Functional Testing

Question 1

what 4 things do you need to record with a tropia

Answer 1

direction, size, timing, and which eye

Question 2

what 2 things do you need to record with a phoria

Answer 2

direction and size

Question 3

how do you measure a misalignment

Answer 3

alternating cover test- fusion is broken at all times during the test

Question 4

when do you stop measuring a misalignment

Answer 4

when the eye stops moving; prism = size of deviation

Question 5

what does prism do

Answer 5

bends rays of light toward the base and shift the image to the apex

Question 6

what are 3 additional tests used to strabismus

Answer 6

hirschberg, krimsky, and bruckner

Question 7

what is a normal result for hirschberg

Answer 7

the light reflexes are centered in each pupil

Question 8

what if the reflex is 1mm away from the center; how much misalignment is that

Answer 8

22 prism diopters

Question 9

how is krimsky different from hirschberg

Answer 9

krimsky measures misalignment for light reflex with prism

Question 10

what setting is the ophthalmoscope set at for Bruckners

Answer 10

+1.0m (green number in window)

Question 11

how far away do you sit from patient during Bruckner’s

Answer 11

1m (focal length of +1 lens)

Question 12

what 3 things are you looking for during Bruckner’s

Answer 12

difference in brightness, clarity, and pupil size

Question 13

what would be abnormal in a Bruckner’s

Answer 13

a lighter pupil, dark figures or different size

Question 14

why is the abnormal pupil lighter colored

Answer 14

the fixating eye aims its fovea at the light

Question 15

what are 2 tests used only for phorias

Answer 15

maddox rod and modified thorington

Question 16

which eye is the maddox rod placed over

Answer 16

the OD

Question 17

why do the eyes go to their phoria positions during the maddox rod test

Answer 17

the images (streak and light) are so radically different that fusion is broken or disrupted

Question 18

why is the OD the “deviating eye”

Answer 18

the light is a more natural source than the streak so the OS stays straight ahead

Question 19

do you perform the modified thorington technique at distance or near

Answer 19

only at near

Question 20

what is the most reliable test for phorias

Answer 20

the thorington test

Question 21

what size optotypes are on the thorington card

Answer 21

around 20/30 at 40cm

Question 22

where do you shine the light during thorington

Answer 22

through the center hole on the card

Question 23

which eye is the fixating eye during thorington

Answer 23

the OS (OD has maddox rod over it)

Question 24

which direction do the cylinders go if measuring a lateral phoria

Answer 24

horizontal

Question 25

which direction do the cylinders go if you are measuring a vertical phoria

Answer 25

vertical

Question 26

how much does the gap between optotypes equal in prism diopters

Answer 26

1 PD when placed at 40cm

Question 27

why is the thorington test so reliable

Answer 27

the small optotype yields a high degree of stability in the accommodative response and it stabilizes accommodative- convergence

Question 28

why is the Duane White classification scheme used

Answer 28

to identify and classify common anomalies of ocular misalignments

Question 29

what are some typical complaints of a Duane White anomaly

Answer 29

asthenopia after less than 30 min of near work, words blur/jump/double when reading, eyes turn out, dislikes reading, poor school performance with 20/20 VA, covers one eye, tilts head, intermittent blur

Question 30

what 2 conditions have similar complaints to a duane white anomaly that you should rule out first

Answer 30

hyperopia and dry eyes

Question 31

what anomaly has ortho in the distance and a large Exo at near

Answer 31

convergence insufficiency (CI)

Question 32

what anomaly has ortho in the distance and a large Eso at near

Answer 32

convergence excess (CE)

Question 33

what anomaly has a large Exo at distance and ortho at near

Answer 33

divergence excess (DE)

Question 34

what anomaly has Eso at distance and ortho at near

Answer 34

divergence insufficiency (DI)

Question 35

what anomaly do you measure the amplitude at distance and then calculate deviation at near (15-age/4)

Answer 35

accommodative insufficiency (AI)

Question 36

what 2 anomalies are the most common

Answer 36

convergence insufficiency and accommodative insufficiency

Question 37

what anomaly is associated with intermittent XT (exotropia) at distance

Answer 37

divergence excess

Question 38

what anomaly is ortho at distance and a small (1-6D) exophoria at near

Answer 38

no anomaly- “expected in normal patients”

Question 39

what deviation is never expected

Answer 39

esophoria