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NBEO Part 2 > Ocular Motility/ Binocular Vision > Flashcards

Ocular Motility/ Binocular Vision Flashcards

1
Q

Deviation is greatest in which gaze for A-pattern exotropia?

A

Down gaze

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2
Q

Deviation is greater is which gaze for V-pattern exotropia?

A

Up gaze

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3
Q

Strabismus is either not present or is minimal in primary gaze, but is larger in both up-gaze and down gaze

A

X- pattern exotropia

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4
Q

Deviation is greater in which gaze for Y-pattern exotropia?

A

Superior gaze
* deviation absent or minimal in primary and down gaze

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5
Q

Patients with A-pattern exotropia or V-pattern exotropia will exhibit what head posture?

A

Chin tilt down

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6
Q

Patients with chin tilted up have what type of eye posture?

A

A-pattern esotropia and V-pattern esotropia

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7
Q

Head tilt to the right or left is typically observed in patients with?

A

Superior oblique palsy

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8
Q

DEM vertical component measures what?

A

Automaticity of number calling

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9
Q

Basic esophoria

A

Eso equal at distance and near (within~5PD)
Average AC/A
decreased distance and near NFV
Decreased vergence facility (base in hard)
Lag MEM
Decreased PRA
Poor binocular accommodative facility (hard to clear minus)
* BIM : base-in & minus are hard for EP

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10
Q

Symptoms of basic eso

A

Horizontal diplopia @ D&N
blur
Asthenopia, worse at end of day

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11
Q

Negative fusional vergence test with?

A

Base in

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12
Q

What is the most common accommodative disorder?

A

Accommodative insufficiency

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13
Q

Decreased amp of accommodation
Lag of accommodation on MEM
Poor monocular accommodative facility
Reduced PRA

A

Accommodative insufficiency

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14
Q

Hofstetter’s formula for minimum amp of accommodation

A

15 - 1/4(age)

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15
Q

Which VT techniques are used to help improve symptoms of accommodative insufficiency?

A
  • Monocular lens clearing and sorting
  • Monocular push-ups
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16
Q

What is always considered abnormal finding on MEM?

A

Any lead
*minus value

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17
Q

Expected values for MEM

A

+0.25 to +0.75 D lag

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18
Q

Treatment for accommodative insufficiency

A

Rx plus-power lenses for reading to help relax accommodation (therefore decreases demand)
Ex: +1.00

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19
Q

What is the initial step in managing amblyopia in children?

A

Full correction of refractive error with spectacles or contact lenses

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20
Q

you just prescribed full correction to your pediatric patient with anisometropic amblyopia, when do you wanna see them back?

A

4-6 weeks to re-evaluate VA before prescribing additional therapy

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21
Q

What is the most common type of muscular dystrophy associated with chronic progressive external ophthalmoplegia?

A

Myotonic dystrophy
* progressive weakening of muscles
* Christmas tree cataracts

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22
Q

True or false
Pupils are affected in chronic progressive external ophthalmoplegia

A

False
Pupils NOT affected

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23
Q

What is the main difference between CPEO and myasthenia gravis?

A

CPEO does not have diurnal variation of ptosis
** myasthenia gravis ptosis worse at end of day or after prolonged upgaze

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24
Q

RTC for CPEO

A

Monitor every 6 months
* no treatment, but managing symptoms is important

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25
Q

Tx/management of CPEO (3)

A
  1. Ocular lubricants for exposure keratopathy
  2. Basedown prism reading glasses if restriction in downward gaze
  3. RTC every 6 months
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26
Q

Inheritance pattern of CPEO

A
  • Mitochondrial (Kearns-Sayre syndrome)
  • Autosomal dominant
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27
Q

NFV

A

Negative fusional vergence
* base in, eyes diverging

Normal values
@D -/7/4 (July 4th!)
@N 13/21/13

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28
Q

PFV

A

Positive fusional vergence
* base out, eyes converging

Normal values
@D 9/19/10 (September 19, 2010)
@N 17/21/11

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29
Q

True or false
Patients with basic exophoria will be expected to have increased PFV @ distance and near

A

FALSE
* they will have decreased positive fusional vergence @ distance and near because with exo-posture harder to converge

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30
Q

What does MEM stand for in the context of accommodative testing?

A

MEM stands for Monocular Estimation Method

A technique used to assess the accommodative response of the patient’s visual system.

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31
Q

What is the primary purpose of the MEM technique?

A

To determine how the patient’s accommodative system responds when performing a near task

This is crucial for understanding visual function, especially in near vision activities.

Normal +0.50- +0.75
Lag: > +0.75
Lead: any minus (always abnormal)

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32
Q

In what lighting conditions is MEM performed?

A

Normal room illumination

This ensures a realistic setting for the patient during the test.

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33
Q

What type of material does the patient read during the MEM test?

A

Age-appropriate material

This ensures that the reading task is suitable for the patient’s reading level.

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34
Q

What is the significance of ‘with’ motion during MEM testing?

A

‘With’ motion indicates accommodative lag

It shows that the patient’s accommodation is not keeping up with the demand of near vision.

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35
Q

What type of lenses neutralize ‘with’ motion?

A

Plus-powered lenses

These lenses help in compensating for the lag in accommodation.

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36
Q

What does ‘against’ motion indicate in MEM testing?

A

Accommodative lead

This suggests that the patient is over-accommodating for the near task.

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37
Q

What type of lenses neutralize ‘against’ motion?

A

Minus-powered lenses

These lenses are used to counteract the excessive accommodation.

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38
Q

What MEM findings are considered abnormal?

A

Findings greater than +0.75

This indicates a significant lag in the accommodative system.

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39
Q

What does any lead in MEM findings indicate?

A

Considered abnormal

A lead suggests that the accommodative response is excessively strong.

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40
Q

What is the role of the clinician during the MEM test?

A

To determine the amount of accommodative lag or lead present

This assessment is crucial for diagnosing potential visual issues.

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41
Q

Fill in the blank: The lenses must be removed quickly during MEM testing to ensure that the patient does not _______.

A

accommodate through the introduced lens

This is important to maintain the accuracy of the test results.

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42
Q

True or false
Maddox rod testing can differentiate between a phoria and a tropia?

A

FLASE !!!
it can only determine the magnitude and direction of the deviation

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43
Q

What is accommodative esotropia?

A

A condition where one eye turns inward due to focusing efforts, typically occurring in young children.

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44
Q

At what ages does accommodative esotropia generally occur?

A

Between the ages of 2 and 5 years.

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45
Q

Can accommodative esotropia be observed in infants?

A

Yes, it can be observed in infants.

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46
Q

What is the typical level of hyperopia in patients with accommodative esotropia?

A

The mean level of hyperopia is roughly 4.75 D.

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47
Q

What range of deviations can occur with accommodative esotropia?

A

A large range in magnitude of intermittent or constant deviations.

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48
Q

What additional condition may patients with accommodative esotropia present with?

A

Amblyopia.

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49
Q

What factors influence the presentation of amblyopia in accommodative esotropia?

A

The frequency of the eye turn and the presence/degree of anisometropia.

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50
Q

True or False: Amblyopia is always present in patients with accommodative esotropia.

A

False.

51
Q

Fill in the blank: Accommodative esotropia typically presents with variable levels of _______.

A

[hyperopia]

52
Q

Oculomotor dysfunction

A

Patient has inappropriate saccadic eye movements or poor pursuits
* perform poorly on DEM

53
Q

What is oculomotor dysfunction?

A

A condition in which a patient displays inappropriate saccadic eye movements or poor pursuits.

54
Q

How do patients with oculomotor dysfunction perform on the Developmental Eye Movement Test (DEM)?

A

Patients perform poorly on the DEM test.

55
Q

What is the procedure of the DEM test?

A

Patients read vertical rows of numbers followed by horizontal rows without moving their head or using a placeholder.

56
Q

What types of errors are marked during the DEM test?

A

Errors are marked as omissions, substitutions, additions, or transpositions.

57
Q

What scores are calculated from the DEM test?

A

Vertical score (time), adjusted horizontal score (time), ratio (horizontal time/vertical time), and total errors.

58
Q

What is the significance of the percentile rank in the DEM test?

A

A percentile rank of less than 16 on the ratio/errors is considered a fail, and between the 16th and 36th percentile is considered suspect.

59
Q

List some symptoms of oculomotor dysfunction while reading.

A
  • Excessive head movement
  • Frequent loss of place
  • Constantly re-reading lines
  • Skipping lines
  • Using a placeholder/finger
  • Decreased reading comprehension
  • Omission of words or lines.
60
Q

Fill in the blank: A percentile rank of less than _______ on the ratio/errors is considered a fail.

A

[16]

61
Q

True or False: A percentile rank between the 16th and 36th percentile is considered normal.

A

False

62
Q

What indicates a normal result in a DEM test?

A

The horizontal, vertical, and ratio are all within normal ranges.

63
Q

What does a high horizontal portion and a normal vertical component indicate in a DEM test?

A

An oculomotor dysfunction.

64
Q

What does it mean if both horizontal and vertical components are high but the ratio is normal in a DEM test?

A

A problem with automaticity (difficulty naming numbers).

65
Q

What is indicated if a patient has high test times for both horizontal and vertical components along with an increased ratio in a DEM test?

A

The patient suffers from both oculomotor and automaticity issues.

66
Q

Fill in the blank: A DEM test result is considered normal if all components are within _______.

A

[normal ranges].

67
Q

Worth 4 dot test examines what type of fusion?

A

2nd degree fusion
* ability to superimpose like objects

68
Q

What is 1st degree fusion?

A

Ability to superimpose two DISSIMILAR objects (like a square and a circle) such that the two objects are perceived to occupy the same space

69
Q

What is 3rd degree fusion?

A

Ability to fuse 2 identical images separated by space resulting in perception of depth
* 3D movies are an example of this

70
Q

Red lens test: patient sees red/whiteish pink light

A

No deviation, no suppression

71
Q

Red lens test set up

A
  1. Red lens over dominant eye
  2. Trans illuminator at 50cm
  3. Pt reports what they see

Repeat at 40cm
Suppression at 40cm =peripheral suppression

Suppression at 6 meters but not at 40cm =central suppression

72
Q

Shallow suppression

A

Suppression at moderate lighting but not at dim lighting

73
Q

Deep suppression

A

Suppression at moderate and dim lighting

74
Q

What is microtropia?

A

A small angle heterotropia of less than 5-10 prism diopters, usually associated with harmonious anomalous retinal correspondence, partial stereopsis, and mild amblyopia.

75
Q

What is the typical nature of microtropias?

A

Microtropias are typically esotropic, but may also present as exotropia or vertical microtropia.

76
Q

What is a common clinical presentation of microtropia?

A

Decreased visual acuity in one eye, not fully corrected by refraction.

77
Q

What is the relationship between uncorrected anisometropia and microtropia?

A

Uncorrected anisometropia is present in nearly all cases of microtropias, commonly associated with hyperopia or hyperopic astigmatism.

78
Q

What findings are typically revealed during a fundus examination in microtropia?

A

No ocular pathology is revealed.

79
Q

What is usually evident in the affected eye of a patient with microtropia?

A

A central foveal suppression scotoma.

80
Q

What is a common occurrence in patients with microtropia despite having a suppression scotoma?

A

Para-foveolar fixation.

81
Q

What is the typical effect of microtropia on stereopsis?

A

Reduced stereopsis, rarely completely absent.

82
Q

What correlation exists in microtropia?

A

A correlation exists between the angle of deviation and the degree of stereoacuity possible.

83
Q

What tests should be carried out meticulously in suspected microtropia cases?

A

Cover test, cover-uncover test, and alternating cover test.

84
Q

What is indicated by a positive alternating cover test in patients with central fixation?

A

Movement is observed.

85
Q

What is ‘microtropia without identity’?

A

Eccentric fixation and anomalous retinal correspondence where the angle of anomaly is not equal to the degree of eccentric fixation, resulting in a positive alternating cover test.

86
Q

What is ‘microtropia with identity’?

A

Eccentric fixation and anomalous retinal correspondence where the angle of anomaly is equal to the degree of eccentricity, resulting in a negative alternating cover test.

87
Q

What may raise suspicion for microtropia?

A

Reduced unilateral visual acuity with binocular single vision.

88
Q

What is the next step if the cover test is negative?

A

Further investigation of fixation is necessary.

89
Q

What confirms the diagnosis of microtropia if there is non-foveolar fixation?

A

The diagnosis of microtropia may be confirmed.

90
Q

What is the purpose of the 4-Diopter Base-Out Prism Test?

A

To diagnose foveal suppression and microtropia

Microtropia is a form of strabismus where the misalignment is subtle.

91
Q

What type of prism is typically used in the 4-Diopter Base-Out Prism Test?

A

4-diopter prism

The orientation is typically base-out because most microtropias are esotropias.

92
Q

What is the initial action of the patient during the test?

A

The patient fixates on a penlight

93
Q

What happens to the light rays when the prism is kept in front of the right eye?

A

The rays of light deviate towards the base of the prism

This causes the light to move away from the fovea in the right eye.

94
Q

According to Hering’s Law, what occurs after the right eye adducts?

A

An equal abduction movement of the left eye occurs

95
Q

What must the left eye do to re-fixate the light on the fovea?

A

The left eye must adduct

96
Q

What occurs if a prism is placed before the left eye of a patient with right eye microtropia?

A

Adduction movement of the left eye occurs, leading to equal abduction of the right eye

This confirms foveal suppression in the microtropic right eye.

97
Q

What happens when a prism is placed before the right eye of a patient with a microtropia?

A

There will be no movement at all

This confirms the diagnosis of microtropia as the light is still within the central suppression area.

98
Q

What does anomalous correspondence (AC) occur under?

A

Binocular fusion

99
Q

What typically happens to a patient with strabismus regarding their vision?

A

They either see diplopia or suppress the image from the strabismic eye

100
Q

What indicates that a patient has anomalous correspondence?

A

The ability to fuse the images in each eye despite strabismus

101
Q

What is the purpose of anomalous correspondence in the visual system?

A

To reorganize the visual direction of the deviating eye

102
Q

In anomalous correspondence, what becomes the corresponding point to the fovea of the fellow eye?

A

A non-foveal point

103
Q

What problem does anomalous correspondence help to overcome?

A

Confusion and diplopia

104
Q

What is harmonious anomalous correspondence?

A

A sub-category of anomalous correspondence where sensory adaptation compensates for the angle of strabismus

105
Q

Why is it called ‘harmonious’ anomalous correspondence?

A

Because the angle of anomaly is equal to the objective angle of strabismus

106
Q

What can be measured on a cover test in cases of harmonious anomalous correspondence?

A

No subjective angle of strabismus

107
Q

What is it called when another part of the retina (other than the fovea) is used for fixation?

A

Eccentric fixation

Eccentric fixation can occur under both monocular and binocular viewing conditions.

108
Q

Under what viewing conditions is eccentric fixation best diagnosed?

A

Monocular viewing conditions

Eccentric fixation can be present in both monocular and binocular conditions but is best assessed monocularly.

109
Q

In esotropia, which retinal point is typically used for fixation?

A

A point on the nasal retina

Esotropia is characterized by inward eye deviation.

110
Q

In exotropes, which retinal point is generally used for fixation?

A

A temporal retinal point

Exotropia is characterized by outward eye deviation.

111
Q

What additional displacement is often observed in the eccentric fixation point?

A

Vertical displacement

The eccentric fixation point may be displaced vertically in addition to its lateral position.

112
Q

What is the easiest way to diagnose eccentric fixation?

A

Visuoscopy with a direct ophthalmoscope

This method involves observing the foveal light reflex while the patient looks at a target.

113
Q

What should be done to the eye not being tested during the diagnosis of eccentric fixation?

A

It should be occluded

This ensures that the patient focuses solely with the eye being tested.

114
Q

What indicates that a patient is using a different point of the retina to fixate in eccentric fixation?

A

The foveal light reflex will not be centered

This observation shows that fixation is not occurring at the fovea.

115
Q

What is the eccentric fixation point?

A

The retinal point located at the center of the fixation target

This point reflects where the patient is actually fixing their gaze.

116
Q

What factors should be noted about the eccentric fixation point?

A

Direction relative to the fovea, magnitude, and fixation stability

Each of these factors provides insight into the nature of the eccentric fixation.

117
Q

What is refractive amblyopia?

A

Refractive amblyopia results from either isometropic or anisometropic uncorrected refractive errors.

Isometropic refers to high but approximately equal refractive errors, while anisometropic refers to significantly unequal refractive errors.

118
Q

What is the impact of isometropic refractive errors on visual development?

A

Isometropic refractive errors create a blurred image on both retinas, leading to a subtle type of form deprivation that can delay normal neurophysiologic development of the visual pathway and visual cortex.

This form deprivation can affect visual acuity.

119
Q

What range of visual acuity loss can patients with isometropic amblyopia experience?

A

Patients can have visual acuity loss ranging from 20/25 to 20/200, with the majority having 20/50 acuity or better.

This indicates a variety of severity in visual impairment.

120
Q

What causes anisometropic amblyopia?

A

Anisometropic amblyopia is caused by uncorrected refractive errors where the difference between the major meridians of each eye causes a clinically significant blurred image in the eye with the greater refractive error.

This disparity affects visual processing.

121
Q

How does the degree of anisometropia relate to visual acuity loss?

A

Typically, the greater the anisometropia, the more severe the visual acuity loss will be.

This relationship highlights the importance of correcting refractive errors.

122
Q

Which type of anisometropia carries a greater risk of amblyopia?

A

Patients with hyperopic anisometropia are at greater risk than those with larger amounts of myopic anisometropia.

This is because hyperopes use the less hyperopic eye for fixation at all distances.

123
Q

What are the potentially amblyogenic refractive errors according to AOA Clinical Practice Guidelines?

A

The potentially amblyogenic refractive errors include:
* Isoametropia
* Hyperopia: >5.00 D
* Myopia: >8.00 D
* Astigmatism: >2.50 D
* Anisometropia:
* Hyperopia: >1.00 D
* Myopia: >3.00 D
* Astigmatism: >1.50 D

These thresholds indicate significant refractive errors that may lead to amblyopia.

124
Q

Astigmatic dial without prescription which set of lines perceived clearest?
Habitual Rx axis OD: 009, OD: 171

A

Use rule of 30 in reverse
(Rule of 30 states axis can be calculated by multiplying lowest clock hour pt sees clearly by 30)

*pt axis is around 180 both eyes
180/30=6
Therefore the lowest clock hour the patient will see clearly is 6:00, thus pat will see 6:00 to 12:00 line the clearest

NBEO Part 2 (20 decks)

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