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34 Cards in this Set
- Front
- Back
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Which of the following is not a symptom that the patient needs a near add:
A. fatigue B. arms too short C. blurring when reading or changing fixation distances D. diplopia E. burning or stinging F. they are all symptoms that the patient needs a near add. G. D and E are not symptoms |
F. they are all symptoms that the patient needs a near add.
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True or false: An exophore will have a harder time with near vision than an esophore.
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False.
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There are several ways to determine a near add. Can you list them?
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1. NRA/PRA,
2. FCC, 3. 1/2 amp in reserve, 4. plus build up, 5. age tables and formulas, 6. bi-chrome (limited due to target availability), and 7. dynamic ret |
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What does "first sustained blur" mean?
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The image gets blurry, and it cannot be cleared.
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What does "blur out" mean?
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The image cannot be read at all.
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NRA/PRA uses "first sustained blur" or "blur out?"
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First sustained blur.
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After you get a tentative add, can anyone besides Amy Beam tell me why the real add could be different?
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Working distance, length of patient's arms, fatigue, myopes (they can hang on longer), detail of the work, etc.
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If the net NRA was +2.50 (10 clicks above MPBVA) and the net PRA was -0.50 (2 clicks below the MPBVA), what would the tentative add be?
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+1.00 D. (Half of +2.50 + -0.50).
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What are Morgan's norms for NRA and PRA?
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NRA: +1.75 to +2.00 D.
PRA: -2.25 to -2.50 D. (Does anyone else want to poison Morgan's drink with arsenic besides me?) |
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Why might the NRA be too high or low?
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Too high? Overminussed.
Too low? Poor convergence. |
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With the FCC, what sphere and cylinder of the cross-cylinder lenses that you put in front of their eyes?
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+0.50 - 1.00 x 090
Minus cylinder axis: vertical (The FCC won't let Eminem be.) |
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Is the vertical line focus posterior or anterior to the horizontal line focus (in the FCC)?
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Vertical is posterior to the horizontal. (So the horizontal is anterior to the vertical.)
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After adding a bunch of plus, which lines will appear clearer (with the FCC)?
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The vertical lines.
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What lighting do you want for the FCC and why?
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Dim lighting so that you get a bigger pupil. No direct lighting on the target.
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If the patient is under accommodated, which lines will be darker (with the FCC)?
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The horizontal lines.
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What is the endpoint for FCC?
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As you are gradually decreasing plus, the lines become equal or the horizontal lines will be clearer (whichever happens first).
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For FCC, if your MPBVA is
-2.00 and your end point for equal is -0.25, what is your tentative add? |
+1.75. The difference between the MPBVA and the LIP is the tentative near add.
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What are the expected values for lag of accommodation?
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+0.50 +/-0.50 (for non presbyopes).
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What could cause the lag of accommodation to be greater than expected?
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Esophoria and accommodative limits/fatigue.
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What could cause the lag of accommodation to be lower than expected?
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Exophoria and spasms of accommodation.
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What information do you need for the 1/2 amp in reserve method?
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The patient's desired working distance and their amps of accommodation.
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Using 1/2 amp in reserve, if a patient's A/A were +3.50 and their WD was 40cm, what is the tentative near add?
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+0.75 D.
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For plus build up, plus is added binocularly until the letters are first legible. Then you continue adding plus until when?
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Until the patient preference is identified and there is no further improvement (it is usually +0.50 past the first legible line).
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Based on the age tables, what would a 48 year old need? What about a 62 year old?
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48 year old: +1.75 D
62 year old: +2.50 D (tops out at +2.50 D) |
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If you didn't measure a patient's A/A, what can you use instead to get the 1/2 amp in reserve?
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You can use Hoffstetter's formula based on their age.
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What is an incipient presbyope?
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An old fart that has presbyopia just starting to appear.
(How is it, Alex?) |
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What is a manifest presbyope?
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An old fart that has some remaining accommodation.
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Are men or women quicker to the punch as far as presbyopia?
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Men.
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To finalize the add, what would you do?
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You would have the patient assume a normal reading position, and then you would place the tentative add in a trial frame (or over the Rx) to demonstrate range, clarity. You then compare it with +/-0.25 D change.
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What is the ideal range of clear vision?
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1/3 in and 2/3 out (i.e., the dioptric midpoint).
(Can anyone explain to me how in Iran that is the dioptric midpoint?) |
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Increasing the add does what to depth of focus?
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It decreases depth of focus.
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Myopes move into presbyopia earlier or later than others?
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Later.
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Hyperopes accommodative demand is less with CL or with spectacles?
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Less with contact lenses.
Vice versa for myopes: accommodative demand is less in spectacles. |
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What alternatives do patients getting an add have?
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Contacts, monovision contacts, multiple single vision spectacles, different types of multifocals.
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