Final: Accommodation Dysfunction

Question 1

3 types of accommodation insufficiencies. Explain them.

Answer 1

1) Ill-sustained - dramatic decrease in performance over time
2) Paralysis
3) Unequal accommodation

Question 2

Duane’s Accommodative Classifications (3)

Answer 2

1) Accommodative Insufficiency
2) Accommodative Excess
3) Accommodative Infacility

Question 3

What do you need to make sure you do with Donders Amp testing? What can you do to diminish inaccuracies?

Answer 3

Make accurate measurements.

Run through a -4.00 lens to make inaccuracies less.

Question 4

Describe the Alternative Pull Away Method for testing Accommodative amplitude. What can give inaccuracies and by how much?

Answer 4

Start with target really close to pt. and pull back until target just readable. Relative Size Magnification can give overestimation of amplitude up to 2.00D.

Question 5

Hofstetters Formula for average Amp.

Answer 5

18 - (1/3) Age

Question 6

Hofstetters Formula for minimum amp.

Answer 6

15 - (1/4) age

Question 7

What does facility testing test?

Answer 7

Ability to stimulate and relax accommodation. Recorded in cycles per minute.

Question 8

How would you record if patient cleared 24 times and failed on minus lenses at 55 seconds?

Answer 8

12 cycles, failed (-) @ 55

Question 9

How would you record if patient cleared 24 times in 60 seconds and did not fail the testing

Answer 9

12 cpm

Question 10

Expected cpm for 6 year old

Answer 10

5.5 cpm +/- 2.5

Question 11

Expected cpm of 7 year old

Answer 11

6.5 cpm +/- 2.0

Question 12

Expected cpm for 8-12 year old

Answer 12

7.0 cpm +/- 2.5

Question 13

Expected cpm 13-30 years old

Answer 13

11 cpm +/- 5.0

Question 14

How do you test MEM (near ret Lag)? What results would we expect?

Answer 14

Have MEM card attached to retinoscope. Have them read at 40 cm for adults and Harmons distance for children. Quickly drop in loose lenses and neutralize. We would expect +0.25 to +0.50.

Question 15

Accommodative Insufficiency Symptoms (6)

Answer 15

1) Blurred Vision
2) Headache
3) Eyestrain
4) Reading Problems like comprehension, avoidance of reading, and movement of print when reading.
5) Pulling sensation around eyes
6) Fatigue and Sleepiness

Question 16

Accommodative Insufficiency Signs (Direct measurements)

Answer 16

High UFCC
High MEM
Reduced amplitude of accommodation
Difficulty clearing -2.00D with monocular facility

Question 17

Accommodative Insufficiency Signs (Indirect measurements)

Answer 17

Reduced PRA
Difficulty clearing -2.00D with binocular facility
Low BO reserves at near
High FCC

Question 18

Accommodative Excess Symptoms

Answer 18

When relating to near tasks:
Blurred vision, worse after reading/near work
Headaches
Eyestrain
Difficulty focusing from near to far
Photophobia- due to ciliary bodies getting tired, send pain signal.

Question 19

Accommodative Excess Signs (Direct measurements)

Answer 19

Difficulty clearing +2.00D on mono. accom. facility

Low lag to lead on UFCC/MEM

Question 20

Accommodative Excess Signs (Indirect measurements)

Answer 20

Low NRA
Difficulty clearing +2.00D on bino. accom. facility
Low FCC
Low BI reserves at near

Question 21

What would we see if we saw a Pseudo CI? What signals a pseudo CI? How do we resolve?

Answer 21

High exo at near with low BO reserves and low amplitude of accommodation.
Poor results on all tests that stimulate accommodation is what signals that it may be Pseudo CI.
If given plus, the exophoric at near will decrease (unlike what it is predicted).

Question 22

What would vision therapy do for patient who has accommodation excess?

Answer 22

Make patient be able to accept more plus

Question 23

What would vision therapy do for patient who has accommodation insufficiency?

Answer 23

Make patient try to work on accepting minus.