prefi 1 Flashcards
BEST AMBLYOPIA MANAGEMENT (3)
Prescription lenses
Vision therapy
Patching
if the px has EOR, we must give this especially if refractive in origin
Prescription lenses
Types of Prescription lenses (2)
- Compensatory Lenses
- Treatment Lenses
is defined as a lens that restores standard (20/20, 6/6, 1.0) visual acuity at distance and in the case of a presbyope, includes an add.
Compensatory Lenses
- More on the grade of the patient
- THIS IS USUALLY PRESCRIBED to PX
COMPENSATORY LENS
- For example, patient has presbyopia, we give plus lenses or progressive, as long as the purpose is to clear the 20/20 best standard VA at near
COMPENSATORY LENSES
type of rx lens Any time a lens other than the compensatory lens is given
Treatment Lenses
treatment lenses is for: (3)
- Reduce visual stress
- Treatment of Visual conditions
- Any add that is not directly related to aging
reduce visual stress treatment lens (3)
prism
plus lens at near
anti fatigue lens
o Example, patient is 4 years old and you checked is near. 13A is ortho. The visual system is not okay, so it is better to give plus lenses at near or at all distance.
reduce visual stress (treatment lenses )
o For example, Px has CI so lack of convergence (there is divergence), we can give lenses or prisms. We can give plus lenses in order to treat insufficiency in accommodation
- Treatment of Visual conditions
o treatment lenses are not lenses alone but also prisms as long as it has a purpose that is different aside from VA
true
o Patients that are strabismus or amblyopic that need reading lenses.
o Best is Flat top and executive, and last is PAL.
o Flat Tops are difficult to prescribe because the patient might be bullied about it.
o Flat top is the best choice because the prism jump is lesser compared to Kryptok. If he looks at far and near, it won’t cause too much “lipong”
o Our bifocals have a “Prism Base Up” effect. If they look at the reading portion, they might get dizzy.
add that is not directly related to aging
Improve Amblyopia to 20/80 or better
Let’s say VA is worse than 20/80 without pathology.
Specific activities are prescribed to improve visual acuity in the amblyopic eye to at least 20/80 level
true
Usually in VT, we do _____ first because if we compare amblyopic and non-amblyopic eye, their visual system is not equal.
There is a tendency that the amblyopic eye fixation is poor, poor accommodation, poor pursuits and saccades, poor CS.
So our first goal is to ____the monocular skills of both eyes and we can do this by occluding one eye.
Next is _____, approximately equal. We teach the two eyes to work together.
Monocular Activity
equalize
Binocular Activity
improve ambly: monocular activities to improve ____
acuity
To Patch or Not to Patch?
To Patch carefully and Actively
- Always _____/ activate the amblyopic eye
stimulate
patching:
if we stimulate the amblyopic eye ___, we stimulate the good eye once.
__not strict rule.
Thrice
3:1
TREATMENT OPTIONS FOR STRABISMUS (6)
no treatment
lenses
prism
occlusion
surgery
referrals
There are cases in that we do not need to treat strab, like ____, no symptoms, no headache, no difficulty reading, and cosmetically okay eye position. There is no treatment needed, they are well-adapted due to ARC.
SMALL ANGLE CONSTANT STRABISMIC (MICROSTRAB)
o The idea alone that the patient has ARC, he reduces the prognosis already. Making it difficult to VT compared to double vision or suppression.
o Usually the patient suppresses when the deviation is big
o It is more difficult to treat small deviations rather than big deviation.
no treatment needed
o Check if Px has EOR because sometimes, it is only the grade that’s the problem. When we put lenses, there are cases that the eyes will be ortho.
- Lenses
o Plus lenses for eso? Not all the time. depending on the case because there are others that the visual system is already not normal.
true
o Hyperope - eso Myope- exo
-
o Example, amblyopic Px has a grade of +3.00 at near, and we add +1.00, we expect exo but the px went more eso. So different visual system.
o If EOR affects alignment, is it more exo or eso? It will depend.
-
o If the patient has diplopia or double vision we can give this based on
NEUTRALIZING LENS.
o Cosmetically straighten the eyes,
TRAINING PRISM.
prism are for (3)
Neutralizing
Measuring
Correcting
o if strab/ambly is an anatomical problem or paralytic
Surgery
Remember that ‘anti-suppression activities’ are part of the strabismic’s therapy program and diplopia is a ‘needed interim’ visual response.
___________must be achieved if binocular vision is to occur.
Sensorimotor fusion
goals for VT
px has strabismus. During the VT program, there must be improvement in intermittent and phoria.
-
Optical Correction
* It is not unusual for the lens correction alone to eliminate the strabismus and to stabilize binocularity
-
- Use the least amount of plus that gets the job done (especially for kids). Leave at least a single to a double buffer uncompensated _____, unless there is a state change with more plus
(+0.75 to +1.50)
