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Vision Therapy > Vergence Theory & Programming > Flashcards

Vergence Theory & Programming Flashcards

1
Q

Remember from earlier PPs:

A

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

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2
Q

What are the 6 phases of VT?

A

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

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3
Q

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

A

true

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4
Q

You should prescribe as to…

A

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

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5
Q

What is very important for patient with fusional difficulty?

A

gross motor

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6
Q

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

A

reading, writing, motor coordination, eye-hand coordination

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7
Q

What is the purpose of the monocular phase?

A

to match skills between eyes (tracking and accommodation

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8
Q

What are possible monocular procedures?

A

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

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9
Q

When can you move on to bi-ocular?

A

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

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10
Q

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

A

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

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11
Q

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

A

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

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12
Q

What is the bi-ocular phase?

A

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

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13
Q

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

A

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

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14
Q

What is the binocular phase?

A

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

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15
Q

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

A

binocular

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16
Q

What are the three degrees of fusion?

A

simultaneous perception, flat fusion (luster), and stereopsis

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17
Q

What is the binocular with loading phase?

A

working on refinements including automaticity of visual skills and flexibility

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18
Q

What skills can one develop flexibility in?

A

accommodative, vergence, accom/vergence interaction

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19
Q

What are possible ways to load binocular skills?

A

cognitive loading, balance board, lenses, prisms

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20
Q

What are the guidelines for training fusional vergence?

A

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

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21
Q

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

A

start peripheral fusion/larger targets

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22
Q

Always emphasize ___ before ___

A

quality, quantity

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23
Q

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

A

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

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24
Q

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

A

smooth vergence

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25
Q

What do you end vergence therapy with?

A

BOP/BIM

26
Q

What is BOP?

A

base out/plus aka convergence/divergence

27
Q

What is BIM?

A

base in/minus aka divergence/convergence

28
Q

What are types of feedback with vergence activities?

A

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

29
Q

What information does diplopia feedback give?

A

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

30
Q

What information does blur feedback give?

A

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

31
Q

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

A

go back to bi-ocular activities

32
Q

T/F vergence techniques contain suppression checks

A

true

33
Q

What is luster?

A

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

34
Q

What colors does luster usually involve?

A

red/green to get a yellowish blend

35
Q

What does it mean if the patient perceives SOLI?

A

what they “know” overrides the visual information

36
Q

What is float?

A

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

37
Q

What perception is float a part of?

A

SILO

38
Q

What is localization?

A

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

39
Q

What is parallax?

A

the appreciation of movement of a target as the patient moves

40
Q

What direction does parallax move with convergence?

A

moves in the same direction as the patient

41
Q

What direction does parallax move with divergence?

A

moves in the opposite direction

42
Q

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

A

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

43
Q

What technique is good for deep suppression?

A

mirror overlap or luster

44
Q

What does mirror overlap do?

A

stimulates 1st degree fusion (simultaneous perception)

45
Q

What is the objective of mirror overlap?

A

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

46
Q

What does luster do?

A

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

47
Q

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

A

TV trainer

48
Q

What is an example of passive bi-ocular therapy?

A

TV trainer

49
Q

What is the TV trainer particularly useful for?

A

distance suppression in younger patients

50
Q

What is Vis-a-vis?

A

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

51
Q

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

A

both

52
Q

What are methods for breaking suppression?

A

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)

53
Q

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

A

candle

54
Q

What are vergence therapies?

A

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

55
Q

What is flashlight pointing?

A

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

56
Q

What does flashlight pointing enhance?

A

peripheral awareness while making central saccades

57
Q

What areas does flashlight pointing work on?

A

accuracy, ability, head movement, body movement

58
Q

What is see 3 coins?

A

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

59
Q

How can you help localize see 3 coins at first?

A

use a pointer

60
Q

What are computer activities?

A

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

61
Q

What conditions is vergence work important for?

A

all of them, accommodative, binocular, oculomotor

Vision Therapy (21 decks)

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