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OD2 S2 > wk6: BV - BV3 Diagnosis of Binocular Vision Disorders > Flashcards

wk6: BV - BV3 Diagnosis of Binocular Vision Disorders Flashcards

1
Q

Describe how the fixation disparity approach works

A

plots the amount of prism required to eliminate FD. This is the associated phoria and can be used to determine amount of prism required to treat some BV disorders

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2
Q

What is fixation disparity?

A

Fixation disparity (FD) is the small misalignment of the eyes under binocular conditions from exact bifoveal fixation

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3
Q

How many profiles/types of fixation disparity are there?

A
  1. I, II, III, IV.

fixation disparity plots to indicate the binocular vision problem from among the 4 types

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4
Q

Is fixation disparity practical clinically? Explain

A

No because it is time consuming

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5
Q

When should we use fixation disparity?

A

Only use if prism is being considered in the management plan

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6
Q

Is graphical analysis practical clinically? Explain (2)

A

No. It is cumbersome and time consuming having to graphically plot findings

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7
Q

What is sheard’s criterion?

A

Reserve = 2 x phoria. So if reserve is less than 2 x phoria then you’re likely to have a BV problem

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8
Q

What is percival’s criterion?

A

Phoria = 1/3rd reserve

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9
Q

What is Morgan’s normative analysis?

A

Groups of BV data are analysed and profiles of patients are formed based on typical presentations

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10
Q

What is the disadvantage of Morgan’s normative analysis?

A

As this approach has not been modified to include more recent clinical tests, it falls short and fails to identify some accommodation and vergence problems

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11
Q

How many practitioners use OEP analytic analysis?

A

Not many

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12
Q

Is OEP analytic analysis an evidence based approach?

A

No. However it is consistent

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13
Q

What type of system does OEP analytic analysis use?

A

21 point system which relates to the 21 things you need to do in clinical settings

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14
Q

What are the disadvantages of OEP analytic analysis? (2)

A

Very rigid/strict approach
All behind phoropter (so no consideration of proximal cues)

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15
Q

Which approach is the most widely used clinically?

A

Integrative analysis approach

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16
Q

List 4 advantages of the Integrative analysis approach

A
  1. compares individual test results against expected published values
  2. identifies any patterns or characteristic signs that indicate a particular profile of an accommodative-vergence problem
  3. integrates this with patient’s symptoms, hx, risk factors, visual demands
  4. narrows and proposes possible diagnosis/diagnoses
    (5. flexible, accurate)
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17
Q

How flexible is the Integrative analysis approach?

A

Quite flexible approach and more likely to produce an accurate representation of patient problems

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18
Q

Explain the Integrative analysis approach in 3 points

A
  1. compare test findings to a table of expected normative data
  2. group the findings that are outside the normal range to look for patterns
  3. identify the possible diagnosis based on the pattern especially if symptoms and signs fit
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19
Q

How does the Integrative analysis approach differ from Morgan’s normative analysis approach?

A

Integrative analysis approach analyses results one by one instead of as groups of data like normative approach

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20
Q

Integrative analysis is the circles inside circles thing. Starting from inner most circle outward, what are the important features we want to integrate? (4)

A
  1. patient symptoms
  2. patient needs + demands
  3. risk factors
  4. clinical findings, characteristic features
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21
Q

List 8 typical symptoms a patient with BV problems may experience (not there are more)

A

Headache with near work
Blurry vision
Diplopia, closing or covering one eye
Avoidance of near tasks
Inability to sustain near tasks
Difficulty concentrating on near tasks
Symptoms after prolonged near work
Eyestrain/fatigue during reading/desk work

22
Q

List another 7 typical symptoms a patient with BV problems may experience

A

Near/distance blur when changing fixation
Words moving or running together
Blinking, tearing, redness
Squinting, rubbing with near work
Poor attention and conc. when doing homework
Loss of place, slow reading speed, uses fingers to read
Poor reading comprehension, avoiding reading, learning concerns

23
Q

What broad visual tasks should you consider for patients? (3)

A

Work requirements (computer, fine detail)
School requirements (whiteboard, laptop)
Hobby requirements (playing pool, music, shooting)

24
Q

What conditions should you consider when thinking about a patient’s visual demands? (3)

A

Time
Lighting
Environment

25
Q

What BV problem might fatigue/prolonged near work/near stress be a risk factor for? (3)

A

Accom insufficiency
Excess convergence insufficiency
Convergence excess

26
Q

What BV problems might genetic predisposition be a risk factor for? (4)

A

Converg Ins.
Converg. Exc.
Diverg. Exc.
Diverg. Ins.

27
Q

What BV problems is uncorrected Rx a risk factor for? (3)

A

Converg. excess
Basic esophoria
Accomm. ins.

28
Q

What BV problems might systemic predisposing factors (diabetes, MG, graves, parkinson’s, hypothyroid) be risk factors for? (3)

A

Accomm ins.
Excess binocularity problems (EOM)
Vergence disorders

29
Q

What BV problems is trauma (A, B, I) a risk factor for? (2)

A

Accommodative spasm
Convergence insufficiency

30
Q

What BV problems are certain medications like for ADHD, antidepressants, and epilepsy a risk factor for? (2)

A

Accommodative insufficiency or excess

31
Q

List 6 risk factors for BV problems

A

Fatigue/near stress/prolonged near work
Genetic predisposition
Uncorrected Rx
Systemic predisposing factors (e.g. diabetes, MG, graves, parkinson’s hypothyroid)
Trauma (A, B, I)
Some medications (e.g. ADHD, antidepressants, epilepsy)

32
Q

What is the minimum battery of clinical tests you must do in a BV workup? (8)

A

Cover test
NPC
Stereopsis
Phorias (distance, near)
NPA/amplitude of accommodation (monocular)
Accommodative facility (+/-2 at near)
Vergence facility (12BO/3BI at near)
MEM dynamic retinoscopy

33
Q

List the 5 approaches for making a binocular vision diagnosis

A

Graphical analysis (donder’s diagram)
Morgan’s normative analysis
Fixation disparity
Analytic analysis
Integrative analysis

34
Q

How does myopic CL wear compare to spectacles in terms of accommodative and vergence function?

A

Generally poorer accommodative and vergence function

35
Q

If a patient has both CLs and glasses, should you assess accommodation and vergence function with both or just one?

A

Both

36
Q

What diagnostic layers need to be ruled out when assessing BV problems? (3)

A

Headaches: could have multiple causes
Anterior eye: could have dry sore eyes due to tear film, allergies, infection, inflammation
Attentional/Developmental: could be other factors affecting abnormal findings and symptoms

37
Q

What will you expect to see in a patient with convergence insufficiency? (5)

A

Near exo greater than distance
Low AC/A
Abnormal remote/Receeded NPC
Reduced PRC and BO facility at near
Low NRA

38
Q

What will you expect to see in a patient with divergence excess? (4)

A

D exo > N
High AC/A
High tonic exophoria
Large exophoria/tropia at distance (intermittent D exotropia)

39
Q

What will you expect to see in a patient with basic exophoria? (3)

A

Exophoria at distance = exophoria at near
Normal AC/A
Low NRA

40
Q

What will you expect to see in a patient with convergence excess? (5)

A

N eso > D
Low AC/A
High tonic esophoria
Low PRA
Reduced NRC and BI facility at near

41
Q

What will you expect to see in a patient with vergence insufficiency? (3)

A

Normal AC/A
Restricted fusional vergence amplitudes
Steep fixation disparity curve

42
Q

What will you expect to see in a patient with basic esophoria? (3)

A

Esophoria at distance = esophoria at near
Normal AC/A
Low PRA

43
Q

What will you expect to see in a patient with vertical phoria? (2)

A

Classify as either comitant deviations or noncomitant deviations (old demcompensated 4th nerve palsy, newly acquired 4th nerve palsy)

44
Q

What will you expect to see in a patient with accommodative insufficiency? (7)

A

Verg Amp: BO blur at near may be low
Low accomm amplitude (low NPA)
Fail negative acc. facility
Slow facility
Abnormal lag
Low PRA
High MEM ret

45
Q

What will you expect to see in a patient with ill-sustained accommodation? (5)

A

Verg amp: BO blur at near may be low
Fails negative acc. facility
Slow verg facility
Low PRA
High MEM (high variable lag)

46
Q

What will you expect to see in a patient with accommodative excess? (4)

A

Verg Amp: BI blur at near may be low
Fails positive acc facility
Low NRA
Low MEM (no lag,may have a lead)

47
Q

What will you expect to see in a patient with Divergence Insufficiency? (5)

A

D eso > N
Reduced PRC at distance
D blur/diplopia
Low AC/A
High tonic esophoria

48
Q

What will you expect to see in a patient with Accommodative spasm? (3)

A

Abnormal lead
Reduced VA or distance blur (pseudo myopia)
Fails positive facility

49
Q

What will you expect to see in a patient with accommodative infacility? (1)

A

Slow accommodative facility

50
Q

What will you expect to see in a patient with vergence infacility/fusion vergence dysfunction? (2)

A

Reduced BI/BO facility and/or
Reduced fusional reserves

OD2 S2 (63 decks)

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