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Vision Therapy > Exam One > Flashcards

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
Q

in this phase of VT we are achieving simultaneous perception ; appreciate physiological diplopia, can also be anti suppression

A

Phase 4: Biocular ( R/G TV trainer, RG Hart Chart, Robbins Rock, Brock String)

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26
Q

Whats Hoffstetters formula for determining the min accom. amp

A

min amt= 15-1/4 age

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27
Q

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

A

ill sustained accommodation

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28
Q

what were the results of the convergence insuffl. tx trial

A

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

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29
Q

how can we make loading harder

A

more targets, smaller spacing between targets, not allowed to touch or track with finger, smaller targets, faster moving targets, increased time on task

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30
Q

diff between laterality and directionality

A

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

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31
Q

how is the CISS used

A

15 questions , score > 16 is diagnostic for ages 9-17, score > 21 diagnostic for 18+ ; change in 10 pts is significant

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32
Q

based on morgans norms what is the normal ACA ratio

A

4/1

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33
Q

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

A

visual efficiency

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34
Q

what is the hierarchy of skills for visual function in VT ( building blocks )

A
  1. orientation of the body in space 2. oculomotor skills 3. binocularity and accommodation 4. perceptual function
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35
Q

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

A

visagraph/ readalyzer

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36
Q

this bv disorder has normal ACA; esophoria of same magnitude roughly at both distance and near; reduced NFV at both distance and near

A

basic esophoria

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37
Q

what are some biocular eye tracking therapies

A

R/G wayne saccadic fixator, R/G hart chart saccades, R/ G pegboard rotator, RB computer saccades,

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38
Q

for all of the bv disorders and accomodative disorders, which are the only ones that DO NOT have VT as their secondary therapy

A

ocular motor dysfunction ( added plus) CI ( prism ) DE ( added lenses) basic eso ( prism ) basic exo ( added lenses ) fusional vergence dysfunction ( prism )

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39
Q

Based on morgans norms what is the distance and near lateral phoria

A

distance - 1 exo near - 3 exo

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40
Q

what was the outcome of the study done on VT with the four diff methods

A

pts who were successful or improved in their clinical signs showed an overall reduction in frequency of adverse academic behaviors

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41
Q

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 ?

A

Office based VT groups

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42
Q

what are the guidelines for VT programming

A

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

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43
Q

what is the NSUCO test

A

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 )

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44
Q

this is a visual verbal format to test saccades ( psychometric test) ; ; not allowed to use finger - two vertical and one horizontal test

A

developmental eye movement test

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45
Q

what do we work on in phase 1 of VT

A

monocular accomodation activities monocular eye tracking activities

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46
Q

T or F: compensating fusional vergence should be twice the phoria

A

T

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47
Q

what is the tx of choice for CI and DI

A

prism or vision therapy

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48
Q

what are some monocular eye tracking therapies

A

wall saccades, wayne saccadic fixator, hart chart saccades, ann arbor Michigan letter tracking, pegboard rotator, talking pen , computer saccades,

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49
Q

What are the VT steps for a DE

A
  1. VT 2. added lenses
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50
Q

what are some common saccadic symptoms of OMD

A

frequent loss of place, omission of words

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51
Q

this takes recordings from both eyes and the time is shown vertically ; should see stair step pattern

A

visagraph/readalyzer

52
Q

why do we Rx lenses during VT

A

to encourage optimal acuity and binocularity ; may decide to add prisms to aid fusion ( Fresnel stick on prisms)

53
Q

how is king devick used in sports

A

testing to evaluate for concussions during sports - looks at RAN; check their baseline score and their score after potential concussion

54
Q

feedback mechanism - poor control of accommodation during eye tracking

A

blur

55
Q

for all of the bv disorders and accomodative disorders, which are the only ones that DO NOT have VT as their primary therapy

A

AI ( plus lenses ) ill sustained accommodation ( plus lenses) DI ( prism ) CE ( added lenses) vertical phoria ( prism)

56
Q

in this condition , pt will have an exophoria at near ; ortho or low exo in the distance ; receded NPC ; reduced PFV ; low AC/A

A

CI- these pts bft well from VT bc lenses don’t have an effect

57
Q

this is a feedback mechanism where you have movememtn of the body while trying to make eye movements

A

motor overload

58
Q

this is a visual verbal format to test saccades; psychometric test ; evaluate time it takes to complete card based on age norms

A

king devick test ( has an early exit pt)

59
Q

how can we make loading easier

A

isolate target, allow pt to touch target, larger target, slowly moving target, decreased time on task

60
Q

these binocular anomalies have High AC/A ratios

A

CE, DE- small changes to their accommodation will have a large change in their phoric posture

61
Q

what are the 4 possible outcomes with DEM Tlest

A
  1. normal performance on all subtests 2. saccadic dysfunction 3. difficulty with RAN 4. difficulty with RAN and saccades
62
Q

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

A

saccades

63
Q

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

A

pursuits

64
Q

this is difficult changing accommodative response level ; latency and speed of accommodation are abnormal ; amp is normal

A

accommodative infacility ( ie you cant stimulate it but then you cant relax it ) - will have probs with the flippers

65
Q

this phase of VT involves automaticity of visual skills; flexibility - accommodative facility, vergence facility, accoomoddation convergence interaction

A

binocular with loading ( rotations, cognitive loading, balance board, lenses, prisms)

66
Q

What are the binocular anomalies that have low AC/A ratios

A

CI, and DI - if we give these pt lenses we wont get a huge change in their phoric posture

67
Q

what does the plus lenses do on a pseudo CI patient :

A

plus acts like a reset button and allows them to bring in their accommodative convergence to keep their eyes pointing where they should

68
Q

these are used to alter the demand on the accommodative or binocular systems ; can be plus or minus

A

added lenses

69
Q

what are the bfts of VT

A

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
Q

What is an example of gross motor skills

A

diff activities on the peg board so you have to move your arm around,

71
Q

which is considered harder saccades

A

Column Jumping

72
Q

what is the traditional programming of VT

A
  1. optimal lens Rx 2. gross motor 3. monocular 4. biocular/ antisuppression 5. binocular 6. binocular with loading
73
Q

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

A

visual efficiency

74
Q

which is considered an easier saccade

A

wall saccades, hart chart saccades

75
Q

based on morgans norms what is the BO and BI vergences for near

A

BO: 17/21/11 BI 13/21/13

76
Q

what is a significant amt of refractive error

A

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
Q

in this phase of VT we work peripheral to central stereopsis ; move through 3 degrees of fusion ( simultaneous perception, luster, and stereopsis)

A

phase 5 binocular ( vectograms, bioptograms, tranaglyphs, computer vergence therapy )

78
Q

feedback mechanism- poor control of vergence during eye tracking

A

diplopia

79
Q

what three areas is visual information processing divided into

A

visuospatial, visual analysis, and visuomotor integration

80
Q

what is the goal of speed in VT

A

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
Q

You can have a CI and an AI at the same time, so how do you determine this

A

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
Q

when should children have normal eye movements

A

by 1-2 YO

83
Q

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

A

DE-

84
Q

this is laterality projected onto others ; understand if object is to R and L of self and in reference to another person

A

directionality

85
Q

which is considered easier pursuits

A

talking pen ( if they follow the pen) ,

86
Q

T or F: with VT its important to start where the pt has success and move to where the pt struggles

A

T

87
Q

this is a highly unlikely tx option for nonstrabismic Bv, accommodative, and oculomotor disorders, consider if horizontal phoria exceeds 30 prism diopters

A

surgery

88
Q

whats the sequence of how our body orientation in space develops

A

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
Q

what were the results of the accommodative dysfunction trial

A

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
Q

what did studies find with CI and BI prism Gls

A

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
Q

morgans norms for monocular accom facility and bino accom fac

A

mono: 7.0 cpm, bino: 5.0 cpm

92
Q

when should changes in accommodation be noted at a VT therapy progress evaluation

A

4 weeks

93
Q

based on morgans norms what is the BO and BI vergences for distance

A

BO: 9/19/10 BI X/7/4

94
Q

T or F: targets within 30 degrees of center - move eyes only

A

T

95
Q

what did the pediatric eye disease investigator group say for moderate amblyopia and occlusion

A

VA 20*40-20/80 patching for 2 hours a day with at least one hour of near activities

96
Q

what is an example of fine motor skills

A

Ann Arbor Michigan Letter Tracking

97
Q

this bv disorder is greater eso at distance than near , reduced divergence at distance , low Ac/A, normal versions ; this is the least common

A

DI

98
Q

what are some functional causes of OMD

A

hx of school related probs : trouble keeping place when reading , skipping lines, trouble copying from board

99
Q

this is the concept of two halves of the body; infants begin using each side interchangeably; eventually one side becomes dominant

A

laterality

100
Q

What is the equation for Percivals Criterion

A

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
Q

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

A

phase 3: monocular ( could do N/F Hart Chart, Letter Tracking, Pegboard Rotator, Wayne Saccadic Fixator, Monocular Accom. Rock)

102
Q

on the DEM what does the ratio score indicate

A

saccades

103
Q

whats the findings for NSUCO usually

A

girls show better scores earlier than boys, ability should be 5 for saccades and pursuits for all ages

104
Q

whats Hofstetters formula for determining the mean accom amp

A

mean amt= 18.5-1/3 age

105
Q

what are some binocular eye tracking therapies

A

wall saccades, wayne saccadic fixator, hart chart saccades, pegboard rotator, eye control , , coin circles, tachictoscope , computer saccades

106
Q

whats the main therapy for developmental oculomotor dysfunction

A

work on gross motor therapy first

107
Q

T or F: Sheards Criterion is more effective for pts with esophoria

A

F: Percivals Criterion is

108
Q

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

A

CE

109
Q

is talking pen small pursuits or big

A

small

110
Q

T or F: in VT programs, include eye tracking skills in all therapy programs

A

T- must be able to fixate a target before ability to fuse a target, must be able to move eyes towards a target

111
Q

equation for Zscore

A

mean- raw/ SD

112
Q

skipping words/ letters/ numbers

A

poor awareness of what comes next in the visual sequence; poor localization of where eyes are in relation to target

113
Q

these are used to alter the demand on fusional vergence

A

prism

114
Q

which two bv conditions are added lenses helpful for

A

CE and DE

115
Q

what is the sequential management approach for visual efficiency

A
  1. optical correction 2. added lens power 3. prism 4. occlusion 5. vision therapy 6. surgery
116
Q

this is the most prevalentof all binocular vision disorder , accommodative, and oculomotor disorders; reported in 3-5 % of the population

A

CI

117
Q

what are the most common accommodative disorders in children

A

accommodative insuff. and accommodative infacility: common tx is plus lenses for near or VT

118
Q

what is the goal of body movement in VT

A

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
Q

how is the COVD scored

A

19 items; score of > 20 = diagnostic ; means they have significant symptoms;

120
Q

what is a precursor to binocularity and accommodation

A

oculomotor skills

121
Q

on the DEM what does the Horizontal Z score indicate

A

RAN + saccades

122
Q

what is the goal of accuracy in VT

A

to improve the precision of the pts eye movements ; can improve with kinesthetic feedback, starting with larger targets and starting with fewer targets

123
Q

what is the goal of head movement in VT

A

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
Q

what was the time frame for the convergence insuff. tx trial

A

12 weeks chosen bc that was likely to show improvements w/o significant drop out rate

125
Q

this is under oculomotor skills- they have poor eye tracking skills, normal gross motor and fine motor, normal developmental milestones , no developemtnal delays

A

functional oculomotor dysfunction ( these pts have “normal “ ability on NSUCO , min body movement maybe some head movement and poor accuracy )

126
Q

what is the first step for a CE prior to doing vision therapy

A

adding plus lenses so 1. added lenses and 2. vision therapy

127
Q

what are some pathological causes of OMD

A

cerebellar disease, ocular motor nerve palsies, myasthenia gravis etc

Vision Therapy (1 decks)

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