Midterm I Flashcards
What is the widely accepted format for documentation of medical and allied health patient records?
- Subjective
- Objective
- Assessment
- Plan
What are the three categories of a chief complaint?
- blur/vision loss
- discomfort/pain/irritation
- routine vision check
What are the uncorrected spherical errors associated with the following snellen VA’s: 1. 20/20; 2. 20/30; 3. 20/40; 4. 20/60; 5. 20/80; 6. 20/120; 7. 20/200
- 0.25
- 0.50
- 0.75
- 1.00
- 1.50
- 2.00
- 2.00-3.00
What are the uncorrected cylindrical errors associated with the following snellen VA’s: 1. 20/20; 2. 20/30; 3. 20/40; 4. 20/60; 5. 20/80; 6. 20/120; 7. 20/200
- 0.25
- 1.00
- 1.50
- 2.00
- 3.00
- 4.00
- 5.00 or greater
What is a complete and thorough listing of all the patient’s health care problems called?
diagnosis
What should the first line of the body of a letter contain?
purpose of the letter
What is a measurement of the fusion free position of the eye?
distance phoria
If someone is not orthophoric at distance what is this abnormality related to?
- fusional adaptation abnormality
- position of eyes in orbit
- relative lengths of EOMs
- position of muscle insertions
- genetic abnormality of EOM
If a person has excessive convergence per 1.00D of accommodation do they have a high or low AC/A? 1. Eso or exo? 2
- high AC/A
2. eso
If a person has deficient convergence per 1.00D of accommodation do they have a high or low AC/A? 1. Eso or exo? 2
- low AC/A
2. exo
What type of fusional convergence (and what type of prism) accommodates for a deficit in tonic or accommodative convergence?
positive (BO) fusional vergence
What type of fusional convergence (and what type of prism) accommodates for a excess in tonic or accommodative convergence?
negative (BI) fusional vergence
What are Morgan’s expected for BI at distance?
x/7/4
What are Morgan’s expected for BO at distance?
9/19/10
What are Morgan’s expected for BI at near?
13/21/13
What are Morgan’s expected for BO at near?
17/21/11
What is an abnormal value for NPC?
> 6cm
Do myopes accommodate more in contacts or glasses?
contacts
Do hyperopes accommodate more in contacts or glasses?
glasses
What does stereo acuity test for?
quality of fusion
What are the conditions that can lead to reduced stereo acuity?
- central suppression
- peripheral suppression
- high phoria with poor vergences
- uncorrected refractive error
- reduced VA from disease, amblyopia, etc
What are the treatment options for convergence insufficiency?
- VT to inc BO
2. near BI prism
What are the treatment options for convergence excess?
- VT to inc BI
2. near add
What are the symptoms of binocular vision dysfunctions?
- inc symptoms at end of day
- blurred vision
- intermittent diplopia
- pulling sensation
- asthenopia
- headaches
- burning or tearing
- inability to sustain concentration
What is the rule that positive relative convergence (BO to blur from demand) should be at least two times the phoria?
Sheard’s Criterion
What is the rule that neither vergence value should be more than twice the other?
Percival’s Criterion
What is the procedure to use an add to meet Percival’s or Sheard’s criterion?
- determine amount of prism using Sheard’s or Percivals
- determine AC/A
- divide prism by AC/A to determine add and round up to nearest 0.25
When do you prescribe for binocular vision problems?
- has symptoms (current or anticipated)
2. performance problems (current or anticipated)
What are vertical phorias more likely to be related to then horizontal?
physical/mechanical factors
What is the epidemiology of a vertical phoria?
- 20% of population (9% significant)
- congenital
- congenital or acquired 4th nerve paulsy
What is the progression of a vertical phoria like for each epidemiology:
- congenital
- vascular/ischemic events
- trauma
- neoplastic
- stable
- improvement over time
- stable
- worsen over time
What are key feature of a vertical phoria that can be observed by the doctor?
- head tilt
- facial muscle tension
- reduced lateral vergences
- reduced stereo acuity
What are methods to analyze vertical phorias?
- cover test
- Von Graefe
- Maddox rod
- Borish card
- vertical vergences
- fixation disparity
7, occlusion (takes long time)
How much prism should be prescribed to a vertical phoria patient?
1/2 to full amount
What are the symptoms of accommodative dysfunction?
- near blur
- irritability
- poor concentration
- headaches
What is the equation to find the normal amplitude values?
18.5 - 0.3x(age)
What is the equation to find the minimum amplitude values?
15 - 0.25x(age)
What is an abnormal PRA value?
1.50 or less
What minimum monocular accommodative facility (flipper)? 1. Minimum binocular? 2
- 12 cycles/min
2. 10 cycles/min
What are the theories to explain presbyopia?
- lenticular
- ciliary muscle
- geometric (not accepted)
At what ages do accommodative amplitudes begin to fall? 1. When do they reach zero? 2
- 6 years
2. 50 years old
Do myopes or hyperopes need an add earlier? 1. At what age do these become similar? 2
- hyperopes
2. 45 yo
What conditions make presbyopia symptoms worse for a patient?
- reduced illumination
- fatigued
- illness
What are the amplitudes of accommodation like for a presbyope?
below 3.00 D
Is the AC/A for presbyopes increasing, decreasing, or staying the same?
increasing
What are the tests used for the assessment and plan for a presbyope?
- demo of age expected add
- dynamic retinoscopy
- amplitude of accommodation
- bionocular cross cyl
- near duochrome
- NRA/PRA
What were found to be the worst tests to use to determine an add power of a presbyope?
- dynamic retinoscopy
2. amps of accom
What were found to be the best tests to use to determine an add power of a presbyope?
- age expected
2. most other acceptable
What are common first add powers for presbyopes?
+0.75 to +1.25
What is the equation for calculating the actual near add a patient is receiving with uncorrected or under-corrected distance refractive error?
EA = Rx(near) - (U(fp) - Rx(spec))
Why is a phoropter not a good demonstration for an add power?
- too dark
2. patient cannot choose where to hold the material
What is one of the most common causes of unhappiness with a new Rx and why?
error in add because loss of intermediate or adaptation
What issues could lead to problems with the acceptance of a bifocal?
- 4th nerve palsy
2. exophoria (low AC/A) so may have to do VT before bifocal
If the patient leans forward during seg height measurement will the segs be too high or too low?
too high
Are seg heights higher or lower with longer vertex distance?
higher
