Abv Test 1

Front 1

VT used to help the development of proper visual function in young children

Back 1

Developmental VT

Front 2

ESOPHORIA:
1. where does the eye drift at rest?
2. what TWO things will help overcome the esophoria?
3. patients will tend to localize objects...?

Back 2

1. drift INWARD
2. NFV helps overcome esophoria (or else diplopia)
2. RELAXATION of accommodation reduces esophoria
3. patient localize object being CLOSER than they really are

Front 3

VT designed to prevent visual problems that would otherwise occur

Back 3

Preventative VT

Front 4

What four pieces of information do you need to calculate the AC/A ratio?

Back 4

1) Patient's PD (cm)
2) Target Distance (m)
3) Far CT finding
4) Near CT finding

Front 5

EXOPHORIA:
1. where does the eye drift at rest?
2. what TWO things will help overcome the exophoria?
3. patients will tend to localize objects...?

Back 5

1. drift OUTWARD
2. PFV helps overcome exophoria (or else diplopia)
2. STIMULATION of accommodation reduces exophoria
3. patient localize object being FURTHER AWAY than they really are

Front 6

VT used to help with vision conditions that have already been identified

Back 6

Rehabilitative VT

Front 7

what are four causes of vertical imbalance (hyperphoria)

Back 7

1. trauma
2. high eso/exo
3. muscle palsy
4. congenital (CN IV or anatomical anomaly)

Front 8

Used to enhance visual skills for sports, work and academic demands

Back 8

Enhancement VT

Front 9

HIGH AC/A ration will be more ____ at near.

LOW AC/A ratio will be more ____ at near.

Convergence (excess or insufficiency) implies that the patient is going to have issues at ___________.

DIvergence (excess or insufficiency) implies that the patient is going to have issues at ___________.

Back 9

HIGH AC/A = more ESO at near


LOW AC/A = more EXO at near

Convergence - Near Point (Low AC/A ratio - If we have NP problems, we would expect more EXO at near)

Divergence - Far Point

Front 10

1. what is UNILATERAL cover test is used to detect?
2. what is ALTERNATING cover test is used to detect?

Back 10

1. unilateral => tropias
a. cover one eye and look at what the OTHER EYE is doing
b. when one eye is covered the turned eye moved to pick up fusion

2. alternating => phorias
a. cover one eye and look at what that SAME eye is doing after uncovering it
b. make sure you cover long enough for the patient to BREAK FUSION

Front 11

Name Peachey's 4 areas of VT

Back 11

1) Developmental
2) Preventative
3) Rehabilitative
4) Enhancement

Front 12

How is the Gradient AC/A measured?

Back 12

The NEAR phoria is repeated with - 1.00 and + 1.00 lenses.

The difference in phoria measurement with and without the lenses give the AC/A ratio.

Front 13

Morgan's Norms:
Distance BO

Back 13

blur/ break/ recovery:
9/19/10

Front 14

Hierarchy of training techniques designed to build more adequate VT skills

Back 14

Sequential training

Front 15

How do MINUS lenses effect the vergence posture?

How do PLUS lenses effect the vergence posture?

Back 15

PLUS increase the EXO posture (relaXes accommodation which stimulates DIVERGENCE)

MINUS increase the ESO posture (stimulates accommodation which stimulates CONVERGENCE)

***This holds true only if the change in the lens power affects the accommodative system***

Front 16

Morgan's Norms:
Distance BI

Back 16

blur/ break/ recovery:
x/7/4

Front 17

Therapy program develops depending on PROGRESS of the paitient

Back 17

Directional training

Front 18

For an uncorrected hyperope, when we correct with lenses, how do we change accommodation?

Back 18

Without glasses they are relatively ESO but when we put a (+) lens in front of their eye, the posture moves more toward EXO

Front 19

Morgan's Norms:
Near BO

Back 19

blur/ break/ recovery:
17/21/11

Front 20

Morgan's Norms:
Near BI

Back 20

blur/ break/ recovery:
13/21/13

Front 21

Morgan's Norms:
NRA
PRA

Back 21

NRA: +2.00
PRA: -2.37

Front 22

do you use habitual near Rx for NPC??

Back 22

YES!!!

Front 23

what is the subjective and objective results for NPC...which one do you use

Back 23

subjective: patient confirms diplopia
objective: doc. see one eye turn OUT

use whichever comes first

Front 24

what are NORMAL breaks and recoveries for NPC

Back 24

normal break: 3-5cm
normal recovery: +/- 3cm from break point

abnormal break: greater than 12cm (receded)

Front 25

for unilateral cover test you must allow both eyes too...on the target

Back 25

FIXATE!!!

Front 26

A - 1.00 lens is placed in front of a fully corrected individual viewing a target at 40 cm. If the patient showed a 3XP without the lens and has and AC/A ratio of 4/1, what would the phoria through the -1.00 lens be?

Back 26

1EP

Front 27

how do you orient the Maddox Rod when testing vertical deviation? lateral deviation?

Back 27

vertical: orient lines vertically
lateral: orient lines horizontally

Front 28

A + 1.00 lens is placed in front of a fully corrected individual viewing a target at 40 cm. If the patient showed a 3XP without the lens and has and AC/A ratio of 4/1, what would the phoria through the + 1.00 lens be?

Back 28

7XP

Front 29

Maddox rod is horizontal OD, the light appears left of streak...what is the diagnosis

Back 29

ESOphoria OD

Front 30

Maddox rod is horizontal OD, the light appears right of streak...what is the diagnosis

Back 30

EXOphoria OD

Front 31

VT techniques for fixation are performed in what way?

Back 31

Monocularly

Front 32

Maddox rod is horizontal OS, the light appears left of streak...what is the diagnosis

Back 32

EXOphoria OS

Front 33

Maddox rod is horizontal OS, the light appears right of streak...what is the diagnosis

Back 33

ESOphoria OS

Front 34

What does a high AC/A ratio mean in layman's terms?

Back 34

When I change the accommodative system, I am going to get a ton of change in the vergence system.

I am going from the far point to the target at near so accommodation is stimulated and thus convergence is stimulated (in the ESO direction).

If we dissociate this patient and have them accommodate by +2.50 then they are going to OVER - Converge because they are over doing it for accommodation.

Front 35

Maddox Rod: the light is above the streak

Back 35

right eye hyper or
left eye hypo

Front 36

When can you start binocular skills in VT?

Back 36

Once monocular skills are adequate and equal between both eyes.

Little binocular training skills are needed once monocular skills are built.

Front 37

Maddox Rod: the light is below the streak

Back 37

the left hyper or
right eye hypo

Front 38

Which types of pursuits are easier to control, small or large?

What other ability does pursuit training develop?

Back 38

Small pursuits are easier to control

Visual attention

Front 39

what is tonic accommodation

Back 39

1. absence of visual stimuli
2. range 0.50-1.00D
2. aka dark accommodation
3. explains night myopia
4. infrared autorefractor used to measure this
5. decreases with age (presbyopia)

Front 40

what is the most accurate way to measure tonic accommodation...why?

Back 40

difference of gaussian grating (DOGG)
1. blur free
2. low center spatial freq
3. no blur driven or convergence accommodation
4. not completely precise, proximal accommodation is not eliminated

Front 41

How long should it take to complete the Distance Hart Chart?

Back 41

15 seconds

Front 42

what is fatigue of accommodation

Back 42

1. inability of the ciliary muscle to maintain contraction while viewing a near object
2. more common in hyperopes (greater demand)
3. increased LAG (accommodative response is less than the accommodative stimulus)

Front 43

what is failure of accommodation

Back 43

inability to produce or maintain an appropriate accommodative response

1. accommodative insufficiency
2. ill-sustained accommodation
3. presbyopia

Front 44

what is accommodative inertia

Back 44

1. aka accommodative infacility
2. problem changing their accommodation (~1s)
3. worked induced MYOPIA
4. trouble relaxing accommodation after prolonged periods of near point work

Front 45

Give an example of how you would PROVIDE ADEQUATE FEEDBACK during PURSUIT training?

Back 45

- Make patient aware of the purpose of the task at hand

- Make patient aware when pursuits are inaccurate

- Use an AFTERIMAGE to "tag" the fovea to help give patient visual feedback as to the accuracy of their pursuits

- Computer activities use auditory feedback as to how accurate their performance is

- Encourage the patient to prove feedback as to how well they think they are doing

Front 46

what is accommodative excess

Back 46

1. spasm
2. pseudomyopia
3. hyperaccommodation, HIGH LEAD (>0.40D)

accommodative response GREATER than accommodative stimulus

Front 47

hofsetters formulae

Back 47

max=25-(2/5)(age)
avg=18.5-(1/3)(age)
min=15-(1/4)(age)

Front 48

what is the purpose of Donder's Push Up technique

Back 48

1. to identify the maximum amount the patient can accommodate
2. bring target to the first sustained blur
3. MONOCULAR

Front 49

what is a LEAD? LAG?

Back 49

Lead: for distant target we tend to over accommodate
Lag: for close near point objects the response is slightly less than the stimulus

Front 50

what is the purpose of Minus Lens Technique

Back 50

1. target is fixed @ 40cm and minus lenses are introduced until the patient cannot clear the target.
2. the total amplitude is the total amount of minus lenses plus the 2.50D (40cm)
3. MONOCULAR

Front 51

If the endpoint of the NRA is diplopia, what could be going on?

Back 51

Patient is a HIGH EXO with a LOW PRV

The patients eyes already tend to rest out, when you add plus lenses in front of the eye, accommodation relaxes and wants vergence to DIVERGE (EXO posture) and their eyes rest so far out is almost impossible for the PRV (CONVERGENCE) to bring them close enough to keep the target single. Essentially the PRV has start the race farther back

Front 52

what is the difference between minus lens and push up technique

Back 52

(-) lens: fixed target, proximal stimulus remains constant, minification from the minus lens
push-ups: angular subtense of the letters keeps increasing as it is brought in (increasing relative mag)

Front 53

If the patient is struggling or showing signs of frustration during pursuit VT, what should the examiner do?

In which 5 ways can this be done?

Back 53

Decrease difficulty of VT tasks

1) Increase interest in task
2) Reduce the task demand
3) Provide adequate feedback
4) Increase kinesthetic feedback
5) Reduce demands and distractions

Front 54

which technique is more natural...minus lens or push up techinque

Back 54

PUSH UP
better results

Front 55

How long should it take to complete the Distance Hart Chart?

Back 55

15 seconds

Front 56

what are the four types of vergences

Back 56

1. tonic: physiological position of rest of the ocular muscles (distance findings)
2. proximal: convergence that arises because of psychological awareness of obj
3. accommodative: convergence that occurs with a change in accommodation
4. fusional: responds to keep obj of regard single

Front 57

what are characteristics of convergence insufficiency

Back 57

1. orthophoria to low exophoria @ distance
2. high exophoria @ near
3. receded NPC
4. low BO ranges
5. low NRA
6. low AC/A ratio

good candidate for visual training

Front 58

what are characteristics of convergence excess

Back 58

1. orthophoria to low exophoria @ distance
2. high esophoria @ near
3. normal NPC
4. low BI ranges
5. low PRA
6. high AC/A ratio
7. large lag of accommodation

good candidate for bifocal Rx

Front 59

what is AC/A ratio

Back 59

the ratio of accommodative convergence to the change in stimulus to accommodation...the measured convergence is divided by the accommodative stimulus

Front 60

how do you set up the phoropter to test for von graffe phorias at DISTANCE? NEAR?

which one is the measuring prism for Lateral Phoria? Vertical?

Back 60

Distance: 6 BD OS and 12 BI OD
Near: 6 BD OS and 15 BI OD

Lateral: Base In is the Measuring Prism
Vertical: Base Down is the Measuring Prism

Front 61

how do you set up for PFV? NFV?

Back 61

1. put patient in phoropter
2. put both Risley Prisms at the 12:00 position
3. turn prism dials Temporally for Base IN (PFV)
4. turn prism dials Nasally for Base OUT (NFV)

Front 62

What are the 5 ways you INCREASE the difficulty of PURSUIT therapy?

Back 62

1) Decreease the interest of the task

2) Increase task demand

3) Reduce Feedback

4) Reduce Kinesthetic Support

5) Increase demands for balance, cognition, and fusional vergence

Front 63

for vergence testing...when is there NOT a blur??

what happens if the patient reports a blur in the specific test?

Back 63

DISTANCE BASE IN
x/7/4

if there is a BLUR the patient is ACCOMMODATING at the FAR POINT

Dx: Accommodative Excess or PseudoMyopia

Front 64

what are the normal values for NPC in adults? kids?

Back 64

adults: 5/7 cm
kids: break at 6cm

Front 65

what does BCC tell you?
what is the expected values

Back 65

1. used to determine POSTURE of accommodation
2. +0.25 to +0.75

Front 66

For PRA, if the endpoint is diplopia, what is going on?

Back 66

HIGH ESO at near with LOW NRV

(-) lenses in front of the stimulates accommodation which then causes vergence to converge. To keep the target single, NRV must DIVERGE to counteract the convergence signal from accommodation. If the patient is a HIGH ESO meaning their posture is IN then they will have to work really hard to try and converge.

Front 67

what is the BEST way to test accommodative posture in adults? in kids?

Back 67

adults: BCC
kids: MEM

Front 68

What does a HIGH PRA mean?

Back 68

Patient could be suppressing an eye which in that case you are performing a MINUS LENS TO BLUR AMPLITUDE inadvertently.

Front 69

what is the set up for BCC

Back 69

1. 40cm using the cross cylinder target
2. +/- 0.50 in both eyes (JCC)
3. very dim illumination
4. add +2.00 over manifest
5. vertical lines should be darker
6. add minus until horizontal lines and vertical lines are the same (or when horizontal lines are darker)

Front 70

What does a LOW PRA mean?

Back 70

1) Difficulty stimulating accommodation

2) High ESO at near compared to the distance

Front 71

Give three examples of EARLY pursuit activities.

Back 71

EARLY pursuits are SMALL pursuit movements.

1) Thumb Pursuits (incorporate kinesthetic effect)

2) Rotating Pegboard (central target with pegboard)

3) Manual Pursuits (with or without kinesthetic support - emphasize small pursuits)

Front 72

what is the purpose of NRA/PRA

Back 72

1. determine ADD
2. test patients range of accommodation under BINOCULAR influence
3. changes accommodation without changing vergence!!
4. check for overminus and indirectly evaluate vergence system

Front 73

Give three examples of LATE pursuit activities.

Back 73

LATE pursuits are LARGE pursuit movements.

1) Groffman Visual Tracing

2) Rotating Pegboard (using outer target on the pegboard and increase the speed of the pegboard)

3) Flashlight Tag (emphasize large pursuits)

Front 74

how does NRA and PRA indirectly test the vergence system

Back 74

1. when MINUS lens added, NEGATIVE relative vergence is needed to maintain alignment
2. when PLUS lenses are added, POSITIVE relative vergence is needed to maintain alignment.

Front 75

what accommodative testing MUST be done to check for suppression

Back 75

binocular accommodative facility (BAF)

Front 76

What is the typical stopping point for PRA?

Back 76

- 2.50

Front 77

what are the three types of stereopsis testing in the randot book

Back 77

1. suppression check (R/L)
a. polarized glasses

2. Wirt Circles (Local)
a. contains monocular cues

3. global stereopsis
a. patient MUST be bifoveal to see target

Front 78

What are 4 examples of EARLY saccadic activities?

Back 78

EARLY saccades are LARGE saccadic movements.

1) 4 Corner Fixations
2) Thumb Saccades
3) Wayne Saccadic Fixator
4) Distance Hart Chart

Front 79

what are the two parallel neurological systems involved in ocular motor?
characteristic of each?

Back 79

magnocellular:
1. peripheral retina
2. fast system that senses MOTION
3. WHERE is the obj

parvocellular:
1. central retina
2. senses color, shape and detail
3. WHAT is the obj

Front 80

What 3 LATE saccadic activities?

Back 80

LATE saccadic activities involve SMALL saccades.

1) Michigan Tracking
2) Computer Saccadic Activites
3) Distance Hart Chart

Front 81

What is the GOAL for balancing NRA/PRA?

Back 81

The goal is to determine a nearpoint lens that places the patient's posture of accommodation in the middle of the NRA and PRA for maximum comfort.

Front 82

what is the difference between the SCCO and NSUCO

Back 82

SCCO: sitting
NSUCO: standing

Front 83

What are 7 methods of DECREASING difficulty of therapy tasks?

Back 83

1) Negate gravity by having the patient in the supine position or be seated

2) Move the target at a slower pace

3) Use a larger target

4) Increase the interest of the target or change the target more often

5) Use kinesthetic support (touch the target)

6) Encourage verbalization of the target

7) Perform therapy in a quiet room

Front 84

in saccades what type of movement error is MOST COMMON

Back 84

undershooting

Front 85

What are 6 methods of INCREASING difficulty of therapy tasks?

Back 85

1) Remove kinesthetic support (do not allow patient to use finger)

2) Perform skill standing or on a balance board or on one leg

3) Increase target speed

4) Decrease size of target

5) Increase demands on the vergence and accommodation system

6) Increase cognitive demand

Front 86

what is unique about the DEM testing

Back 86

1. tests AUTOMATICITY
2. determines if the patient has difficulty in recalling numbers

Front 87

what are the FOUR possible outcomes of the DEM

Back 87

Type 1: Normal
Type 2: OMD only (normal vertical, low horizontal, high ratio)
Type 3: AUTO only (low vertical and horizontal, normal ration)
Type 4: OMD and AUTO (H>V, HIGH RATIO)

Front 88

what does the ratio in DEM testing indicate

Back 88

Ratio= H/V
tiebreaker between type III and type IV

vertical test for automaticity

Front 89

what are the four categories of saccadic dysfunction

Back 89

1. velocity
2. accuracy
3. initiation
4. inappropriate saccade

Front 90

What does the blur point represent?

Back 90

The blur point represent the point where the patient can no longer compensate for the prism - induced retinal disparity while maintaining stable accommodation

Front 91

what are 3 ways to manage OMD

Back 91

1. correct refractive error
2. PLUS lenses for NEAR
3. vision therapy

Front 92

During the NRV/BI testing, blur will occur for what reasons?

Back 92

1) Low DIVERGENCE reserves like in ESO

2) Accommodation NOT being stimulated

Front 93

what is the most common problem with PURSUITS?

when is this problem seen?

Back 93

COGWHEELING
1. steplike eye movements that replaces smooth ones
2. basal ganglion disease, Parkinson's and Cerebellar disease

Front 94

what are FOUR examples of FIXATION therapy

Back 94

1. dotting O's
2. monocular stick in straw
3. AN star fixation
4. stationary peg board

Front 95

What does a LOW NRV/BI finding mean?

Back 95

1) Near ESO (eyes rest in and therefore they have hard time DIVERGING out)

2) Difficulty STIMULATING accommodation

Front 96

what are SIX examples of PURSUITS therapy

Back 96

1. thumb pursuits
2. manual pursuits
3. marsden ball
4. flashlight tag
5. rotating pegboard
6. visual tracing (groffman tracing)

Front 97

What does a HIGH NRV/BI finding mean?

Back 97

1) Near EXO (eyes rest out and therefore have less to go when they DIVERGING out)

2) Difficulty RELAXING accommodation

Front 98

what are FIVE examples of SACCADES therapy

Back 98

1. thumb saccades
2. four corner wall fixation
3. distance hart chart
4. saccadic workbook
5. michigan tracking

Front 99

what are the steps in development of vision therapy

Back 99

1. fixation
2. small pursuits to larger pursuits
3. large saccades to small saccades
4. ocular therapy with accommodative and vergence therapy

Front 100

During PRV/BO testing, what are some reasons blur occurs?

Back 100

1) Low CONVERGENCE ability like in HIGH EXO at Near

2) Difficulty RELAXING accommodation (NRA)

Front 101

what are BIOCULAR techniques in OMD therapy

Back 101

activities that are done with both eyes open but the patient is not fused

ex: dissociating prism during marsden ball pursuits

Front 102

PRV:
1. When does the blur occur?
2. What happens after the blur occurs?
3. When does diplopia occur?

Back 102

When accommodation can no longer act independently from the vergence system.

Accommodation then supports convergence to keep the target single.

Diplopia occurs when PRV (causes they eyes to converge) and PAV can no longer keep up with the increasing amounts of convergence.

Front 103

AC/A FORMULA

Back 103

AC/A=IPD(cm) + NFD(m)(Hn-Hf)

IDP: interpupillary distance (cm)
NFD: near fixation distance (m)
Hn: Near Phoria (eso +, exo -)
Hf: Far Phoria (eso +, exo -)

Front 104

LOW PRV/BO finding mean what?

Back 104

1) Near EXO

2) Difficulty RELAXING accommodation

Front 105

scenerio:
1. patient is fixated on a target at 40cm
2. PLUS lens is introduced
3. what happens to the accommodation?
4. what does the vergence plane want to do? what will happen?
5. what has to occur for the vergence to not move

Back 105

1. accommodation is RELAXED
2. vergence plane wants to move with accommodation
3. if vergence is allowed to move with accommodation, DIPLOPIA will occur
4. positive relative vergence (PRV) must be stimulated to keep the target single

Front 106

HIGH PRV/BO finding mean what?

Back 106

1) Near ESO

2) Difficulty STIMULATING accommodation

Front 107

what is relative vergence

Back 107

vergence that functions INDEPENDENTLY from the accommodative system

Front 108

What is the vergence movement used to resolve retinal disparity of an image?

Back 108

Fusional Vergence

Front 109

In NRA/PRA, how do you test which system is having the difficulty (accommodation or vergence)

Back 109

1. COVER ONE EYE
2. if the target clears, problem with PRV/NRV not ACCOMMODATION

Front 110

What term will be reserved for describing the vergence movements free from accommodation during fusional vergence testing (before the blur point)?

Back 110

Relative Vergence

Front 111

how do you balance NRA/PRA

Back 111

[(NRA+PRA)/2]+RPV

relative point value:
1. if done through manifest, RPV=0
2. if done through BCC, RPV=BCC

Front 112

What encompasses both relative vergence and accommodative vergence?

Back 112

Total Vergence
(Positive or Negative)

Front 113

scenerio:
1. patient is fixated on a target at 40cm
2. MINUS lens is introduced
3. what happens to the accommodation?
4. what does the vergence plane want to do? what will happen?
5. what has to occur for the vergence to not move

Back 113

1. accommodation is STIMULATED
2. vergence plane wants to move with accommodation
3. if vergence is allowed to move with accommodation, DIPLOPIA will occur
4. negative relative vergence (NRV) must be stimulated to keep the target single