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Vision Therapy > Visual Efficiency Diagnosis > Flashcards

Visual Efficiency Diagnosis Flashcards

1
Q

Recite the three basic steps of integrative analysis

A

1) compare individual tests to tables of expected findings 2) group the findings that deviate from expected 3) identify the syndrome based on steps 1 and 2

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2
Q

What are common signs and symptoms of vergence and accommodative anomalies?

A

blurred vision, headache, asthenopia, fatigue, diplopia, motion sickness, loss of concentration

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3
Q

Why do we need to diagnose vergence and accommodative anomalies as early as possible?

A

prevention of accommodative esotropia, prevention of decompensation into other strabismus, and prevention of academic/learning difficulties

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4
Q

What are the three categories of binocular anomalies?

A

Low AC/A, Normal AC/A, High AC/A

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5
Q

What categories of binocular anomalies do Duane-White classification fall under?

A

Low AC/A and High AC/A

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6
Q

What are low AC/A anomalies?

A

convergence insufficiency and divergence insufficiency

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7
Q

What are normal AC/A anomalies?

A

fusional vergence dysfunction, basic exophoria, basic esophoria

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8
Q

What are high AC/A anomalies?

A

convergence excess and divergence excess

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9
Q

What is convergence insufficiency?

A

exo N>D; exo at near > 4 ^; ortho or low exo at distance, receded NPC, reduced PFV (low BO); low AC/A

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10
Q

Which anomaly is often seen in early presbyopic patients when their accommodation decreases?

A

CI because they can’t compensate for convergence difficulty

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11
Q

What is the convergence insufficiency prevalence?

A

the most common of all non-strab BV disorders

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12
Q

How can you determine a pseudo-CI from a CI?

A

CI has problem with convergence, pseudo CI has accommodation problem– run CT through +1 and the pseudo CI will improve

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13
Q

What is a pseudo CI?

A

accommodative issue; reduced accommodation=less accommodative convergence

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14
Q

What presentation does a pseudo CI have?

A

greater XP at near, patient uses more PFV to maintain single vision resulting in a reduced ability to converge

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15
Q

What may a pseudo CI have that a true won’t?

A

low amps, high MEM, reduced (-) on facility

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16
Q

What is divergence insufficiency?

A

eso D>N, reduced BI at distance (NFV low), low AC/A, normal versions

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17
Q

What is the prevalence of DI?

A

least common and least studied, warning flag!

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18
Q

Why is a DI a warning flag?

A

must rule out pathology like brain stem tumors, vascular conditions, etc. especially in sudden onset, refer for MRI and check for divergence paralysis

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19
Q

Which anomaly is a red flag?

A

DI if sudden onset

20
Q

What is convergence excess?

A

eso N>D, eso at near, ortho or low eso at distance, reduced NFV (BI), high AC/A

21
Q

What is the prevalence of CE?

A

fairly common

22
Q

What is divergence excess?

A

exo D>N, greater exophoria at distance than at near, may see IXT at distance, normal stereo at near, typically normal PFV, high AC/A

23
Q

What divergence excess finding may throw you off?

A

normal PFV, this condition is often hidden until fatigue

24
Q

Which anomaly can be found in conjunction with strabismus (XT)?

A

divergence excess

25
Q

What is fusional vergence dysfunction?

A

reduced/tight PFV and NFV, normal AC/A, normal phoria at both distance and near, reduced vergence facility

26
Q

Which anomaly is subtle and hard to diagnose?

A

fusional vergence dysfunction

27
Q

What is basic esophoria?

A

normal AC/A and approximately same eso deviation at distance and near that is outside the norms, reduced NFV at both distance and near

28
Q

What range of prism diopters is ok for comparing distance and near phorias of basic eso and exo patients?

A

4-5 prism diopters

29
Q

What is basic exophoria?

A

normal AC/A with exo approximately the same at distance and near, reduced PFV at both distance and near

30
Q

What percent of patients with exo deviations are basic exophores?

A

27.6%

31
Q

What method do normative values of accommodative amplitude come from?

A

push-up

32
Q

Which method of accommodative amplitude measurement is most reliable?

A

pull-away

33
Q

Monocular accommodative findings can help differentiate between accommodative and binocular diagnoses, but…

A

remember patients are allowed more than one diagnosis

34
Q

What is accommodative insufficiency?

A

difficulty stimulating accommodation, accommodative amplitude below lower limit expected for age

35
Q

How are presbyopic patients different when it comes to accommodative amplitude?

A

amps may be low, indicating possible early presbyopia or latent hyperopia

36
Q

What is one of the most common types of accommodative dysfunction?

A

accommodative insufficiency

37
Q

What is ill-sustained accommodation?

A

sometimes considered a subclass of accommodative insufficiency, amplitude is normal but deteriorates over time and under stress

38
Q

What is accommodative paralysis?

A

a true subclass of AI, completely stuck, associated with organic causes, very rare!

39
Q

What are organic causes of accommodative paralysis?

A

increased ICP, tumor, degenerative disease, encephalitis, if new/sudden onset need imaging and referral

40
Q

What is accommodative excess/spasm?

A

difficulty relaxing accommodation (overaccommodating for a given target), poor ability to perform testing with plus lenses, may have blurry distance vision after near work

41
Q

What are other names for accommodative excess/spasm?

A

ciliary spasm, spasm of the near reflex, pseudomyopia

42
Q

Is accommodative excess/spasm more or less symptomatic than some other anomalies?

A

more

43
Q

What is accommodative infacility?

A

difficulty changing accommodative response level, both latency and speed of accommodative response are abnormal but amplitude is normal

44
Q

T/F it is common for patients with accommodative dysfunction to show accommodative infacility

A

true

45
Q

What are ICD-10 codes?

A

diagnostic codes, some diagnoses get grouped together

46
Q

Which codes are considered refractive and medical won’t accept?

A

H52

47
Q

What does the final digit mean in ICD-10 codes?

A

1=OD, 2=OS, 3=OU

Vision Therapy (21 decks)

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