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89 Cards in this Set
- Front
- Back
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what's a latent deviation of the eyes?
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phoria
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what deviation of the eyes is only detected when the pt is dissociated?
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phoria
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what helps overcome esophoria so diplopia doesn't occur? (2 things)
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negative fusional vergence OR relaxation of accommodation (opposite for exo)
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Esophoric patients will tend to localize objects closer/further?
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closer (exo=further)
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what are some symptoms that manifest when the pt is trying to keep an abnormal amount of deviation under control (with the accomm. and/or vergence systems)?
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blur, fatigue, eyestrain, diplopia
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what are four causes of vertical imbalance (hyperphoria)?
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1. trauma
2. high exo/eso 3. muscle palsy 4. congenital (4th nerve palsy, anatomical anomaly) |
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what are 3 methods to break pt's fusion?
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1. cover test
2. von graefe (prisms) 3. maddox rod |
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T or F: pt wears habitual Rx and accomm. must be controlled when performing the cover test
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T! (control accomm. b/c it affects vergence!)
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why do you have to wait at least 3 seconds after you cover an eye to switch to the other eye on the ACT?
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to give pt enough time to break fusion
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T or F: you are evaluating the "just uncovered" eye on the UCT.
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F! ACT!
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T or F: you MUST dissociate the pt to uncover a latent deviation
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T
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T or F: you can quantify with prism the amount of tropia with UCT
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FFFFF!!! you quantify phorias with ACT
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what prism do you use to neutralize EXOphorias?
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BI
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T or F: it is not necessary to control accommodation on a von graefe phoria measurement
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F!
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T or F: habitual Rx in the phoropter is necessary to measure von graefe phorias
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T
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what does dr. fecho say to set up the prism in von graefe phoria testing? (BI, BO etc over what eyes?)
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6 BD OS, and 12 BI OD (15BI for near)
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if a pt has a vertical phoria behind the phoropter, what test could you do to confirm it?
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maddox rod (being behind the phoropter may cause the vertical imbalance)
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what instructions do you need to tell pts for the von graefe phoria test?
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"keep looking at this target (one eye occluded to point out which is the non-moving target) and make sure you keep it CLEAR" (controlling accomm)
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how do you record this: endpoint of von graefe is 1 BU over the OS
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1 hyper OD
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T or F: an eso deviation results in uncrossed diplopia
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T
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the maddox rod must have the grooves oriented ______ to test lateral deviations
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horizontally (red light is vertical)
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if your patient has a blur on distance BI findings (smooth vergence testing), what does this mean?
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pt is accommodating at distance....over-minused or spasm of accomm
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what prism do we start with on smooth vergence testing?
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BI
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T or F: you need to have the pt's manifest Rx in the phoropter during smooth vergence testing
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T
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Smooth vergence testing is primarily testing what?
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NRV/NFV or PRV/PFV
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what needs to be recorded on smooth vergence testing?
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blur/break/recovery
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Rouse et al found only a fair INTRA-examiner reliability with smooth vergence testing. Changes greater than ___ prism diopters may be needed to be confident that it is indeed a real change
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12
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T or F: pt must wear best correction during NPC
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T
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T or F: an accommodative target is not used during NPC testing
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F!! (blur doesn't matter but recovery is important)
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What's the purpose of the BCC?
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used to determine the posture of accomm
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What are the expected values for BCC (non-presbyope)?
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+0.25 to +0.75 (lag)
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How do you setup for BCC?
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1. target at 40 cm (cross cyl target)
2. put in cross cyl (+/-.50) 3. very dim illum 4. add +1.00 over manifest 5. vertical lines should be darker...(add minus for vertical, plus for horizontal) |
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whats the endpoint of BCC?
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horizontal=vertical OR you get the first horizontal darker
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What's a better way to determine the posture of accomm on non-presbyopes (than BCC)?
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MEM (monocular estimation method)
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what does NRA/PRA indirectly evaluate?
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the vergence system
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what's the purpose of NRA/PRA testing?
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to determine the pt's add as well as the pt's range of accommodation under the influence of the binocular system
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what are the expected values for NRA and PRA?
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NRA: +2.00
PRA: -2.37 |
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when plus lenses are added in front of the eye in NRA and causes accomm to relax, what is keeping the eyes on the target?
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PRV (positive RELATIVE vergence)
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T or F: the pt's near correction must be used to evaluate the amplitude of accom on Donder's push-up technique
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F! distance Rx
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T or F: dim lighting is needed for Donder's push-up technique
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F. well illuminated near target
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Donder's push-up technique: monocular or binocular?
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monocular
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Minus lens to blur: with a target at 40 cm, what's the AA if the manifest in the phoropter was -2.00 and the blur was reported at -4.00?
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-2.00 --> -4.00 = -2.00....have to add initial demand...pt was accommodating 2.50 already, so final answer is -4.50 D
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what target is usually used for minus to blur?
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one line above the pt's best near acuity
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T or F: the minus to blur technique will give a lower AA value than the Donder's push-up method
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T
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What facility test must be performed with a suppression check?
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BAF! (this tests not just accomm but binocularity as well)
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what's the velocity of pursuits?
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60-70 degrees/second
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T or F: pursuits have smaller latency than saccades
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T (130 ms compared to 200 ms for saccades)
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the most common innacuracy of a saccadic movement is what?
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an undershoot
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Pursuits and saccades follow different neurological pathways. Examining a patient with a problem in one eye movement and not the other can suggest a ____ cause to OMD and should be followed up on
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organic (infection, tumor, etc)
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T or F: OMD is a diagnosis of exclusion
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T
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T or F: only saccades depend on proper fixation
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F! both!
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saccades depend on information from the ____ to tell the brain that there is something ahead that needs to be fixated on
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periphery
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T or F: Saccadic suppression is normal
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T....suppression not normal in pursuits
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OMD is a general term that encompasses a dysfunction in what 3 things?
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fixation maintenance, pursuits and saccades (it's rare to see an isolated one of these....and also rare to see OMD without accommodative, binocular and visual perception disorders
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Which is the slowest to develop: accommodative, binocular or ocular motor system?
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ocular motor (due to cognition, attention...)
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T or F: treating ocular motor dysfunction may improve reading, attention and visual perception
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T
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What's the main point of the 3 studies by Sherman, Hoffman and Lieberman?
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There is a high prevalence of OMD in children with learning disabilities and emotional disorders, as well as in children without learning disorders and emotional disabilities
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T or F: Fixation testing: test monocular first and then if deficient, test binocularly
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F (binoc first, then monoc if deficient)
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A person gets a score of 2+ on Fixation testing according to SCCO if they do what?
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Have steady fixation for less than 5 seconds or if hand support is needed (4+= ten seconds)
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Gross saccadic testing is referred to as SCCO testing....what's the difference between this and NSUCO testing of saccades?
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NSUCO: similar to gross but standardized and strict criterion for asministration
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What is the patient graded on in NSUCO testing?
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Ability, Accuracy, and Body/Head movement
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T or F: if the pt passes the NSUCO saccade test, you can rule out the existence of OMD
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F!
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If a patient performed well on the DEM test but you saw excessive head movement, what does that tell you?
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this suggests OMD regardless of performance
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What percentile is normal in DEM testing?
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>35th percentile
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How do you find the ratio for OMD?
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horizontal time/vertical time
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Is it necessary to perform more than one test to diagnose OMD?
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YES
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T or F: both the King-Devick and the DEM test can test for automaticity
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F! only DEM!
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Authors of the King Devick test found that poor _____ contribute to poor reading ability
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saccades
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What test uses infrared goggles that monitor eye movements?
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Visigraph 2
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T or F: Visigraph 2 is more reliable than DEM for monitoring patient improvement in vision therapy
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T
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What does the Pierce test evaluate?
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gross saccades
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Which grading system is good to evaluate saccades and pursuits in children under 5 years of age?
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SCCO
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Pursuits should be smooth in children ___ years of age
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8
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Fidgeting or unrelated verbalization during ocular motor testing is referred to as __________.
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motor overflow
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What are the 4 categories of pathological (functional) causes of saccadic dysfunction?
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Disorders of velocity, Accuracy (Dysmetria), Initiation, and Inappropriate saccades
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In Congenital Oculomotor Apraxia, what is a characteristic movement? What is faulty in these people?
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Head Thrusting; they have delayed initiation of voluntary saccades
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What are inappropriate saccades?
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Saccades that interfere with normal fixation
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Excessive _____ is abnormal and can suggest disease of the cerebellum
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overshooting
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What the most common neurological problem with pursuits?
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Cogwheeling: steplike eye movement that replaces the smooth pursuit
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T or F: good oculomotor skills depend on good acuity
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T
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To manage OMD, you can correct the _________, use lenses with plus adds (if there is a ____ or ____ problem associated with the OMD), or use the primary approach which is ______.
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refractive error; accommodative or binocular; vision therapy
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T or F: plus adds can help reading skills in all children with OMD
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F! only those who show signs of plus acceptance (shift toward NRA on NRA/PRA shows a sign of plus acceptance)
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Kommerell et al studied adaptation of saccadic ability after a __________. Found that the CNS can/can't readjust the saccadic innervation.
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6th nerve palsy; can (thereby improving performance)
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Wold studied 100 patients who did what? What did he find?
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who completed a VT program; showed statistical changes in pursuit and saccadic function
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Solan studied who to find that reading rate improved, there were fewer fixations and fewer regression after vision therapy?
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63 achieving high school students
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What did Rounds et al use to evaluate eye movement before and after VT? What did he find after 4 weeks?
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Visigraph; the study group showed trends toward improving reading eye movement efficiency, but that statistical differences were not evident
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What did Young et al use to record eye movement in schoolchildren who failed a vision screening? What did he show after 6 weeks of VT?
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Eye Trac; significant decrease in fixations, increase in reading speed, and decrease in fixation duration
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How studies shown that ocular motor function can improve in adults?
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yes
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The program for OMD typically lasts for ______ sessions but is dependent on the individual and on their other visual problems.
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12-24 (CITT study: 12 weeks)
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