of accommodative insufficiency that is rare and assoc with an organic cause - they cant stimulate their accommodation at all;

A

accommodative paralysis

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17
Q

T or F: targets greater than 45 degrees of center - move head/neck/ body

A

T

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18
Q

whats the equation for Sheards Criterion

A

(2/3) phoria- (1/3) compensating fusional vergence

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19
Q

this bv disorder is exophoria at distance and near of roughly equal amts; normal ACA; reduced PFV both distance and near

A

basic exophoria

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20
Q

this is difficulty relaxing accommodation ; poor ability to perform testing with plus lenses, may have blurry distance vision after near work aka ciliary spasm, accommodative spasm; affects pre presbyopes

A

accommodative excess/ spasm - mainly in children through university students

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21
Q

what three areas does visual efficiency look at

A

oculomotor, accomodation, and binocular status

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22
Q

these binocular anomalies have normal AC/A ratios

A

fusional vergence dysfunction, basic exophoria and basic esophoria

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23
Q

what is the goal of ability in VT

A

to allow for the pt to make fixations, saccades, and /or pursuits for the visual task necessary for the pts activities of daily living ( improve by beginning with gross motor and fine skills, begin with shorter activites)

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24
Q

with this disorder, the primary problem is accommodative insufficiency ; they will have reduced accommodative convergence , greater demand on positive fusional vergence ; results in reduced ability to converge ; presents similar to CI; giving low plus at near improves phoric posture and NPC

A

Pseudo CI

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25
in this phase of VT we are achieving simultaneous perception ; appreciate physiological diplopia, can also be anti suppression
Phase 4: Biocular ( R/G TV trainer, RG Hart Chart, Robbins Rock, Brock String)
26
Whats Hoffstetters formula for determining the min accom. amp
min amt= 15-1/4 age
27
this is a subclass of accommodative insufficiency where amp is normal but deteriorates over time and under stress ; these are people that say towards the end of the day their vision blurs
ill sustained accommodation
28
what were the results of the convergence insuffl. tx trial
statistically significant diff between groups ; improvement in symptoms for office based VT group compared to other 3 groups ( no diff in other 3 groups ) ; improvement in clinical signs - statistically significant improvement in clinical signs for office based VT groups compared to other 3 groups BUT all groups showed some improvement
29
how can we make loading harder
more targets, smaller spacing between targets, not allowed to touch or track with finger, smaller targets, faster moving targets, increased time on task
30
diff between laterality and directionality
laterality is the awareness of right and left on self ; directionality is awareness of right and left projected into space - can incorporate with eye tracking
31
how is the CISS used
15 questions , score \> 16 is diagnostic for ages 9-17, score \> 21 diagnostic for 18+ ; change in 10 pts is significant
32
based on morgans norms what is the normal ACA ratio
4/1
33
these are the ways in which various ocular systems operate over time and under various viewing conditions; this includes sufficiency, facility ( flexibility), accuracy, and stamina
visual efficiency
34
what is the hierarchy of skills for visual function in VT ( building blocks )
1. orientation of the body in space 2. oculomotor skills 3. binocularity and accommodation 4. perceptual function
35
this is a recording device ( electrodiagnostic ); provides info on fixations, regressions, duration of fixations, reading rate, relative efficiency, grade equivalence ; pt reads a grade level pasasage and answers questions about it
visagraph/ readalyzer
36
this bv disorder has normal ACA; esophoria of same magnitude roughly at both distance and near; reduced NFV at both distance and near
basic esophoria
37
what are some biocular eye tracking therapies
R/G wayne saccadic fixator, R/G hart chart saccades, R/ G pegboard rotator, RB computer saccades,
38
for all of the bv disorders and accomodative disorders, which are the only ones that DO NOT have VT as their secondary therapy
ocular motor dysfunction ( added plus) CI ( prism ) DE ( added lenses) basic eso ( prism ) basic exo ( added lenses ) fusional vergence dysfunction ( prism )
39
Based on morgans norms what is the distance and near lateral phoria
distance - 1 exo near - 3 exo
40
what was the outcome of the study done on VT with the four diff methods
pts who were successful or improved in their clinical signs showed an overall reduction in frequency of adverse academic behaviors
41
with the VT case based studies on Pencil Push Ups, Home based online therapy + pencil push ups, Office based therapy and office based placebo, which was more STATISTICALLY significantly more successful and improved group than the other three groups ?
Office based VT groups
42
what are the guidelines for VT programming
start with large/gross saccades and work towards smaller / fine saccades ; start with small pursuits and work towards larger pursuits ; work on accuracy of eye movemets before speed
43
what is the NSUCO test
its testing based on direct observation of saccades and pursuits ( free space testing ); rates pt based on ability, accuracy, head and body movement ; graded on a scale of 1-5 ( 5 is best )
44
this is a visual verbal format to test saccades ( psychometric test) ; ; not allowed to use finger - two vertical and one horizontal test
developmental eye movement test
45
what do we work on in phase 1 of VT
monocular accomodation activities monocular eye tracking activities
46
T or F: compensating fusional vergence should be twice the phoria
T
47
what is the tx of choice for CI and DI
prism or vision therapy
48
what are some monocular eye tracking therapies
wall saccades, wayne saccadic fixator, hart chart saccades, ann arbor Michigan letter tracking, pegboard rotator, talking pen , computer saccades,
49
What are the VT steps for a DE
1. VT 2. added lenses
50
what are some common saccadic symptoms of OMD
frequent loss of place, omission of words
51
this takes recordings from both eyes and the time is shown vertically ; should see stair step pattern
visagraph/readalyzer
52
why do we Rx lenses during VT
to encourage optimal acuity and binocularity ; may decide to add prisms to aid fusion ( Fresnel stick on prisms)
53
how is king devick used in sports
testing to evaluate for concussions during sports - looks at RAN; check their baseline score and their score after potential concussion
54
feedback mechanism - poor control of accommodation during eye tracking
blur
55
for all of the bv disorders and accomodative disorders, which are the only ones that DO NOT have VT as their primary therapy
AI ( plus lenses ) ill sustained accommodation ( plus lenses) DI ( prism ) CE ( added lenses) vertical phoria ( prism)
56
in this condition , pt will have an exophoria at near ; ortho or low exo in the distance ; receded NPC ; reduced PFV ; low AC/A
CI- these pts bft well from VT bc lenses don't have an effect
57
this is a feedback mechanism where you have movememtn of the body while trying to make eye movements
motor overload
58
this is a visual verbal format to test saccades; psychometric test ; evaluate time it takes to complete card based on age norms
king devick test ( has an early exit pt)
59
how can we make loading easier
isolate target, allow pt to touch target, larger target, slowly moving target, decreased time on task
60
these binocular anomalies have High AC/A ratios
CE, DE- small changes to their accommodation will have a large change in their phoric posture
61
what are the 4 possible outcomes with DEM Tlest
1. normal performance on all subtests 2. saccadic dysfunction 3. difficulty with RAN 4. difficulty with RAN and saccades
62
this enables rapid redirection of the line of sight to allow foveal viewing ; fastest eye movement; normal latency 200 ms ; reaction time dependent on luminance, size, contrast of target, motivation, and attention
saccades
63
this enables continuous clear vision of moving targets - max velocity Is 60 degrees per second; shorter latency than saccades; affected by age, attention, and motivation ; assoc. with poor sports performace
pursuits
64
this is difficult changing accommodative response level ; latency and speed of accommodation are abnormal ; amp is normal
accommodative infacility ( ie you cant stimulate it but then you cant relax it ) - will have probs with the flippers
65
this phase of VT involves automaticity of visual skills; flexibility - accommodative facility, vergence facility, accoomoddation convergence interaction
binocular with loading ( rotations, cognitive loading, balance board, lenses, prisms)
66
What are the binocular anomalies that have low AC/A ratios
CI, and DI - if we give these pt lenses we wont get a huge change in their phoric posture
67
what does the plus lenses do on a pseudo CI patient :
plus acts like a reset button and allows them to bring in their accommodative convergence to keep their eyes pointing where they should
68
these are used to alter the demand on the accommodative or binocular systems ; can be plus or minus
added lenses
69
what are the bfts of VT
reduces symptoms increases Amp and facility eliminates accom. . spasm improves NPC increases fusional vergence amps and facility eliminates suppression improves stereopsis improves accuracy of saccades and pursuits improves stability of fixation
70
What is an example of gross motor skills
diff activities on the peg board so you have to move your arm around,
71
which is considered harder saccades
Column Jumping
72
what is the traditional programming of VT
1. optimal lens Rx 2. gross motor 3. monocular 4. biocular/ antisuppression 5. binocular 6. binocular with loading
73
this determines how clearly, efficiently, and comfortably a persons vision will be t/o the day and t/p various tasks or activies of daily living
visual efficiency
74
which is considered an easier saccade
wall saccades, hart chart saccades
75
based on morgans norms what is the BO and BI vergences for near
BO: 17/21/11 BI 13/21/13
76
what is a significant amt of refractive error
hyperopia \> +1.50 Myopia \> -5.00 any age -300- to -5.00 , Rx at age 1-3 -1.00 to -3.00, Rx at age greater than 3 astigmatism \> -1.00DS, Rx at age greater than 3YO
77
in this phase of VT we work peripheral to central stereopsis ; move through 3 degrees of fusion ( simultaneous perception, luster, and stereopsis)
phase 5 binocular ( vectograms, bioptograms, tranaglyphs, computer vergence therapy )
78
feedback mechanism- poor control of vergence during eye tracking
diplopia
79
what three areas is visual information processing divided into
visuospatial, visual analysis, and visuomotor integration
80
what is the goal of speed in VT
to improve the speed with which a patient is able to make saccades or pursuits ( use a metronome to help pt develop a sense of rhythym , slower saccades first )
81
You can have a CI and an AI at the same time, so how do you determine this
to determine if they could also have a CI , we need to determine it by doing monocular testing. Most commonly for AI we give them a BF or add for near and repeat their tests, if it improves then it was an accommodative issue
82
when should children have normal eye movements
by 1-2 YO
83
this bv disorder is greater exo at distance than near ; exo deviation may be phoria or tropia ; normal stereo at near; typically normal PFV, high ACA
DE-
84
this is laterality projected onto others ; understand if object is to R and L of self and in reference to another person
directionality
85
which is considered easier pursuits
talking pen ( if they follow the pen) ,
86
T or F: with VT its important to start where the pt has success and move to where the pt struggles
T
87
this is a highly unlikely tx option for nonstrabismic Bv, accommodative, and oculomotor disorders, consider if horizontal phoria exceeds 30 prism diopters
surgery
88
whats the sequence of how our body orientation in space develops
gross motor-\> fine motor -\> oculomotor ( major muscles lead , and smaller muscles supplement , oculomotor allows for vision to join in process of movement and exploration)
89
what were the results of the accommodative dysfunction trial
all tx groups showed improvement in amps at 4 week visit ; office based therapy showed greatest increase and showed improvements at 4,8, and 12 wks ; all groups showed improvement in accommodative facility - office based showed improvement at 4 and 8 wks, home based therapy at 4 and 8 wks, pencil push ups at 8 wks, BUT only office based showed statistically significant increased in facility compared to placebo
90
what did studies find with CI and BI prism Gls
no diff between the two groups in change in symptoms ; no clinically significant reduction in symptoms based on CISS ; BI prism not a txd of choice for a CI
91
morgans norms for monocular accom facility and bino accom fac
mono: 7.0 cpm, bino: 5.0 cpm
92
when should changes in accommodation be noted at a VT therapy progress evaluation
4 weeks
93
based on morgans norms what is the BO and BI vergences for distance
BO: 9/19/10 BI X/7/4
94
T or F: targets within 30 degrees of center - move eyes only
T
95
what did the pediatric eye disease investigator group say for moderate amblyopia and occlusion
VA 20\*40-20/80 patching for 2 hours a day with at least one hour of near activities
96
what is an example of fine motor skills
Ann Arbor Michigan Letter Tracking
97
this bv disorder is greater eso at distance than near , reduced divergence at distance , low Ac/A, normal versions ; this is the least common
DI
98
what are some functional causes of OMD
hx of school related probs : trouble keeping place when reading , skipping lines, trouble copying from board
99
this is the concept of two halves of the body; infants begin using each side interchangeably; eventually one side becomes dominant
laterality
100
What is the equation for Percivals Criterion
P = (1/3) G- (2/3) L P = prism amt to Rx, G = greater of BI or BO blur , L = lesser of BI or BO blur
101
in this phase of VT we work to match skills between the R and L eyes ; this phase focuses on accommodation and eye tracking skills
phase 3: monocular ( could do N/F Hart Chart, Letter Tracking, Pegboard Rotator, Wayne Saccadic Fixator, Monocular Accom. Rock)
102
on the DEM what does the ratio score indicate
saccades
103
whats the findings for NSUCO usually
girls show better scores earlier than boys, ability should be 5 for saccades and pursuits for all ages
104
whats Hofstetters formula for determining the mean accom amp
mean amt= 18.5-1/3 age
105
what are some binocular eye tracking therapies
wall saccades, wayne saccadic fixator, hart chart saccades, pegboard rotator, eye control , , coin circles, tachictoscope , computer saccades
106
whats the main therapy for developmental oculomotor dysfunction
work on gross motor therapy first
107
T or F: Sheards Criterion is more effective for pts with esophoria
F: Percivals Criterion is
108
this bv disorder is eso at near, greater than distance ; ortho or low eso at distance ; reduced NFV ; high ACA ; one of the more common bv disorders
CE
109
is talking pen small pursuits or big
small
110
T or F: in VT programs, include eye tracking skills in all therapy programs
T- must be able to fixate a target before ability to fuse a target, must be able to move eyes towards a target
111
equation for Zscore
mean- raw/ SD
112
skipping words/ letters/ numbers
poor awareness of what comes next in the visual sequence; poor localization of where eyes are in relation to target
113
these are used to alter the demand on fusional vergence
prism
114
which two bv conditions are added lenses helpful for
CE and DE
115
what is the sequential management approach for visual efficiency
1. optical correction 2. added lens power 3. prism 4. occlusion 5. vision therapy 6. surgery
116
this is the most prevalentof all binocular vision disorder , accommodative, and oculomotor disorders; reported in 3-5 % of the population
CI
117
what are the most common accommodative disorders in children
accommodative insuff. and accommodative infacility: common tx is plus lenses for near or VT
118
what is the goal of body movement in VT
to decrease body movement to allow the eyes to move independently of the body ( improve via begin with gross motor / fine skills, start with smaller movements , provide awareness of body movement)
119
how is the COVD scored
19 items; score of \> 20 = diagnostic ; means they have significant symptoms;
120
what is a precursor to binocularity and accommodation
oculomotor skills
121
on the DEM what does the Horizontal Z score indicate
RAN + saccades
122
what is the goal of accuracy in VT
to improve the precision of the pts eye movements ; can improve with kinesthetic feedback, starting with larger targets and starting with fewer targets
123
what is the goal of head movement in VT
to decrease head/neck movement to allow the eyes to be moving independently of the head ( begin with gross motor and fine skills, start with smaller eye movements, provide kinesthetic feedbackO
124
what was the time frame for the convergence insuff. tx trial
12 weeks chosen bc that was likely to show improvements w/o significant drop out rate
125
this is under oculomotor skills- they have poor eye tracking skills, normal gross motor and fine motor, normal developmental milestones , no developemtnal delays
functional oculomotor dysfunction ( these pts have "normal " ability on NSUCO , min body movement maybe some head movement and poor accuracy )
126
what is the first step for a CE prior to doing vision therapy
adding plus lenses so 1. added lenses and 2. vision therapy
127
what are some pathological causes of OMD
cerebellar disease, ocular motor nerve palsies, myasthenia gravis etc

Vision Therapy (1 decks)

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