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34 Cards in this Set

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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.
True or false: An exophore will have a harder time with near vision than an esophore.
False.
There are several ways to determine a near add. Can you list them?
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
What does "first sustained blur" mean?
The image gets blurry, and it cannot be cleared.
What does "blur out" mean?
The image cannot be read at all.
NRA/PRA uses "first sustained blur" or "blur out?"
First sustained blur.
After you get a tentative add, can anyone besides Amy Beam tell me why the real add could be different?
Working distance, length of patient's arms, fatigue, myopes (they can hang on longer), detail of the work, etc.
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?
+1.00 D. (Half of +2.50 + -0.50).
What are Morgan's norms for NRA and PRA?
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?)
Why might the NRA be too high or low?
Too high? Overminussed.

Too low? Poor convergence.
With the FCC, what sphere and cylinder of the cross-cylinder lenses that you put in front of their eyes?
+0.50 - 1.00 x 090
Minus cylinder axis: vertical

(The FCC won't let Eminem be.)
Is the vertical line focus posterior or anterior to the horizontal line focus (in the FCC)?
Vertical is posterior to the horizontal. (So the horizontal is anterior to the vertical.)
After adding a bunch of plus, which lines will appear clearer (with the FCC)?
The vertical lines.
What lighting do you want for the FCC and why?
Dim lighting so that you get a bigger pupil. No direct lighting on the target.
If the patient is under accommodated, which lines will be darker (with the FCC)?
The horizontal lines.
What is the endpoint for FCC?
As you are gradually decreasing plus, the lines become equal or the horizontal lines will be clearer (whichever happens first).
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.
What are the expected values for lag of accommodation?
+0.50 +/-0.50 (for non presbyopes).
What could cause the lag of accommodation to be greater than expected?
Esophoria and accommodative limits/fatigue.
What could cause the lag of accommodation to be lower than expected?
Exophoria and spasms of accommodation.
What information do you need for the 1/2 amp in reserve method?
The patient's desired working distance and their amps of accommodation.
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?
+0.75 D.
For plus build up, plus is added binocularly until the letters are first legible. Then you continue adding plus until when?
Until the patient preference is identified and there is no further improvement (it is usually +0.50 past the first legible line).
Based on the age tables, what would a 48 year old need? What about a 62 year old?
48 year old: +1.75 D
62 year old: +2.50 D (tops out at +2.50 D)
If you didn't measure a patient's A/A, what can you use instead to get the 1/2 amp in reserve?
You can use Hoffstetter's formula based on their age.
What is an incipient presbyope?
An old fart that has presbyopia just starting to appear.

(How is it, Alex?)
What is a manifest presbyope?
An old fart that has some remaining accommodation.
Are men or women quicker to the punch as far as presbyopia?
Men.
To finalize the add, what would you do?
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.
What is the ideal range of clear vision?
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?)
Increasing the add does what to depth of focus?
It decreases depth of focus.
Myopes move into presbyopia earlier or later than others?
Later.
Hyperopes accommodative demand is less with CL or with spectacles?
Less with contact lenses.

Vice versa for myopes: accommodative demand is less in spectacles.
What alternatives do patients getting an add have?
Contacts, monovision contacts, multiple single vision spectacles, different types of multifocals.