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Z. Vision Therapy — Class Final > Vergence > Flashcards

Vergence Flashcards

1
Q

T/F: Bifoveal vision is mandatory for RDS

A

TRUE

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2
Q

T/F: Pt w/ CAET may see RDS

A

FALSE

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3
Q

T/F: Pt w/ IRXT may see RDS

A

TRUE; sometimes

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4
Q

Each Category of Vergence Dysfunctions (1-4), all are subdivided into Low (___ at distance), Normal (ortho at distance), and High (___ at distance)

A

Low — exo
High — eso

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5
Q

Why do we not want to correct LOW hyperopes with CI (that can accommodate)?

A

(+) can worsen CI

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6
Q

T/F: CI pts have excellent early prognosis with VT

A

TRUE; 85-95% success

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7
Q

What is the most common non-strabismus Vergence diagnosis?

A

CI

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8
Q

CI struggles with ____ (BI/BO)

A

BO; can’t converge

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9
Q

T/F: CI may cause suppression at N

A

TRUE

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10
Q

Who HATES (+)?

A

AE and CI

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11
Q

T/F: For CI pts, NV will be worse in the morning

A

FALSE; end of day

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12
Q

T/F: Add power is appropriate for CI pts

A

FALSE

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13
Q

When should we consider NOT Rxing BI prism for CI pt?

A

If SRx is FTW and pt is ortho at D —> will make them eso at D :(

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14
Q

Small lag/lead seen in (3)

A
  1. AE
  2. CI
  3. Basic exo
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15
Q

Systemic DDX for CI’s include (7)

A
  1. Ischemic infarction
  2. Myasthenia Gravis
  3. Infection (Viral/Flu)
  4. Demyelination (MS)
  5. Parkinson’s
  6. Parinaud’s
  7. Trauma
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16
Q

Parinaud’s Syndrome

A

Ophthalmoplegia 2/2 midbrain lesions:
1. Paralysis of conjugate mvmt
2. Upgaze paralysis
3. Nystagmus on attempted convergence
4. Light near dissociation
5. Bilateral papilledema

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17
Q

Associated Phoria is measured in ___, while Fixation disparity ins measured in ___

A

PD, mins of arc

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18
Q

Fixation disparity is measured under ___ (Associated/Dissociated) conditions

A

Associated (unlike phoria)

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19
Q

Least common/studied non-strabismic Vergence Dx

A

Divergence Insufficiency

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20
Q

Why is prism more effective for DI vs CI?

A

BO prism will make pt a bit more exo, which is acceptable

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21
Q

T/F: Add is an appropriate TX for DI

A

FALSE

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22
Q

DDX for DI: (2)

A
  1. 6th Nerve Palsy (noncomitant deviation + endpoint nystagmus)
  2. Divergence paralysis (sudden onset homonymous diplopia)
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23
Q

Basic ESO pts struggle with ___ (BI/BO) due to their limited ___ (NFV/PFV); this is also why they struggle with ___ (minus/plus)

A

BI; NFV; minus

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24
Q

Basic ESO has a Type ___ FD curve

A

2

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25
Q

Basic ESO has a ___ (smaller/larger) lag

A

LARGE; due to Accommodative Vergence (trying to diverge by relaxing/lessening accommodation)

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26
Q

Basic EXO pts struggle with ___ (BO/BI) due to their limited ___ (NFV/PFV); also why they struggle with ___ (minus/plus)

A

BO; PFV; plus

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27
Q

Basic EXO has a Type ___ FD curve

A

3

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28
Q

T/F: Binocular Instability has an excellent prognosis with VT

A

TRUE

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29
Q

Binocular Instability is aka

A

Fusional Vergence Dysfunction

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30
Q

In Binocular Instability, ___ (NRA/PRA) will likely be reduced

A

BOTH

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31
Q

What binocular dysfunction can simulate Binocular Instability?

A

Pt with both Accomm and Vergence Issues

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32
Q

T/F: Prism is an appropriate TX for Binocular Instability

A

FALSE; fails BO and BI

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33
Q

DDX for Fusional Vergence Dysfunction (7)

A
  1. AI
  2. Latent hyperopia
  3. Vertical/cyclo-deviation
  4. FD
  5. Aniseikonia
  6. Medication induced
  7. Sensorimotor issue
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34
Q

DDX for CE (4)

A
  1. Acc/Conv spasm due to inflammation (eg, iritis, scleritis, uveitis)
  2. Sympathetic paralysis
  3. Syphilis
  4. Drugs (seediness, pilo, VitB1, sulfonamides)
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35
Q

CE will show a ___ (larger/smaller) EP at NEAR

A

Larger

36
Q

CE pts hate ___ (BI/BO) due to their limited ___ (NFV/PFV); also, they struggle with ___ (plus/minus)

A

BI, NFV, minus

37
Q

Prognosis for CE in VT

A

“Good to very good” (no excellent) — 62-84%

38
Q

T/F: Add is appropriate for CE pts

A

TRUE

39
Q

DE: more ___ (eso/exo) at ___ (distance/near)

A

Exo at distance

40
Q

Who closes their eyes in bright light?

A

CI or DE

think near triad

41
Q

T/F: pts with DE will have reduced BO and increased BI

A

FALSE; normal/limited DBI and adequate DBO

42
Q

T/F: Low NFV/DBI can occur in both DI and DE pts

A

TRUE

43
Q

“Hypo” is reserved for vertical ____ (phoria/tropia)

A

TROPIA

44
Q

T/F: vertical phorias remain similar at all distances

A

TRUE

45
Q

Parks 3 Step

A
  1. Hyper (R or L)
  2. Worse in which gaze (R or L)
  3. Worse in which head tilt (R or L)
46
Q

Parks 3: Right hyper, left gaze worsens, and right head tilt indicates

A

RSO (CN 4) Palsy

47
Q

Parks 3: Left hyper, right gaze worsens, and left head tilt indicates

A

LSO (CN 4) Palsy

48
Q

Refer to systemic/endo/neuro if hyper + (3)

A
  1. Recent onset diplopia
  2. Non-comitant EOMs
  3. VF defect
49
Q

Binocular vision DDXs for Dry Eye (5)

A
  1. CI
  2. Accommodative Dysfunctions
  3. Vertical Imbalance
  4. FD
  5. Proprioceptive Disparity
50
Q

NON-accommodative target NPC removes ___, therefore, you are only testing ___

A

Accommodative Vergence;
Fusional & Proximal Vergence

51
Q

Difference between Pseudo CI & TRUE CI

A

In Pseudo CI…
1. NPC: acc ≈ non-accom target
2. Additional (+) at near —> improved NPC
3. Possible low PRA and BAF (AI hates minus)
4. Low amps, large lag, low MAF

REMEMBER: Pseudo CI = AI

52
Q

Keystone: Card 1

A

Dog/Pig: checks simultaneous perception

53
Q

Keystone: Card 2

A

Line through the circle;
Checks vertical posture

54
Q

Keystone: Card 3

A

Arrow pointing at number;
Checks horizontal posture

55
Q

Card 3 is for distance; Card ___ is the same card but for near

A

10

56
Q

Keystone: Card 4

A

4 Circles (red, green, white);
Checks H posture & flat fusion

57
Q

Card 4 is for distance; Card ___ is the same card but for near

A

11

58
Q

Which Rx used for Keystone?

A

Distance at distance; near at near

59
Q

Rx for Cheiroscope Tracing?

A

Distance

60
Q

Chiroscope Tracing: midline of design should be lined up with

A

0

not NP 0

61
Q

Cheiroscope: if the pt is LEFT handed, the blank side should be on the ___ side

A

LEFT

62
Q

Cheiroscope Tracing: a separation of ___ indicates ortho ; greater indicates ___, less indicates ___

A

68 mm
Greater = exo
Less = eso

63
Q

Cheiroscope: If pt’s separation is 64 mm, describe the pt’s posture

A

2 PD eso

2 mm = 1 PD
> 68 = exo
< 68 = eso

64
Q
A

Right Hyper

65
Q
A

ESO shift

66
Q
A

HIGH eso

67
Q
A

Anisometropia OR pt’s drawing (not tracing)

68
Q

What do you measure for Van Orden (VO) Star?

A

Tips of triangles

69
Q

Vectogram: letters = ___ (BI/BO)

A

BI

70
Q

Vectogram: numbers = ___ (BI/BO)

A

BO

71
Q

What should be assessed on vectogram? (5)

A
  1. Blur/Break/Recovery
  2. Float
  3. Localization
  4. SILO vs SOLI
  5. Parallax
72
Q

SOLI vs SILO: what happens in real life?

A

SOLI

73
Q

SILO vs SOLI: what is the expected for this test?

A

SILO

74
Q

Parallax: with BO, pt should see ___ (with/against) mvmt

A

WITH

75
Q

T/F: Barrel cards are mainly used for training CE

A

FALSE!! Trains CI (not CE)

76
Q

Management Considerations (4)

A
  1. Optical/refractive correction
  2. Fusional prism
  3. Plus/minus added, as needed
  4. Vision Therapy
77
Q

VT can be considered for…

A
  1. Anti-suppression
  2. Sensory Motor: Improve Fusional Vergence, Accommodation, and Versional Accuracy
78
Q

What does jump duction measure?

A

Recovery

79
Q

What is measured in BOP/BIM?

A

Recovery

80
Q

Lifesaver: Transparent card is associated with ___ (BI/BO)

A

BI

81
Q

Lifesaver: Opaque card is associated with ___ (BI/BO)

A

BO

82
Q

Lifesavers: increase difficulty with BO

A

Try to “look close” + move card forward and backwards

83
Q

Lifesavers: if difficulty with BI

A

Try “looking far”

84
Q

Lifesavers: increase difficulty

A

Move cards H, V, and circular

85
Q

Aperture Rule: Single Windows trains

A

PFV

86
Q

Aperture Rule: Double Windows trains

A

NFV

Z. Vision Therapy — Class Final (7 decks)

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