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VT > MT 1 > Flashcards

MT 1 Flashcards

1
Q

How can you change acc. demand?

A

Lenses or distance

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2
Q

What inspires accommodation

A

Attention

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3
Q

What tests for Accomodation

A

Absolute accom, relative accommodation, posture/accuracy, facility

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4
Q

Tests for absolute accommodation

A

Donder’s push up and minus lens method

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5
Q

Will dander’s or minus lens method give greater AA

A

Donders

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6
Q

What if you get OD and OS difference with minus lens method?

A

Adaptation may be occurring. Try from other eye.

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7
Q

Tests for Relative accommodation

A

PRA and NRA

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8
Q

PRA

A

Perform mono and if increased accommodation (mergence will be problem) and vice. Pt. must diverge.

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9
Q

Determining a near point add

A

halfway between NRA and PRA

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10
Q

NRA

A

Convergence. If it is high it is due to overminusing

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11
Q

BCC

A

Determine posture. Make pt. spherical. Start with increased plus so vertical lines clear first.

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12
Q

Who would you not run BCC on?

A

Ptt. with incorrect cyl. May have meridonal amblyopia.

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13
Q

Plus/Minus facility procedure

A

Perform for 2 minutes. If really failing can go for 1 minute.

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14
Q

Which equates with near point symptoms best?

A

Acc. facility

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15
Q

What is most common symptom of accommodation disfunction?

A

Headache

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16
Q

What affects fixation most strongly?

A

Attention

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17
Q

SCCO 4+ system

A

Have pt. look at a target for 10 sec. If cannot hold for 5+ then there is a great problem.

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18
Q

Line scanning with opthalmoscope

A

Measures where the eye normally fixates when looking ahead

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19
Q

Should you train fixations?

A

No pursuits is better. Fixations are boring

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20
Q

Fixation training tests

A
  1. Golf tees with hopping
  2. McDonald Chart
  3. Tachistocopic task (flash letters and see what remembers)
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21
Q

Pursuit dysfunction tests

A
  1. NSUCO 2. Low bead test score 3. Suspision during motility
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22
Q

Pursuit disfunction Symptoms

A

Excessive head moving when reading. Confusion during return sweep. Skipping lines when reading. Losing place when reading. Using finger when moving. Word omission or transposition when reading. Illusory text movement. Deficient ball playing. (Won’t find pt. that only has pursuit problem)

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23
Q

Pursuit Training

A

Relative motion between the observer and the target of interest. Should have predictable direction and speed. It is not a pursuit movement if you have to write it down to remember it.

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24
Q

How should you train pursuits

A

Monocular–>binocular

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25
Q

Motion in training pursuits

A

Can have target, head, or both.

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26
Q

Why is it important to pay attention during pursuit training?

A

You should modify to make them more challenging.

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27
Q

Loading examples in pursuit training

A

Have them stand on unstable surface. Cognitive load them by having them say the alphabet backwards.

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28
Q

Rolling ball

A

Have pt. track ball while it rolls back and forth. Can track with light or laser.

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29
Q

Stationary target head movement

A

have the patient move and look at a stationary target

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30
Q

How to modify pursuit tasks

A

Cannot complete task goal, jerky pursuits, uncontrollable head/body tracking, clenching hands, rigid neck, facial contortions.

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31
Q

Thumb pursuits

A

Have patient track their thumb. Provides strong feedback. Can go to a large, no detail–>smaller, no detail–>smaller, central detail.

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32
Q

Flashlight tag

A

Pursuit training.

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33
Q

Marsden Ball Pursuits

A

Can lay down, hopping (follow ball with tennis racket and when you say to they will hoop it), tapping, or bunting.

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34
Q

Penny Drop

A

Pursuit training. Have the patient drop penny in cup when you say when

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35
Q

Spear the Picture

A

Pursuit training.

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36
Q

Pegboard rotator

A

Outside rotates faster. Have them watch and fill in certain areas

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37
Q

What is the main ddx question you have to ask when you find pursuit problems?

A

Is the problem worsening (acquired) or has it never been good in the first place (developmental lag)

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38
Q

Extreme Pursuit Issues

A

See cogwheel steplike pursuit. Would also see basal ganglia and cerebellar disease. Should comange with other specialties.

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39
Q

Is a VT exam the same as a Primary care exam?

A

NO! A primary care exam should be done before a VT exam. Primary care only samples skills and sees if they are normal

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40
Q

VT Case History

A

Main concern, secondary concern, review refractive history, review of ocular or systemic histories (esp, meds and neurological), goals of patient, Standardized symptoms survey (CISS)

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41
Q

Most common signs of prolonged near work/concentration

A

blurred vision, double vision, squinting, HA, eye fatigue/strain, inexplicable rubbing or itching of eyes, sleepiness with near work

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42
Q

Other signs of prolonged near work/concentration

A

Instability of print, excessive tearing/blinking, nausea, difficulty copying from the chalkboard, difficulty reading, avoidance of near work (may get tangled up with ADHD), Difficulty staying on task.

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43
Q

Convergence Insufficency Symptoms Survey

A

15 symptoms rated on a scale from 0-4. Better if you read ? to pt. 0=never 1=infrequent 2=sometimes 3=fairly often 4=always. Score of > 16=symptomatic of CI

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44
Q

VT and Refraction

A

Refraction should have been done prior to VT. Measure VA’s and make sure run is accurate. Accurate run is critical to accurate assessment of accommodation and vergence

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45
Q

Calculating mergence demand for the pt

A

pd in cm/target distance in m

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46
Q

Vergence demands can be created by..

A
  1. target distance 2. prisms 3. target separation (to be fused)-target demand 4. the need to counterbalance a heterophoria
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47
Q

Primary stimulus for vergence

A

binocular retinal image disparity

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48
Q

Tonic vergence

A

The underlying level of vergence activity without a target. Just space out and see where mergence lays. Distance cover test approx.

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49
Q

Fusional Vergence

A

The mergence that occurs in response to binocular target disparity. Used to overcome phonic tendencies.

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50
Q

Accommodative vergence

A

Vergence that occur in response to change in accommodation

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51
Q

Proximal vergence

A

mergence that occurs due to mental or psychological awareness of target nearness.

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52
Q

What system innervates the EOM

A

Somatic nervous system

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53
Q

What does stress affect?

A

Accommodation that will then affect vergence. Vergence is not affected directly.

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54
Q

Can vergence be voluntary?

A

No! Must affect accomm. that then affects vergence.

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55
Q

What lenses do you want to use to measure vergence?

A

CAMP lenses-> corrective ammetropia most plus.

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56
Q

Esophoria

A

The eyes tend to aim closer than the target

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57
Q

Exophoria

A

The eyes tend to aim further than the target

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58
Q

Heterotropia

A

An abnormal condition of vergence posture in which binocular vision is absent or abnormal and only one eye is aimed at the target of regard.

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59
Q

cover test set up

A

Discrete target to fixate. Hold target at primary gaze. Bracket prism results. Have control lenses but before refraction.

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60
Q

Expected vergence posture far

A

0-2 exo

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61
Q

Expected vergence posture near

A

0-7 exo

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62
Q

Gradient AC/A

A

Normally at near. Change lenses and keep distance the same

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63
Q

Gradient AC/A lens response

A

May have a closer response with minus lenses. Plus and minus with differ.

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64
Q

Gradient vs. calculated AC/A

A

Highest AC/A with calculated–>middle is negative AC/A–>lowest is positive AC/A. Commonly do Plus lens as want to rxn plus lens.

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65
Q

Normal AC/A from calculated

A

3-5

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66
Q

High AC/A

A

Low accommodation adaptation, higher prism adaptation

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67
Q

Low AC/A

A

High accommodation adaptation, lower prism adaptation

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68
Q

Forced mergence fixation disparity cuve

A

Saladin card, sheedy disparometer, computerized chart system (far). indicates ability for fast prism adaptation

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69
Q

Prism adaptation

A

Indicated by speed with which the mergence system re-creates the habitual vergence posture (phoria) when it is challenged with prisms

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70
Q

Which patients are not good candidates for prism therapy

A

Patients that are fast prism adaptators.

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71
Q

Which patients are more likely to have near point stress?

A

Patient with poor prism adaptation.

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72
Q

Before what surgery should the prism adaptation test be performed?

A

Before surgical management of strabismus

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73
Q

Sheard’s and Percival’s criterion

A

Assume that symptomology is not related to vergence dysfunction if the criterion is met. Also provides additional method to calculate a prism prescription to alleviate symptoms. (forced mergence curves are better though)

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74
Q

Sheard’s Criterion

A

The blur point in the compensating vergence ‘reserve’ (the range opposite the phonic posture i.e. BO for exo) is at least twice the demand.

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75
Q

For sherd’s criterion if the 40 cm phobia is 9 exo what must the patient have to not have symptoms

A

the PRV must be at lest 18

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76
Q

What deviations does sherd’s work best with?

A

Exo

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77
Q

Percival’s criterion

A

The demand line (not the phobia value) should be in the middle third of the total mergence range (from BO blur to BI blur). This method requires plotting the zone of clear single binocular vision.

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78
Q

what deviations does percival’s work best with?

A

eso

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79
Q

Type I ogle curve

A

Most common. No problem

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80
Q

Type II ogle curve

A

Eso. Responds to plus. Shift down

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81
Q

Type III ogle curve

A

EXO. Response to prism. No minus

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82
Q

Type IV ogle curve

A

Very rare. no prism can shift

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83
Q

What type of an ogle curve do you want?

A

Flat in the center

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84
Q

NPC

A

Use threshold target acuity. Accommodative and vergence demand are the same. Repeat 5 times to assess stamina.

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85
Q

Minimum NPC values

A

Break=8 cm. Recovery=11 cm

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86
Q

Capobianco method

A

Record NPC break using a penlight without a red lens and then through a red lens. >2 cm difference is problematic.

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87
Q

when do you always do mergence amplitude?

A

Near. Only far prn.

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88
Q

When to use prism bar?

A

Very young or intermittent strab.

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89
Q

Vergence facility

A

Cannot be measured without accommodation. Use flippers or hayne’s distance rock.

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90
Q

Prism flipper facility

A

Ask patient to report any suppression or diplopia. Do not flip until time runs out. Record suppression or diplopia and NOTE which side.

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91
Q

Binocular Vision

A

How visual space is represented in the binocular vision process. Motor and sensory aspects of binocular vision. Corresponding retinal points.

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92
Q

Binocular sensory fusion

A

The neurological blending of visual information presented to each eye so that greater information is derived from the binocular image.

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93
Q

Levels of sensory fusion

A

none, stimulus perception, superimposition/flat fusion, steropsis.

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94
Q

Is stereopsis threshold measured normally?

A

No as test doesn’t go down far enough

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95
Q

Random dot

A

Global test. Requires bifixation (unlike local)

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96
Q

Lateral disparity

A

Local test. Does NOT require bifixation.

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97
Q

Howard-Dolman Device

A

No monocular cues if set right. Can get an actual threshold here for steropsis.

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98
Q

Test for assessment of superimposition/flat fusion

A

worth dot test or computerized chart systems.

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99
Q

What stops sensory fusion from occurring

A

suppresion, anisometropia, fixation anomalies, strabismus, inadequate motor vergence

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100
Q

Is it possible to have suppression at far but not near?

A

yes as the flashlight gets further it becomes more difficult to fuse

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101
Q

What is the minimum data for a vergence system evaluation?

A

Phorias, vergence ranges, NPC, facility, steropsis.

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102
Q

NSUOCO Oculomotor test

A

Fixation stability (not part of test). Gross pursuit eye movements, gross saccadic eye movements. Patient is standing, hand at side. No instruction on head movement. Separation of targets 20 cm apart.

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103
Q

DEM

A

Looks at reading eye movements

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104
Q

Visagraph/readalyzer

A

Looks at oculomotor movement

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105
Q

Type I DEM

A

Normal

106
Q

Type II DEM

A

Saccadic disfunction

107
Q

Type III DEM

A

Delayed verbal automaticity

108
Q

Type IV DEM

A

Combination of II and III

109
Q

Signs/Symptoms of Saccadic disfunction

A

re-read or loose place when reading, move head when reading, use of finger when reading, reread or skips words, choppy or slow reading, poor reading comprehension, may have vestibular problems.

110
Q

NSUCO fail

A

When below expected performance for age

111
Q

DEM Fail

A

Below 16 percentile in ratio or error scores.

112
Q

Visagraph fail

A

Below expected performance for age.

113
Q

Primary goal with saccadic VT

A

them to perform better in their own enviorment

114
Q

How do you know where to saccade?

A

Your peripheral vision

115
Q

First priority with saccadic VT training?

A

Accuracy

116
Q

Second priority with VT saccades?

A

increase speed with accuracy.

117
Q

Final priority with VT saccades?

A

Automaticy and transfer of skill

118
Q

With saccadic VT begin with _____ movement at far, proceed to _____ movements at near.

A

gross, fine.

119
Q

Saccade demand variables

A

Vergence and accommodation at play with a saccade at near vs. far. Moving the distance is not a big factor. The distance the saccade place a greater role.

120
Q

What do you expect if accommodation is not a problem with Hayes distance rock

A

They will be able to say the first row of letter fine but then it will be hard to get to second line as they have to saccade.

121
Q

Saccadic training start binocular or monocular

A

start monocular (make the patient do twice as much work. both will be moving)

122
Q

Saccadic training sequencing

A

Initially use finger guiding then remove. Eliminate head movement (beanbag), low cognition to high cognition and distraction. Predictable to less predictable patterns

123
Q

Is the distance to saccade the same in reading?

A

no words are different lengths

124
Q

Loading in saccadic training

A

Add speed on top of skill, metronome when predictable, plus and minus lenses, BI and BO prism, acuity requirement, distraction/repetition, gross motor activity.

125
Q

When to use a metronome?

A

If task is predictable and accuracy is achieved but speed and automaticity is needed.

126
Q

Frustation levels with VT

A

Work at the patients level. Not above

127
Q

Phase Ia of Saccadic Therapy

A

Gross saccades (predictable)

128
Q

Doorwary or corner saccades

A

Phase Ia. far or near. Have them saccade to four corners like on a door. Can add a metronome.

129
Q

Hart chart options

A

Phase Ia. Hart chart strips (for more even saccades) , column jumps, 4 corner saccades. Can add a metronome and pointing feedback (laser). Can add balance demand.

130
Q

Alphabet pencil saccades

A

Phase Ia. Can add metronome or pencil movement. Recommend 1 cm separation to 10-15 cm. Hold against solid color awl to facing cluttered room. Can add slight viewing distance difference between pencils.

131
Q

Sequential fixator

A

Phase Ia. Print on transparencies. Baseball or stickers. Must be predictable targets.

132
Q

Meter stick saccades

A

Phase Ia. Have them look at different things on stick. See the marking prior to the saccade. Focus on peripheral vision.

133
Q

Feedback with corner/dorwary saccades

A

use a device with an after image. Will see a plus or after image. put target on one place and see if over or under shooting.

134
Q

Hart chart strips

A

Cut two strips. Tape on wall at given distance. Control head movement. Add metronome.

135
Q

hart chart column jumps

A

Position 1-6 m away. Variation of any pattern can be made but you need a purpose. hard to go from second to second last.

136
Q

4 corner saccades with hart chart

A

Can use feedback with after image. Can add metronome. Go from corners with

137
Q

Is it harder for children if their saccade pencils are close together or further apart?

A

Easier if they are separated by a further distance (gross develops first). Fine saccades are harder.

138
Q

Phase IB of saccadic therapy

A

Gross saccades (less predictable)

139
Q

Wayne Saccadic Fixator

A

Phase IB. Gross unpredictable saccade. Feedback via lights and sound. Self-paced mode scores time to complete. Instrument-paced mode scores number of hits. Add letters under lights. Want a low score (as a timed scored)

140
Q

Instruments similar to Wayne Saccadic fixator

A

SVT (australia), Sanet vision integrator, Vision coach, Dynavision (only one with buttons)

141
Q

Laser spelling

A

Saccadic phase Ib. Random letters scattered on a wall/door. Feedback with laser or pencil. Searching saccades. Add distractors. Can add metronome.

142
Q

Sequential fixator for phase Ib

A

Phase Ib. Transparency sheet with less predictable pattern. No metronome as not predictable

143
Q

Continuous motion

A

phase Ib. Random numbers or letters scattered on a page. Have them circle the letters or number continuously. Searching saccade. Can add metronome?

144
Q

Computer Saccade Programs

A

Phase Ib. Computer example for gross unpredictable saccades. Allows control of stimulus presentation. Scores average response time and % correct. use it as a reward as kids like.

145
Q

Wayne Directional Sequencer

A

Phase Ib. Pattern overlays for lightboard. Follow the arrow pattern. Feedback with lights and sounds. Metronome mode.

146
Q

Saccadic Phase II

A

Fine saccades (predictable pattern)

147
Q

Percon/saccadic workbooks

A

Phase II. Gross to fine saccades. Gross column jumps, intermittent row saccades. variety of patterns.

148
Q

Column and page saccades

A

Phase II. Column: call out first and last letter on each line then go to 2nd or 3rd. Page saccades: same concept but call out the first and last word on each line

149
Q

4 corner saccades at near

A

Phase II as at near.

150
Q

Saccadic Ladders

A

Phase II. Go from 2:1

151
Q

Saccadic Phase III

A

Reading pattern saccades

152
Q

X and O worksheet

A

Phase III. Closer to reading type saccades. Good lead into michigant tracking. Can add flippers for accommodation.

153
Q

Michigan Tracking

A

Phase III. Searching task with alphabet clusters. Accuracy first, then speed. Work to smaller font size. Can add flippers for accommodation.

154
Q

Word finds

A

Phase III. Searching task with alphabet. Work to smaller font sizes. Instructions are critical for predictable saccade.

155
Q

Symbol counting

A

Phase III. Searching task with symbol clusters. Can add flippers. Know the correct amount by first and last number

156
Q

Dotting o’s in newspaper magazine

A

Phase III. Searching task with alphabet clusters. Can add flippers.

157
Q

Guided / Moving Window

A

Phase III. Computer based program. Controls exposure of words during reading to direct saccades. Build speed of controlled eye movement during reading.

158
Q

Tachistoscopic task

A

Phase III. Increase span of recognition per fixation. Develop better mechanism to guide saccades.

159
Q

Strobelights/ NIke strobe

A

Devlops prediction saccades. Slower flash rate requires saccade prediction. Must know where you are saccading.

160
Q

Generic programing considerations

A

Gross to fine. Approximate to refine responses. In to out of instrument. Monocular to binocular. Peripheral to Central. Suppression controls. Challenge without overwhelming. Skills in isolation to skill integrations.

161
Q

What lenses should the patient be wearing during VT?

A

The best lens for the patient. A plus add will limit phasic response, limit accommodation adaptation requirements, reduce AC/A influence. Because of adaptation may have better results with less plus.

162
Q

Accommodation adaptation

A

The key to keeping symptoms down. Phasic is a quick response.

163
Q

Cookbook approach for bioengineering VT

A

Stimulus sensitivity–>phasic training–>specific skills–>adaptive training

164
Q

Stimulus Sensitivity

A

Bring awareness to stimulus cues. Internalize responses for voluntary control. What does it feel like to change accommodation. May not need any time for this.

165
Q

Stimulus sensitivity example with accommodation

A

Blur detection: plus/minus lens sortion Awareness of accommodation: plus and/or BO walk away, mental minus, split pupil rock

166
Q

Stimulus sensitivity example with vergence

A

Prism sorting (put prism monocularly and ask if image moves until they find lowest prism with movement.

167
Q

why Phasic training important

A

daily visual tasks need it, link to asthenia, aid progression through other steps, find minor deficiency or OD/OS performance imbalance

168
Q

Phasic training vergence examples

A

Facilities. Plus/minus flippers, prism flippers, near far rock

169
Q

Rank the combinations from hardest to easiest. BIM/BOP, BOM/BIP, BI/BO only, +/- only

A

Hardest (BIM/BOP) –> BI/BO +/- only–> BOM/BIP

170
Q

Specific Skills

A

Training deficient skills. General treatment approach with this model. General treatment approach within the model. Slow rate of change of any phasic activity. Hold facility activities for longer periods. Hold ramp stimulus extremes for short periods. Large jump stimulus. Should use diagnosis-specific recommendations, in to out of instruments, large to small visual features, increasing demands, multi sensory elements

171
Q

Example of training deficient skills with accommodation

A

Normalize amplitude. Equalize skill increasing/decreasing accommodation. Voluntary control over acc excess/plus tolerance.

172
Q

Ex of training deficient skills with vergence

A

improve and balance fusional ranges, normalize recoveries, control/accuracy of disparity, synchronize sensory benefits with motor vergence

173
Q

Adaptive training

A

Adaptive training will decrease regression. Some think improved phasic skills may be enough. Problem is that symptoms are normally gone when adaptation training has began. Do a task all at once. Hold activity for adaptation (up to 2 minutes). Add free space activity and out of primary gaze

174
Q

Adaptive training example with accommodation

A

Read two minutes before flipping.

175
Q

Adaptive training examples with vergence

A

Large changes in stereoscope for 2 minutes. Large prism changes every 2 minutes.

176
Q

What do you need for optimal stereoscopic vision?

A

Equal consistent input, equal monocular perception, perception integration, relative comparision of object distances.

177
Q

What contributes to good 3D vision?

A

Optical accuracy, accommodation and mergence consistency, no fusional disruption (suppression), perception. Anything less then optimal=stereopsis less than optimal

178
Q

3D vision and breastfeeding

A

Those that breastfeed have better stereoscopic vision

179
Q

3D vision and visual input

A

A poor input=poor 3D. Optics: power accuracy. Visual health: tears, cornea, lens Visual skills: poor accommodation or mergence control

180
Q

SILO

A

Feedback cues for 3D vision. Can use for control of mergence

181
Q

Can steropsis be improved?

A

Yes.

182
Q

How long was 3D vision penalized after patching?

A

Occurred after only 8 hours of patching.

183
Q

Why do 3D vision symptoms increase?

A

Increase with vestibular interaction and disorder, neuromuscular disorder, accommodation or mergence disorder, medications, sedentary lifestyle.

184
Q

Why do 3D vision symptoms decrease?

A

Immersion, presbyopia.

185
Q

Progression of 3D vision training

A
  1. awareness of float 2. localization of float image (unnatural image has a location compared to physical objects) 3. localization comparison of 2 floating images (refinement, stereoscopic movement perception) 4. similar steps at far.
186
Q

Awareness of float examples

A

Marsden ball and quoits juxtaposition. See the ball going through the ring.

187
Q

Localization of floating image

A

Relies on comparison to a physical object. Use one hectogram with many pieces of built in depth. Pointer for localization. Progress with more obvious float to less float (typically BO activity). Do 2-5 minus, 2-3 times a day. Modify BO demand with each trial. Get rid of pointer and then start using BI.

188
Q

Localization comparison of floating images

A

Use a double vecto holder. Two matched vectos and polarized glasses. Set to 2-4 (Top BI and bottom BO). Patient studies size and location of top and bottom image through filters. Shows a dramatic SILO effect. Can also set top image for small BO and patient bracket lower image to match float. Continue with BO and then finally BI.

189
Q

Localization comparison of floating images at home

A

Have them use the chart but make them ignore the numerical values

190
Q

3D training at far

A

Can use stereoscope cards or juxtapose at distance. Can also use projected hectograms and match distances.

191
Q

Steresocope cards

A

Train 3D at far. Brewster stereoscope. Intially BO demand cards. Can have a pointer localization task. Can change demands and depth with tromboning. Requries fund in and trusted patient. Recommend at least 10 minutes a day.

192
Q

Therapy devices for Accommodative disorders

A

Lenses, target distance, target features, the patient (success determined by how pt. uses device)

193
Q

Is it better to do one long section each day or a couple of short sections a day?

A

It is better to build a habit and do them more often

194
Q

Sensitivity to blur/awareness of accommodation

A

Often only in office required (if no amblyopia). Awareness of blur, awareness of accommodation effort, voluntary control of accommodation. Can do lens sorting or minus lens activities.

195
Q

Lens Sorting

A

Primarily use clarity cues to sort lenses by optical power. Must patch. Use a distance chart or general viewing conditions. Start with plano, +1, +2. Tell them that lens shape, mag do not help. With young patients handle and give forced choice.

196
Q

Lens sorting progression

A

Increase plus with .25 increments. If mix in a minus lens start with higher values (-1 no less then -.5).

197
Q

RXN lens sorting

A

Often only in office.

198
Q

Minus lens activities

A

Target 1.5 m away. Monocular. Variety of minus lenses. Include all techniques with a minus lens.

199
Q

Accommodation Awareness training

A

Check if clarity can be achieved with a -4 lens. Patient describes sensation associated with increasing an decreasing accommodation. Voluntaryily hold accommodation with lens insertion and with removal. Normally use as an intro to mental minus.

200
Q

Mental Minus

A

Use for voluntary accommodation. After awareness of accommodation. Voluntary increase or decrease accommodation before the lens is applied or removed. Should do 5X each eye.

201
Q

Accommodative Infacility

A

Reduced facility, poor sustaining of near visual comfort, lag of clarity. Can use VT or low plus for partial relief.

202
Q

VT for accommodative in facility goals

A

Normalize facility values, minimize plus/minus skill difference, reduce or eliminate symptoms. usually takes 3-12 sessions

203
Q

Phasic training ideas for accommodative infacility

A

Near far rock, split pupils rock, loose lens rock, plus/minus flippers, BIM/BOP facilities.

204
Q

Near Far rocks

A

Accommodation infacility. Hold one chart close to you. Go to where right before you blur. Try to get as far as you can for distance. Prescribe 2-3X per day. Add metronome once it is not overwhelming. Want 60-75 bpm for this task. Can do loading technique-balance and beanbag. Can use near acetate chart to watch eyes

205
Q

Split Pupil Rock

A

Use prism in lens. Arms length facilities. Change vertex distance to alter dioptric amount. Monocular. Progress by increasing power, push maximum facility improvement. RXN of OD and OS 2-3 total minutes each.

206
Q

Split pupil rock goals

A

-6 lens in spectacle plane with 15-20 cpm on 30sec trial.

207
Q

Bi-ocular Rock

A

Get double vision. Increase accommodation to make lower one clear. Must do voluntary accommodation to direct eyes between images. Do not use with patient that gets motion sick

208
Q

Loose lens rack and plus/minus flippers

A

Accommodative in facility. Normalize facility with little decline over 2 minutes of facility challenge. Want 10 flips each 30 s for 2 min with +/- 2. Therapy: push for up to 20 cpm in one minute trial; at least 15 cpm average for 2 minute trial.

209
Q

Loose lens rack and plus/minus flippers goal

A

Establish power for training and increase to +2/-5. May need to use BOM/BIP initially. Maybe only plus or only minus at a time.

210
Q

RXN loose lens rack and plus/minus flippers

A

Determine max power to reduce facility to 7-9 flips in 30 s. When patient reach at least 12 cpm increase the power until a goal is reached.

211
Q

BIM/BOP Facility

A

Accommodation Infacility. Start with 6 BI/BO and +/-1.50. 30 sec want 7-9 flips. Adjust one power up or down at a time to achieve this rate and then send home.

212
Q

Specific skills and adaptive training with in facility training

A

Normally don’t do either of these.

213
Q

Key points of accommodative insufficiency

A

Inadequate accommodative amplitude. Reduced or unsustained clarity at near. Distance blur after sustained near work. Brow or headache.

214
Q

Using CISS for AI

A

Repeatable and reliable.

215
Q

Treatment for Accommodative insufficency

A

Plus add for immediate relief. VT for improvment

216
Q

VT and accommodative insufficency

A

3-12 session. Want to normalize accommodation amplitude and amplitude based symptoms. Blur sensitivity training activities are very useful.

217
Q

Accommodative Insufficency Phasic training

A

Improve amplitude with directional phasic activities such as greater minus powers with facility. Graduate to increased and more sustained amplitude activities.

218
Q

Specific Skill improvement ideas

A

jenson rock, split pupil rock, minus lens tromboning, minus lens walk up

219
Q

Jensen Rock

A

Maximize accommodative demand of near-far rock. Reduce letter size as possible if not progressing to other activities. Monocular. Hold chart a few cm further away than NPA. Near far rock as prior. Can use transparent near rock.

220
Q

Modified Jensen Rock

A

Accom. Insuff. Monocular. Push up amplitude: hold slow count to 5. Line 1 of near far rock. Repeat each time moving to the next line down the chart.

221
Q

Split pupil rock

A

Accom. Insuff. Use maximum minus (-8). Work to bring lens to spectacle plane.

222
Q

Minus lens tromboning

A

Accom. insuff. Minus lens (-4 to -8). Monocular. Slowly bring the lens from arms length to spectacle plane and keep target centered in the lens. Slowly reveres the movement. Keep target clear. Point is to move lens slowly. Sustain at spectacle plane for 10 sec.

223
Q

Minus Lens Walk Up

A

Accom. insuff. Similar to tromboning but use distance rather than lens. Start at 2-3 min. Once it is perfectly clear take a step forward. Repeat until cannot go closer without blur. Add minus lens in 2 D when 10 cm achieved.

224
Q

Variables for adaption

A

Large change, all at once, hold. Use a large lens change, rest breaks with goal of distance clarity, extended tasks

225
Q

Accom. insuff. adaption skills

A

Monocularly: at leat 2 D of loose lens changes. Change power for each long article
Binocularly: change flipper power each page turn of a novel. Loaner lenses of varying amounts. Recommend up to 15 minutes per day total. Varying reading/working distance every few minutes.

226
Q

Other issues to consider with Accom. Insufficency

A

Medications and post trauma

227
Q

Ill Sustained Accommodation

A

A less degree of AI. NRA and PRA reduced. Repeated NPA results in fatigue. Facilities are slow. Fatigue towards the end of the day.

228
Q

Treatment for ill sustained accommodation

A

VT. Mayble low plus to provide partial relief.

229
Q

Goals for ill sustained accommodation

A

Improve amplitude, normalize accommodation facility, emphasize adaptation elements. normally 2-9 sessions

230
Q

How to treat ill sustained accommodation

A

Treat like you would accommodative insuficiency

231
Q

False CI Review

A

Low stimulus AC/A. More normal resonse AC/A. larger than expected plus. Asthenopia. Difficulty with near point.

232
Q

Treatment for CI

A

Low plus additional may improve accommodation response. VT.

233
Q

Treatment for CI goals

A

Improve accommodation accuracy/sustaining. Normalize any residual vergence skills deficiency. 6-16 sessions.

234
Q

Phasic training for false CI

A

Blur sensitivity before or at the same time. Use same techniques as accommodative in facility.

235
Q

Specific skill training false CI

A

Improve any minor amplitude deficiencies (emphasize detailed targets and need for clarity). Possibly BIM added to previous activity ideas, especially with small target detail. Crossed cylinder focus.

236
Q

BIM addition for false CI

A

Challenge the acquired range and accuracy of accommodation against opposing mergence demand. BINOCULAR. Near far rock with BI for near target. Remove for distant target. BIM/BOP facility after +/- alone. With each step of binocular test walk up add 10-15 BI prism.

237
Q

Crossed cylinder focus for false CI

A

Increase patient appreciation for degrees of clarity. Improve patient’s ability to regulate accuracy and stability of accommodation. Monocular. Patient adjust focus to make vertical and horizontal lines darker. Add plus or minus sphere for a challenge. A finishing technique. G

238
Q

Adaptive training for false CI

A

See AI

239
Q

Accommodative Excess Review

A

Reduced lag/any lead with MEM, less than +0.5 on BCC. Low NRA binocular and monocular. Nearpoint strain. Distance blur after near work.

240
Q

Treatment for accommodative excess

A

VT. Passive plus lens treatment may be used, typically in conj. with VT

241
Q

Goal for VT Tx of AE

A

Address any causative mergence problem. Normalize accommodative release skills. Normalize lag. Takes 6-18 sessions.

242
Q

Phasic training for AE

A

Same accom. infacility

243
Q

Specific skill improvement for AE

A

Split pupil rock, plus lens walk away, base out walk away, Jensen rock. Combination of above.

244
Q

Split pupil rock

A

Improve reduction direction of facility. Encourage improvement of speed in reduction direction.

245
Q

BOP walk away

A

Need reduced total accommodative response at near. Plus lenses +/-1. largest BO prism they can fuse at 20 cm. Start 20 cm then take a walk back. Pt. must know what excellent clarity looks like. Only perform a max of 6x per day.

246
Q

Adaptive tx for BOP walk away

A

Plus additional lens wear. Sustain large lens change about every two minutes of reading. Rest breaks from near tasks, maybe with bO prism when looking at far distances.

247
Q

Pseudomyopia Tx

A

Full tolerable plus rx at all distance. VT.

248
Q

Pseudomyopia review of key problems

A

Variable distance and/or near blur, var. manifest refraction, small to moderate difference between manifest and cylcoplegic refraction, low NRA, variable esotropia at far and/or near, AE may be similar pattern at far, may be worse after near point task

249
Q

Goals for pseudomyopia

A

Extending near viewing, mergence difficulty as primary problem, medication, trauma, emotions. Cycloplegia.

250
Q

Tx for Pseudomyopia

A

Full tolerable plus rx at all distances, VT.

251
Q

Phasic training for pseudomyopia

A

Emphasize facility activities, maybe plus only or very small plus/minus facilities, try to equalize response time in each direction, BIM/BOP facilities.

252
Q

BOP walk away

A

Good for pseudo myopia.

253
Q

Adaptive component ideas for Pseudomyopia

A

Same as accommodative excess.

254
Q

Other issues with pseudomyopia

A

Medication, physical or emotional trauma, may need retainer plus addition lenses

255
Q

Accommodative Spasm Key Points

A

Variale distance and/or near blur, variable exophoria at far and/or near, low NRA, Minus addition X cylinder value, variable refraction, significant difference between manifest and cylcoplege, may have extreme near point strain, diplopia. Generally quick onset.

256
Q

Accom. Spasm tx

A

Full tolerable plus at all distances, VT, Reduction/removal of any contributing issues as possible. Cycloplegia-cyclopenolate to break spasm. Consider intermittent mild cycle if tapering

257
Q

Goals for accom. spasm

A

Normalize reduced facilities, elimination of variable far and near blur, voluntary control of accommodation. Typically 8-18 sessions.

258
Q

Phasic training for acc. spasm

A

Facilities. Plus only. Try to equalize response time in each direction. BIM/BOP facilities.

259
Q

BOP the spasm

A

Modify for far as possible.

260
Q

Adaptive component with spasm

A

Use as accommodative access.

261
Q

Other issues with accommodative spasm

A

Medications, physically or emotional trauma, may need retainer plus additional lenses.

VT (2 decks)

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