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47 Cards in this Set

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T or F: Fully correcting the refractive error first applies to all accommodative and binocular conditions)
T
What are the three conditions you would add plus for?
Accommodative insufficiency, ill-sustained accommodation, symptomatic esophoria at near with signs of plus acceptance
What is the general from for accommodative therapy? (4 steps)
1. Develop rapport with patient (define clear set of goals)
2. Monocular therapy
3. Biocular therapy (if suppression isn't an issue, this step can be streamlined)
4. Binocular therapy (watch for suppression!)
During accommodative therapy, feedback should be incorporated. What type of things does this include?
feeling, size changes, distance changes (SILO vs. SOLI)
T or F: Emphasize speed of accommodative response early in training before amplitude
F! amplitude first
For AI and ill-sustained accommodation, we emphasize the feeling of ___ using ___ EARLY in thearpy. For AE, we emphasize the feeling of ___ using ___ EARLY in thearpy.
stimulating; minus; relaxing; plus (but need to work on the opposite as well to BALANCE the system)
For monocular lens sorting, what are the max plus and minus lenses you can use for a particular patient?
Plus: if you give them a lens whose focal point is not at the reading material, it will always be blurry. So, +3 is max (33cm WD).
Minus: up to half the accommodative amplitude
For monocular lens sorting, if the patient is having a hard time appreciating change with a +1.00 lens, what lens would you give them next?
A stronger lens! anything over +1.00...should be easier for them to appreciate larger print/closer card.
What's the final step of monocular lens sorting?

What's the endpoint of monocular lens sorting?
Have the pt sort the lenses from what makes them feel more relaxed, to what makes them feel more strained. Start with large increments and move to smaller (ex: .50 steps). Quicker=better.

Pt is able to sort 8 lenses from plus to minus in .50D increments.
Loose lens rock:
1. What's level 1?
2. What's level 2?
1. Pt tries to clear target thru lens; not timed
2. MAF! Pt uses +0.50/-0.50 up to +2.50/-6.00 flippers or lenses..tries to clear them as quickly as possible, then tries to get to 20cpm.
What's the endpoint of loose lens rock therapy?
Pt able to clear +2.50/-6.00 with both eyes equally, 20 cpm (upper end of minus determined by half pt's amplitude of accomm)
Explain Level 1-3 for Near-Far Hart Chart
1- small chart is 40cm from pt with one eye occluded; pt reads top line only when it's clear, and then next line of large hart chart; alternate for several mins; repeat with other eye

2- Similar to above, but pt brings small chart closer to eye while reading the first line until they can't clear it, then shift to distance

3- Repeat level 1 but with card 1-2 inches closer than the blur point.
What's the endpoint for Near-Far Hart Chart?
When pt can complete the task with near chart 3 inches from the eye
Biocular loose lens rock restores amplitude and facility while eliminating _____.
suppression
What is the difference between biocular loose lens rock and loose lens rock?
Biocular uses both eyes open with a 6D prism over one eye to dissociate the pt
With Red-Red rock, the eye with the _____ filter sees the print on the cards, and the eye with the ___ filter sees the print on the acetate that is on the light box.
green; red
The test that uses red/green glasses and one minus lens over one eye with one plus lens over the other is called what?
Red-Red rock (Biocular technique)
What's the endpoint for Red-Red rock (biocular)?
When pt can clear +2.50 and -6.00 (or half AA) (these are over each eye simultaneously)
What are three suppression checks used in BAF therapy?
Number 9 card, Red/green bar reader, polarized bar reader (and any binocular vision target for later in therapy)
What's the endpoint of BAF therapy?
When pt can clear +/- 2.50 flippers, 20 cpm with no suppression
When decreasing difficulty of therapy techniques with plus and minus lenses, we ___ the WD when working with plus lenses and ___ the WD when working with minus lenses.
decrease; increase
T or F: color fusion is the lowest level of sensory fusion
T
Can suppression occur in patients without strabismus?
YES! it can occur in heterophoric pts but not as intense as in strabismus; only in severe binocular distress.
What's the equation for average and minimum accommodative amplitude?
Average= 18- 1/3(age)

minimum= 15- 1/4(age)
How many symptomatic patients out of 119 actually had BV problems according to Hokada? Out of these patients, how may had accommodative problems?

What did Scheiman find the prevalence of accomm disorders to be?

What did Porcar and Nartinez-Palomera find the prevalence of accomm disorders to be in university students?
25; 80%

6%

17%
What's the most common accommodative disorder according to Hokoda?
accommodative insufficiency (then infacility then excess)
What's the norm for MEM?
+0.25 --> +0.75
T or F: photophobia is a common complaint with AI
T
What conditions would you expect a lag of accomm on MEM? (2)

What conditions would you expect a lead of accom on MEM? (2)
AI and CE

AE and CI
T or F: Both AI and AE can manifest an ESO or EXO phoria
T
Name 6 exam values suggesting the need for plus for near.
1. Low amp
2. Low PRA
3. Asymmetry in NRA/PRA (NRA>PRA)
4. Eso at near
5. High lag on MEM
6. New myopic RX showing ESO at near and accomm insufficiency
What three things do we add plus (to the Rx) for?
Accommodative insufficiency, ill-sustained accomm, symtomatic eso at near with signs of plus acceptance

(AE and AInfacility= 1st line is VT)
Liu et al, Bobier and Sivak, Hoffman, and Daum all did research proving what?
the efficacy or accommodative therapy
T or F: suppression can exist in the monocular state
F
For the Brewster stereoscope:
1. Whats the target separation for ORTHO at DISTANCE? at NEAR?

For the Correct Eye Scope:
1. Whats the target separation for ORTHO at DISTANCE? at NEAR?
1. 87mm, 63mm

1. 68mm, 58mm
For Van Orden star AND Cheiroscopic tracing, what stereoscope do they use? What is ortho (how many millimeters apart?)
Correct-Eye scope; 68mm
What information does Van Orden star tell us about the patient?
their binocular POSTURE
What does Sheard's criterion say?
an individual must have two times the compensating vergence to overcome their phoria
What is the compensating vergence for ESO?

EXO?
NFV

PFV
What does Percival's criterion say?
Pt should be operating in the middle third of their fusional vergence range to be comfortable
What's the most common non-strabismic disorder?
Convergence insufficiency
What is the prevalence of CI?
3-5%
What is the inclusion criteria for CI in the CITT study?
1. exophoria greater at near than at distance (at least by 4)
2. Receded NPC (greater than or equal to 6 cm)
3. Inadequate PFV at near (Fails sheard's or PFV less than or equal to 15 (blur or break))

4. Age 9-17
5. CI symptom survey of 16 or more
Whats the most consistent finding in patients with CI?
receded NPC
In a false CI, what 2 findings will differentiate it from a true CI? What's the primary dysfunction?
they accept plus at near and they show a lag on MEM/BCC! accommodative insufficiency
T or F: A sixth nerve palsy is comitant while divergence paralysis is non-comitant
F...opposite
What deviation is also found in 50% of divergence excess patients?
vertical (inferior oblique may be at fault)