Station 2 Flashcards
Vergence therapy modifications: easier
Conv/BO: minus lenses, BI prism, incr working distance
Div/BI: plus lenses, BO, incr working distance
Vergence therapy modifications: harder
Conv/BO: plus lenses, BO, decr working distance
Div/BI: minus lenses, BI, decr working distance
Brock String
- purpose/category
- procedure
- coaching
- recording
Vergence Awareness
Unattached end b/w index and thumb, thumb to the nose
Dr covers each eye to demonstrate viewing changes/app of “both” strings, one from each opposite ear
Pt looks at a bead, asked where the two strings intersect - at (o), behind (exo), front (eso)
Facility - look from bead to bead
Eso/front = relax, think about looking behind the bead Exo/behind = look hard, think about looking in front of the bead
Beads at 8in, 20in, 50in
Pt is able to appreciate the x, no suppression noted
Pt states x of middle bead crosses slightly behind. Coached to “look harder”
Pt was able to perform 5 cycles moving b/w beads
Barrel Card
- purpose/category
- procedure
- coaching
- recording
Vergence Awareness
Pt holds the card like a septum, converge their eyes at furthest barrel. Ask about luster, let dr know if not there. If difficulty, hold card 5-8cm from nose.
Try closer barrels. Practice back and forth.
Watch pts eyes, give feedback
“Look hard” and “cross the eyes”
If still difficult, have pt pinch both sides of the card (proprioceptive feedback)
Barrel card held at bridge
Pt able to fuse furthest and middle barrel, hold for 5 sec
Unable to fuse nearest.
Coached to tighten eyes
Wheatstone Stereoscope
- purpose/category
- procedure/coaching
- recording
Tonic Range Extension
Start at ortho (or objective angle for constant strab), nose against W
Ask if they see suppression checks
Div/BI - gradually/slowly widen while coaching to “relax”. Once fusion is broken, decr demand until recover
Conv/BO - gradually/slowly narrow while coaching to “look hard”. Once fusion is broken, decr demand until recover
Goal: 10BI, 20BO (D)
15BI, 30BO (N)
BI: 14pd break, 8pd recovery
BO: 12pd break, 6 recovery
Pt had difficulty with convergece, was coached to “cross their eyes”
Brewster Stereoscope
- purpose/category
- set up
- procedure
- coaching
- recording
Tonic vergence extension
Stereoscope w/ +5.00 lenses and 95mm separation of optical centers
2nd/3rd degree targets (cards)
Method 1: first card at far point (20cm), look at the targets and fuse them, check suppression controls. Move to next card in sequence, etc.
Method 2: BOP/BIM tromboning
BO/PFV - start close (least BO demand), gradually move away
BI/NFV - start far (least BI demand), slowly move in
BO/PFV = “look hard”, “pretend you’re looking closer” BI/NFV = “relax”, “think about looking thru the target like a window”
Pt was able to fuse up to 4BI and 10BO
Tromboning: difficulty with moving BI targets closer. Coached to relax the eyes
No suppression or blur noted
Vectogram
- purpose/category
- procedure/coaching
- recording
Tonic Range Extension
Polarized glasses, eye level, start at ortho, ask about suppression checks and 3D app - demonstrate by alternately covering, instruct to inform dr if suppressing Est. SILO awareness Train divergence (BIL)/NFV - coach to “relax”, “look far”. Once fusion is broken coach to regain by “looking thru the target” Train convergence (BON)/PFV - coach to “look hard”, “cross the eyes”. Once fusion is broken, coach to regain.
Tonic extension: BI: H break/C recovery
BO: 20pd break, 16pd recovery
Pt had difficulty with divergence, was coached to “relax”. No suppression noted
Variable Tranaglyph
- purpose/category
- set up
- procedure/coaching
- recording
Tonic Range Extension
RG glasses, 40cm, start at zero, ask about suppression R/L
SILO check: place G 2-4pd right for BI, slowly move R 2-4 pd right for BO
Do extensions: break/recovery CORR, DIGR
Conv/BO training - R to right, “look hard”, “keep the eyes crossed”
Div/BI training - G to right, “relax”, “look thru the target”
Goal: 15-20 BI, 25-30BO
Tonic extension: BI: 15 break/10 recovery
BO: 18 break/14 recovery
No significant differences in BI/BO. No suppression noted
Pt appreciated SILO effect
Variable Tranaglyph/Vectogram Jumps
- purpose/category
- set up
- procedure
- coaching
- recording
Jump Vergence Extension
RG glasses, start ortho, ask about R/L suppression checks and 3D app
Recoveries: slowly separate while keeping targets fused, every few pds have pt break fusion by closing eyes, recovery as quickly as possible
Goal: P and 33 easily
Jumps: 2 vectograms - top BI D (4pd), bottom BO 7 or 8pd. Instruct pt to alternatively fuse BI and BO targets
Watch pts eyes - conv with BO, div with BI. Ask if target is double or flat, ask about SILO
Conv/BO - “look hard”, “cross the eyes”
Div/BI - “relax”, “think about looking thru the target”
Phasic Extension (Recoveries): able to fuse 10BI and 12 BO. No suppression noted. Phasic Extension (Jumps): able to jump b/w 10BI and 25BO. More difficult with BI. Coached to relax their eyes. No suppression noted
Non-Variable Tranaglyph
- purpose/category
- set up
- procedure
- coaching
- recording
Jump Vergence Extension
RG glasses, R over OD, 40cm
Phasic Extension: easiest card, G to R (BI) then R to R (BO). Move to next card until reach goal: 20BI, 30BO
Jumps: top slide BC/51 backwards (G to right/BI) and bottom slide BC/52 (R to right/BO). Ask pt to fuse alternatively, periodically check suppression. Continue until goal: 20BI, 30BO.
DIGR/BI = “relax”, “look thru the target” CORR/BO = “look hard”, “cross the eyes”
Phasic Extension (Recoveries): able to fuse 10BI and 12 BO. No suppression noted. Phasic Extension (Jumps): able to jump b/w 18BI and 15BO. More difficult with BI. Coached to relax their eyes. No suppression noted
Aperture Rule
- purpose/category
- set up/procedure
- coaching
- recording
Chiastopic/Orhtopic Fusion
Conv/Chiast: single aperture, booklet on shaft at zero, first card. OD should see L target, vice versa. Converge eyes thru single aperture. Once clear, alternately look over the flip card to distance, then back to regain fusion.
Div/Orthop: double aperture, same set up. OD should see R target. Diverge eyes thru apertures. Once clear, alternate b/w distance and card.
BOTH: once successful on a card, move to next, more difficult card
Conv/Chaist = “cross eyes”, “relax focusing” to decr accommodation Div/Orthop = “relax eyes”, “tighten focusing” to incr accommodation
Able to fuse 10pd BI and 20BO
No suppression noted. Convergence targets were blurry, coached to tighten eyes while relaxing focusing to obtain clarity.
Lifesaver Card and Eccentric Circles
- purpose/category
- procedure
- coaching
- recording
Chiastopic/Orthopic
Conv/Chiast: opaque card, 40cm, pointer b/w card and nose. Slowly move pointer away while keep focus on it. Notice third circle at the pointer. Instruct pt to clear it, hold for 10 seconds, remove pointer and hold another 10 seconds.
Div/Orthop: clear card, 40cm, pointer behind card. Slowly move pointer away.
Conv/BO/Chais = “cross your eyes”, “think about looking close” Div/BI/Orthop = “relax your eyes”, “think about looking far”
Divergence training: able to fuse bottom targets and hold 10 seconds. Able to perform without a pointer
Convergence training: able to fuse bottom targets and hold 10 seconds. Unable to fuse without pointer.
Pt appreciated depth when fused.
