Vergence Theory & Programming Flashcards
Remember from earlier PPs:
start where the patient has success, work through the phases, treat amblyopia early
What are the 6 phases of VT?
optimal lens prescription, gross motor, monocular, bi-ocular, binocular, binocular with loading
T/F you may need to sacrifice VA for better alignment
true
You should prescribe as to…
encourage optimal acuity and binocularity, consider prism to aid fusion as needed
What is very important for patient with fusional difficulty?
gross motor
Many patients have associated difficulty with visually guided learning such as:
reading, writing, motor coordination, eye-hand coordination
What is the purpose of the monocular phase?
to match skills between eyes (tracking and accommodation
What are possible monocular procedures?
NFHC, letter/Michigan tracking, pegboard rotator, Wayne saccadic fixator, MAR
When can you move on to bi-ocular?
when skills in each eye are roughly equal. when skills in each eye are normal
What should you aim for before moving from monocular to bi-ocular?
ability to: stimulate and relax accommodation, make accurate and quick large and small saccades, make accurate pursuits for both slow and fast targets
What is the rule of thumb for monocular to bi-ocular?
when the patient has successfully completed many different therapies over several sessions and you can’t make the activities more challenging… move on!
What is the bi-ocular phase?
achieve simultaneous perception (1st degree fusion), appreciate physiological diplopia, minimize or eliminate suppression
When should you move from the bi-ocular phase to the binocular phase?
slowly add in more challenging bi-ocular/MFBF therapies, make patient aware of diplopia and where eyes are pointing
What is the binocular phase?
work from peripheral to central stereo for general BV dysfunctions (strabismus and amblyopia will work differently)
During which phase do you move through the three degrees of fusion?
binocular
What are the three degrees of fusion?
simultaneous perception, flat fusion (luster), and stereopsis
What is the binocular with loading phase?
working on refinements including automaticity of visual skills and flexibility
What skills can one develop flexibility in?
accommodative, vergence, accom/vergence interaction
What are possible ways to load binocular skills?
cognitive loading, balance board, lenses, prisms
What are the guidelines for training fusional vergence?
ensure monocular skills are equal. ensure anti-suppression has been successful, and begin working on vergence where the patient can succeed
Should you start with peripheral or central fusion and larger or smaller targets first?
start peripheral fusion/larger targets
Always emphasize ___ before ___
quality, quantity
T/F you should never allow for blur when training fusional vergence
false, you should allow some blur if it helps with fusion– at first
Which is worked on first, smooth vergence or step/jump vergence?
smooth vergence
What do you end vergence therapy with?
BOP/BIM
What is BOP?
base out/plus aka convergence/divergence
What is BIM?
base in/minus aka divergence/convergence
What are types of feedback with vergence activities?
diplopia, blur, suppression, luster, kinesthetic awareness, SILO, float, localization, parallax
What information does diplopia feedback give?
the eyes are not aligned to the same position in space, the patient is not suppressing, physiological diplopia is often used as a self-check
What information does blur feedback give?
the patient is over or under using accommodation relative to the target’s location, often used as a way to overcome a vergence deficit
If suppression is significant what must you do to your VT program?
go back to bi-ocular activities
T/F vergence techniques contain suppression checks
true
What is luster?
the perception of a combination of colors, indicates 2nd degree fusion
What colors does luster usually involve?
red/green to get a yellowish blend
What does it mean if the patient perceives SOLI?
what they “know” overrides the visual information
What is float?
the perception that a target is floating closer or farther away than the actual target location when vergence demand is changed
What perception is float a part of?
SILO
What is localization?
the ability to determine where the target appears to be in space when fusion has occured
What is parallax?
the appreciation of movement of a target as the patient moves
What direction does parallax move with convergence?
moves in the same direction as the patient
What direction does parallax move with divergence?
moves in the opposite direction
What are examples of bi-ocular/anti-suppression therapies?
cheiroscopic traces, red pen coloring, Russell ring fixations, MFBF matching game, Sherman R/G playing cards, VO star, squinchel
What technique is good for deep suppression?
mirror overlap or luster
What does mirror overlap do?
stimulates 1st degree fusion (simultaneous perception)
What is the objective of mirror overlap?
place two dissimilar objects on top of each other using the mirror, want both channels on at the same time
What does luster do?
red/green penlight can be used for any distance (easiest ceiling light, harder non-illuminated target)
What bi-ocular/anti-suppression technique is great for younger patients?
TV trainer
What is an example of passive bi-ocular therapy?
TV trainer
What is the TV trainer particularly useful for?
distance suppression in younger patients
What is Vis-a-vis?
patient and examiner each wear a pair of polarized specs or patient wears them and looks in the mirror, if an eye disappears there is suppression
Is Vis-a-vis good for distance or near suppression?
both
What are methods for breaking suppression?
increase target brightness, use flashing targets, use moving targets, increase target contrast, use colorful targets, use larger targets (more peripheral), auditory feedback on the side of suppression, kinesthetic feedback (blink/wink)
What is one of the best targets for breaking suppression in adults?
candle
What are vergence therapies?
C-P saccades, brock string, vectogram, barrel card, eccentric circles, lifesaver card, dissociated marsden ball, aperture rule, visicare cards, AN series
What is flashlight pointing?
similar to C-P saccades but higher level; exchange stick with flashlight and X with Hart chart
What does flashlight pointing enhance?
peripheral awareness while making central saccades
What areas does flashlight pointing work on?
accuracy, ability, head movement, body movement
What is see 3 coins?
patient uses two coins and fuses to make the third appear, usually done with convergence, coins should be kept clear
How can you help localize see 3 coins at first?
use a pointer
What are computer activities?
vision builder, computer orthoptics, VTS 3/VTS4, vivid vision VR system, includes vergence and oculomotor, Sanet vision integrator
What conditions is vergence work important for?
all of them, accommodative, binocular, oculomotor
