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VT > Final > Flashcards

Final Flashcards

1
Q

Is accommodation accurate?

A

No

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2
Q

what to access with accommodation

A

relative amp, absolute amp, accuracy, facility

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3
Q

How to chance accommodation stimulus?

A

Lens or distance

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4
Q

What to look up with AA?

A

Does pt. have AA for near demands and for age

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5
Q

Does PRA have a normal distribution?

A

NO! Has a cut off. Normal standard evaluation will give false negatives!

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6
Q

What is accommodative test is the best predictor of symptoms?

A

NRA.

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7
Q

IS NRA a normal distribution?

A

No!

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8
Q

Tests for posture?

A

BCC or MEM

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9
Q

BCC

A

pre-clarity. Pt. must be spherical. High nest-start with excessive plus.

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10
Q

Mem

A

Don’t leave in longer than 1s.

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11
Q

Who has greater accommodation affect: lenses or near-far rock?

A

lenses

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12
Q

Monocular flipper cuttoff

A
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13
Q

Binocular flipper cuttoff

A
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14
Q

What is the most common symptom of accommodative disorder?

A

HA

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15
Q

SCCO 4+ System

A

Test fixation. Look at 20/80 for 10s. 5s or less=failure.

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16
Q

Line scanning laser opthamoloscope with fixation assessment

A

Use a machine to determine your fixation.

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17
Q

Fixation training examples

A

Hooping with golf tees. McDonald Chart. Tachiostopic. Any task with zero velocity.

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18
Q

How many sessions for Pursuit Dysfunction

A

8-24

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19
Q

Does pursuit dysfunction exist by itself?

A

Very rarely. There will be accommodative and mergence problems as well.

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20
Q

Should pursuit tasks be predictable?

A

YES!

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21
Q

Goals with pursuits

A

accuracy over speed. Minimize head movement. Monocular->binocular. Loading the task to encourage distraction. Want it to be hard but not too hard.

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22
Q

Modifying pursuits

A

Use a loading demand or a cognitive demand.

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23
Q

Pursuit training examples

A

Rolling ball. Can modify with a flash light. Can have a stationary target and a head movement. Thumb pursuits. Flashlight tag. Marsden ball and can hoop. Penny drop. Spear the picture.

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24
Q

Pursuit problems

A

Will likely also see basal ganglia disease, parkinsonism, and cerebellar disease. Commonage with others.

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25
Q

What do you need for 3D vision

A

Equal consistent input, equal monocular perception, perceptual integration, relative comparison of object distances. Accommodation and mergence consistency.

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26
Q

SILO

A

Perception change due to vergence changes.

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27
Q

What causes stereopsis symptoms to increase

A

Vestibular interaction and disorder, neuromuscular disorder, accommodation or vergence disorder, medications, sedentary lifestyle.

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28
Q

What causes stereopsis symptoms to decrease

A

Immersion and presbyopia.

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29
Q

Progressive of stereopsis training

A

Awareness of float, localization of lost, localization comparison of two objects, similar at far.

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30
Q

Training for awareness of float

A

Marsden ball and quoits juxtaposition. Use polarized glasses. Adjust BI until patient sees hooping.

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31
Q

localization of float

A

use a single vectogram and typically start with BO. Once pointer not needed can increase and go for

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32
Q

Compared localization of float

A

quoits preferred. Use polarized flippers to reverse BI and BO. Can also do matching float (adjust lower image to match).

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33
Q

Stereopsis training at far

A

Brewster: Use BO first. Change demand and depth with thromboning. Juxtapose with natural targets: any object farther than marsden ball. Projected vectograms, computer-based.

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34
Q

What lens should be used with VT?

A

Plus add if needed to limit phasic response, limits accommodation adaptive requirements, reduce AC/A influence.

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35
Q

Bioenginering VT approach

A

Stimulus Sensitivity, phasic training, specific skills, adaptive training.

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36
Q

Stimulus Sensitivity

A

Bring awareness to stimulus cues. I.e. how does it feel to accommodate.

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37
Q

Stimulus sensitivity examples with accommodation

A

Plus blur/lens sorting, plus and/or BO walk away. Mental minus/split pupil rock.

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38
Q

Stimulus sensitivity examples with vergence

A

Prism sorting, brock string, disparity sensitivity.

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39
Q

Why is phasic training important

A

Linked to asthenia, helps other steps, daily visual tasks need. Find minor deficiencies or OD/OS imblance

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40
Q

Phasic training

A

Facilities. Can use flipper with BIM/BOP.

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41
Q

Training Deficient Skills

A

Work more directly on the weak skill area but avoid training in only one direction. i.e. normalizing amplitudes

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42
Q

Adaptive training Importance

A

Linked to asthenia and can have return to VT without finishing with adaptive training

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43
Q

Problem with adaptive training

A

symptoms are normally gone by this time so patient is not as motivate.

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44
Q

How to train adaption

A

Large changes, all at once, hold activity for adaption.

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45
Q

EX: of adaption with accommodation

A

Read two minutes before changing flipper.

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46
Q

Feature for accommodative training

A

lenses, target distance, target features.

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47
Q

Is it better to do 20 minutes practice a week or do 4 days of 5 minutes?

A

Better to form a habit and do a little bit each day

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48
Q

Lens sorting

A

Sensitivity to blur. Monocular. Start with plan, +1, +2. Use smaller increments. With minus at first must be at least 1 from.

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49
Q

Minus lens activities

A

Sensitivity to blur. Monocular. Use target about 1.5 m away. Can do accommodation awareness and progress to mental minus

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50
Q

Accommodation awareness with minus lens

A

Start with -4. Patient feels sensation of changing clarity. Holds when lens inserted and removed. Used generally as intro to mental minus

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51
Q

Acc. awareness w/ Mental minus

A

Learn to voluntary control accommodation. Will voluntary increase or decrease prior to lens introduction.

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52
Q

Accommodative infacility

A

Typically 3-12 sessions. Facility alone often improves quickly. Do all the facilities with this patient.

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53
Q

Near far rocks

A

Use with accommodative in facility. Can also use metronome. Want 60-75 ppm with no errors or pauses. Can also do loading technique.

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54
Q

Split Pupil Rock

A

Do with accommodative in facility. Change vertex distance to alter distance. Prescribe 2-3 minutes each eye.

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55
Q

Split Pupil Rock Goals

A

-6 lens in spectacle with 15-20 cpm in 30s trial.

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56
Q

Bi-ocular Rock

A

Accommodative in facility. Same as split pupil rock but no occlusion. See double and shift between the two images. Do not use with those that may get sick.

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57
Q

Lens flippers goals

A

Put for 15 cpm average in 2 minutes. Stop at +2/-5. Can move to BIM/BOP.

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58
Q

Prescribing lens flippers

A

Determine power to reduce facility to 7-9 flips in 30 sec. When patient races 12 cpm increase the power until goal is reached.

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59
Q

Specific skills with accommodative infacility

A

Generally already accounted for.

60
Q

Adaptive training with accommodative infacility

A

No adaptive training here.

61
Q

Treatment for accommodative insufficency

A

Immediate help=plus add. VT for long term

62
Q

Can you use CISS for AI

A

Yes

63
Q

Length of VT for AI

A

3-12 sessions.

64
Q

Phasic training for AI

A

Train facilities. Specifically use Jensen rock, split pupil rock, minus lens tromboning, minus lens walk up

65
Q

Jensen rock

A

used with AI. Hold near chart a few CM further away than NPA. Near far rock as before.

66
Q

Modified Jensen Rock

A

Can push up the near card while doing it.

67
Q

Minus lens tromboning

A

Min=-4 Sustain at spectacle plane for 10s.

68
Q

Minus lens walk up

A

Take one foot length forward when clear. Stop when too blurry. Can add minus once can do this.

69
Q

Adaptive training for AI

A

Change large lens and hold. Can hold a large lens for 2 minutes and then change. Recommend 15 minutes per day total.

70
Q

Ill Sustained Accommodation TX

A

VT. Maybe low plus for partial relief. 2-9 sessions.

71
Q

Goals with ill sustained accommodation VT

A

improve amplitude, normalize facility, emphasis adaption. Very similar to AI sequence.

72
Q

False CI

A

Low stimulus AC/A but more normal response. Lag.

73
Q

False CI TX

A

Low plus may improve accommodation. VT. Typically 6-16 sessions.

74
Q

BIM addition with False CI

A

Specific skills training with false CI to improve AA

75
Q

Crossed Cylinder Focus

A

Improve pt. ability to regulate accommodation. Use crossed cylinder lens at 90 or 180. Use cross cylinder target. Have patient change to make vertical and then horizontal clear. This is likely a finishing technique.

76
Q

AE

A

6-18 sessions.

77
Q

BOP walkaway

A

Used for AE. Encourages reduction in accommodation. Plus lens greater than +1. RXN 6X per day.

78
Q

Adaption with AE

A

Plus addition lens wear, sustain large lens change with two minutes of reading.

79
Q

Pseudo myopia VT.

A

4-12 sessions. May do plus only facilities. Can do BOP walkaway as well.

80
Q

Accommodative Spasm

A

DO plus only facilities! BOP the spasm.

81
Q

DE TX

A

VT, overminused at distance with plus at near, prism.

82
Q

How many sessions with DE

A

6-18

83
Q

Goals for DE VT

A

Want to increase PRV without drawing on accommodation. Above 8 prism. Want to get to 20.

84
Q

Phasic activities for DE

A

Distance facilities through prism (more BO). Near far with GTVT and minus at near, BO at far. Near sequence with BIM/BOP.

85
Q

First step with DE for specific skills

A

Check near skills. Use plus and do brock string, analgphs, hectograms, etc.

86
Q

BOP walkaways

A

Use with DE. Continue fusing while accommodation decreases. Can use prism with GTVT, chiastopic fusion tasks.

87
Q

Steps in DE VT

A

Start at near, near with plus, move from near to far, simulated far point, true far point

88
Q

Brewster with DE

A

Stimulated far point. Expand PRV ability. Trombone away.

89
Q

What happens when you move card away

A

BOP effects

90
Q

What happen when you move card closer

A

BIM

91
Q

Optical far point with DE

A

Use distant anaglyph target. Can do BO prism pops or BOP walkaway. Can also do Near far with anaglyphs. Can also do prism bar.

92
Q

Why are anaglyphs a good choice?

A

Suppression control and float.

93
Q

Projected targets in DE

A

Use anaglyph or hectogram The same instruction as with near.

94
Q

Adaptive for DE

A

Large prism change every 2 minutes, large change on stereoscopes.

95
Q

Basic EXO VT

A

8-18 sessions. Phasic-see accommodative and mergence in facility. More emphasis on N-F. Basic Skill-combination of activities for CI and DE.

96
Q

How hard is DI to treat

A

A very challenging case. 10-20 sessions

97
Q

Phase 1 for DI

A

Pencil Push away. Brock string: bead push away, steps and jumps, lenses. Accommodative activities: distance rock and then flippers binocular.

98
Q

Phase 2 for DI

A

Vectrograms, Transaglyphs, computer, brewster, prism. Start at near and then progress to far.

99
Q

Most common symptom of DI

A

Diplopia.

100
Q

Hectograms for DI

A

Work in one direction for 2-5 minutes. 4 times as much BI. Can project vector at far or add +2.50. Next add look aways and jumps. Then BIM/BOP

101
Q

Tranaglyphs for DI

A

Smooth, step, BIM/BOP. For far can do walk aways, step demands, BIM demands

102
Q

Computer for DI

A

Works in break/recovery zone. Can project in some programs.

103
Q

Brewster

A

Bring the card closer for BIM affect. Can add look aways.

104
Q

Phase 3 DI

A

Start with near-far. Aperture rule trainer and lifesaver/eccentric circles

105
Q

ART for DI

A

Work divergence 4 times as much. Use double aperture for divergence. Step or jump mergence.

106
Q

Dismissal from Active VT

A

RTC 1 month. Prescribe 1-2 HVT procedures. Progress at 1 month. RTC 2 months and continue HVT. Eval at 3 months and if okay RTC 6 months and discontinue HVT. Repeat at 9 months and if okay RTC 1 year for CVE.

107
Q

Basic ESO Tx

A

Quick: full plus at all distances, BO prisms, Commonly associated with uncorrected hyperopia. Long term: VT

108
Q

Difficulty of basic ESO VT

A

difficult. 10-20 sessions.

109
Q

Signs of Vert. deviations

A

head tilt, vertical phobia, reduced vergence recoveries in both directions, unilateral eyebrow furrowing.

110
Q

Finding vert. dissociated phoria

A

Maddox is great. Screen 9 positions of gaze.

111
Q

Finding AP for vert.

A

Use saladin. Trial frame and look for adaption. If FD stays constant there is no adaption.

112
Q

If no prism adaption is seen?

A

Prism may be better choice. VT only necessary if prism doesn’t work.

113
Q

If prism adaption is seen?

A

VT is the best choice.

114
Q

How long therapy for Vert.

A

4-24 (varies greatly) Non strab

115
Q

Ways to train vert. fusion

A

Move target or move head (easier as we do this in life)

116
Q

Do you train with or without compensating prism?

A

Start all activity with compensating prism so they now how to do it. May/may not use at home but eventually will use opposite prism.

117
Q

Vertical facility

A

Use at least 3 prism in opposing direction with no compensating eventually. Can start with compensating prism with equal BD/BU facility. Find prism they can do by increasing compensating prism (Make so that values of compensating in flipper are increased)

118
Q

Recommended vertical facility

A

12-15 cpm. Want 2 minutes of facility 3-5 times a day.

119
Q

Other options for vertical facility

A

Use vertical anaglyphs with R/G flippers, vertical hectograms with polarizing filters.

120
Q

Which is harder R/G flipper or prism flipper?

A

R/G as only a bit of eyes is stimulated to move up or down

121
Q

Steps for vertical deviation training

A

compensating prism-no prism-opposite prism

122
Q

Vertical fusion range approaches

A

step prism range, smooth prism range, modifications.

123
Q

Smooth vertical fusion range

A

Want to expand FR to >3 D in opposite direction. Require responding to drift in panum’s fusion area

124
Q

Smooth vertical fusion Activity

A

Use vertical hectogram, anaglyph, or rotation prism. Practice slow break/recovery. Can modify with head movement, target movement, both movement, tilting head, titling target, vestibular input.

125
Q

Head rolling with horizontal analgyph

A

Smooth vertical fusion. Have patient move head and try to keep fused.

126
Q

Drive a horizontal anaglph

A

Emphasize left and right turn.

127
Q

Rotating prism

A

Fuse Small BO prism. Slowly rotate toward BU or BD to break/recovery. Increase prism by 1 when can rotate to bu?bd

128
Q

Is there SILO with vertical fusion

A

NO silo.

129
Q

Step Vergence

A

Use small step increments to practice fusion. Uses peri-macular stimulus. Can use fixed vertical analgphys. Adaption is a key to sucess

130
Q

Step vergence with prism bar

A

Starting from no prism fuse each window for a few seconds before moving to the next.

131
Q

Step vergence with fixed vertical anaglphys

A

Same procedure as with bars.

132
Q

Vertical fusion adaption

A

Time, big change all at once

133
Q

Adaption training activities

A

Can do prism while doing horizontal fusion activities, Can hold maximum right or left turn while driving, Can also do challenging vertical prism while on a computer, or can tilt head with TV

134
Q

Post VT mgmt for vert

A

FU in 1 month, Follow up 3 months, at 6 months if still okay stop home. RTC only if VT needed

135
Q

When to train horizontal before vertical

A

vertical only there when dissociated, vertical is small, horizontal deviation is large. If Vertical is large compensate during horizontal training.

136
Q

What is computer VT not a substitute for

A

office VT or examinations and FU

137
Q

Glasses in computer

A

R/B. Red over right.

138
Q

Time with HTS iNET

A

5 times a week for 20 minutes for about 3 months

139
Q

VTS3

A

use in office. Very expensive.

140
Q

Dedicated VT practice

A

one or more ODs specializing in VT. Can be group therapy.

141
Q

General optometric practice that provides VT

A

Limited to easily treatable conditions. Mostly home base with Evaluations. Mostly in rural settings.

142
Q

General optometric practice that contracts VT

A

VT comes on site once a week or so and performs.

143
Q

OD in opthamology

A

Help with amblyopia, pre/post surgical strap, CI/CE.

144
Q

Discussing tx

A

Start and end with the best choice

145
Q

Estimating number of sessions

A

Number of conditionsX5 +5

146
Q

FU with VT

A

3-6-9

VT (2 decks)

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