Vergence Theory & Programming

Question 1

Remember from earlier PPs:

Answer 1

start where the patient has success, work through the phases, treat amblyopia early

Question 2

What are the 6 phases of VT?

Answer 2

optimal lens prescription, gross motor, monocular, bi-ocular, binocular, binocular with loading

Question 3

T/F you may need to sacrifice VA for better alignment

Answer 3

true

Question 4

You should prescribe as to…

Answer 4

encourage optimal acuity and binocularity, consider prism to aid fusion as needed

Question 5

What is very important for patient with fusional difficulty?

Answer 5

gross motor

Question 6

Many patients have associated difficulty with visually guided learning such as:

Answer 6

reading, writing, motor coordination, eye-hand coordination

Question 7

What is the purpose of the monocular phase?

Answer 7

to match skills between eyes (tracking and accommodation

Question 8

What are possible monocular procedures?

Answer 8

NFHC, letter/Michigan tracking, pegboard rotator, Wayne saccadic fixator, MAR

Question 9

When can you move on to bi-ocular?

Answer 9

when skills in each eye are roughly equal. when skills in each eye are normal

Question 10

What should you aim for before moving from monocular to bi-ocular?

Answer 10

ability to: stimulate and relax accommodation, make accurate and quick large and small saccades, make accurate pursuits for both slow and fast targets

Question 11

What is the rule of thumb for monocular to bi-ocular?

Answer 11

when the patient has successfully completed many different therapies over several sessions and you can’t make the activities more challenging… move on!

Question 12

What is the bi-ocular phase?

Answer 12

achieve simultaneous perception (1st degree fusion), appreciate physiological diplopia, minimize or eliminate suppression

Question 13

When should you move from the bi-ocular phase to the binocular phase?

Answer 13

slowly add in more challenging bi-ocular/MFBF therapies, make patient aware of diplopia and where eyes are pointing

Question 14

What is the binocular phase?

Answer 14

work from peripheral to central stereo for general BV dysfunctions (strabismus and amblyopia will work differently)

Question 15

During which phase do you move through the three degrees of fusion?

Answer 15

binocular

Question 16

What are the three degrees of fusion?

Answer 16

simultaneous perception, flat fusion (luster), and stereopsis

Question 17

What is the binocular with loading phase?

Answer 17

working on refinements including automaticity of visual skills and flexibility

Question 18

What skills can one develop flexibility in?

Answer 18

accommodative, vergence, accom/vergence interaction

Question 19

What are possible ways to load binocular skills?

Answer 19

cognitive loading, balance board, lenses, prisms

Question 20

What are the guidelines for training fusional vergence?

Answer 20

ensure monocular skills are equal. ensure anti-suppression has been successful, and begin working on vergence where the patient can succeed

Question 21

Should you start with peripheral or central fusion and larger or smaller targets first?

Answer 21

start peripheral fusion/larger targets

Question 22

Always emphasize ___ before ___

Answer 22

quality, quantity

Question 23

T/F you should never allow for blur when training fusional vergence

Answer 23

false, you should allow some blur if it helps with fusion– at first

Question 24

Which is worked on first, smooth vergence or step/jump vergence?

Answer 24

smooth vergence

Question 25

What do you end vergence therapy with?

Answer 25

BOP/BIM

Question 26

What is BOP?

Answer 26

base out/plus aka convergence/divergence

Question 27

What is BIM?

Answer 27

base in/minus aka divergence/convergence

Question 28

What are types of feedback with vergence activities?

Answer 28

diplopia, blur, suppression, luster, kinesthetic awareness, SILO, float, localization, parallax

Question 29

What information does diplopia feedback give?

Answer 29

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

Question 30

What information does blur feedback give?

Answer 30

the patient is over or under using accommodation relative to the target's location, often used as a way to overcome a vergence deficit

Question 31

If suppression is significant what must you do to your VT program?

Answer 31

go back to bi-ocular activities

Question 32

T/F vergence techniques contain suppression checks

Answer 32

true

Question 33

What is luster?

Answer 33

the perception of a combination of colors, indicates 2nd degree fusion

Question 34

What colors does luster usually involve?

Answer 34

red/green to get a yellowish blend

Question 35

What does it mean if the patient perceives SOLI?

Answer 35

what they "know" overrides the visual information

Question 36

What is float?

Answer 36

the perception that a target is floating closer or farther away than the actual target location when vergence demand is changed

Question 37

What perception is float a part of?

Answer 37

SILO

Question 38

What is localization?

Answer 38

the ability to determine where the target appears to be in space when fusion has occured

Question 39

What is parallax?

Answer 39

the appreciation of movement of a target as the patient moves

Question 40

What direction does parallax move with convergence?

Answer 40

moves in the same direction as the patient

Question 41

What direction does parallax move with divergence?

Answer 41

moves in the opposite direction

Question 42

What are examples of bi-ocular/anti-suppression therapies?

Answer 42

cheiroscopic traces, red pen coloring, Russell ring fixations, MFBF matching game, Sherman R/G playing cards, VO star, squinchel

Question 43

What technique is good for deep suppression?

Answer 43

mirror overlap or luster

Question 44

What does mirror overlap do?

Answer 44

stimulates 1st degree fusion (simultaneous perception)

Question 45

What is the objective of mirror overlap?

Answer 45

place two dissimilar objects on top of each other using the mirror, want both channels on at the same time

Question 46

What does luster do?

Answer 46

red/green penlight can be used for any distance (easiest ceiling light, harder non-illuminated target)

Question 47

What bi-ocular/anti-suppression technique is great for younger patients?

Answer 47

TV trainer

Question 48

What is an example of passive bi-ocular therapy?

Answer 48

TV trainer

Question 49

What is the TV trainer particularly useful for?

Answer 49

distance suppression in younger patients

Question 50

What is Vis-a-vis?

Answer 50

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

Question 51

Is Vis-a-vis good for distance or near suppression?

Answer 51

both

Question 52

What are methods for breaking suppression?

Answer 52

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)

Question 53

What is one of the best targets for breaking suppression in adults?

Answer 53

candle

Question 54

What are vergence therapies?

Answer 54

C-P saccades, brock string, vectogram, barrel card, eccentric circles, lifesaver card, dissociated marsden ball, aperture rule, visicare cards, AN series

Question 55

What is flashlight pointing?

Answer 55

similar to C-P saccades but higher level; exchange stick with flashlight and X with Hart chart

Question 56

What does flashlight pointing enhance?

Answer 56

peripheral awareness while making central saccades

Question 57

What areas does flashlight pointing work on?

Answer 57

accuracy, ability, head movement, body movement

Question 58

What is see 3 coins?

Answer 58

patient uses two coins and fuses to make the third appear, usually done with convergence, coins should be kept clear

Question 59

How can you help localize see 3 coins at first?

Answer 59

use a pointer

Question 60

What are computer activities?

Answer 60

vision builder, computer orthoptics, VTS 3/VTS4, vivid vision VR system, includes vergence and oculomotor, Sanet vision integrator

Question 61

What conditions is vergence work important for?

Answer 61

all of them, accommodative, binocular, oculomotor