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64 Cards in this Set

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what vergence ranges should you pay closer attention to for an esophoric patient?
BI ranges (divergence ranges...if they have poor divergence ranges, they are going to have symptoms)
t or f: a person with a slight lag of accomodation is more "normal" than a person with a slight lead
t
for what measurement should you place an "X" in the blur value and why? what are the two situations that could be possible if you got a number value for this?
distance NFV because a patient shouldn't be accomodating at a distance target; you over-minused a myope or the pt is a hyperope (latent usually)
what is morgan's norm for the distance phoria?
1 prism diopter exophoric (or range of 0-2 exophoria)
If a pt has a PRA value past -4, what could be happening?
pt could be suppressing an eye
a pt has a NPC of 10/12cm. the pt might be manifesting signs of what?
convergence insufficiency (under 6cm, pt could be manifesting convergence excess)
what are the four types of convergence (same for accomodation)?
tonic, proximal, accomodative, fusional
t or f: someone with convergence insufficiency could have low exophoria at far and high exophoria at near
t
for convergence insufficiency, would the NRA be high or low?
low (relax accom=relax convergence) (convergence excess= low PRA bc we are stimulating accom which causes over-convergence for these people)
t or f: the posterior pole of the lens moves forward and anterior pole stays stationary during accomodation
f
dark accomodation/dark focus falls within the definition of which type of convergence?
tonic accom (if a myope complains a lot about having good vision during the day and then blurry vision driving at night, you could give extra quarter minus) (.5-1.00D of power)
what's the best target to test tonic accom?
DOG (difference of gaussian)
what's the normal amount of proximal accommodation we have?
.45D
what's hofstetter's formula for the minimum amplitude of accomodation based on age?
minimum= 15.5-.25(age)
what are the two methods to test for amplitude of accomodation?
push up/pull away (Donder's) and minus to blur
a larger target for amplitude of accomodation testing will produce what result?
erroneously larger amplitude of accom
for distance targets we usually show a lead/lag and for near targets we usually show a lead/lag? how do we see clearly if this is occuring?
lead, lag; depth of focus-- blur won't happen until the "slop" exceeds 1/2 the d.o.f. (~.45D)
which A.Accom. value will be higher for the same individual: Donder's push up/pull away method or minus to blur method?
donder's (angular subtense of letter increases......with minus to blur, target size is gradually decreased)
is amplitude of accom testing done monocularly or binocularly?
monocularly
Minus to blur: a 40cm target is shown. you had to turn the phoropter 2 clicks for the patient to say it's blurry. what's the amplitude of accom.?
2.50 + (.25x2) = +3.00D
a binocular push up test is done to evaluate what value?
near point of convergence (NPC) (remember, monocular push up is done for amplitude of accom)
if the pt exhibits a lag of accomodation during BCC, which lines will look darker? what power needs to be added to get the lines closer to looking equal?
horizontal (lead=vertical lines will appear darker); plus power
what minimizes the depth of focus of the eye when performing BCC?
performing the test in DIM illumination
BCC: what should you do in young pre-presbyopes before starting the test?
add +1.00 to stabilize accom response (since they can manipulate the test)
according to dr. falco, what patients are ideal for BCC?
pts who are getting their first add (35-45) (if they already have an add, she uses plus build-up)
using the flippers (+2/-2) is doing what testing? monocular or binocular?
accomodative facility (also checks for spams of accom, pseudomyopia and accom insufficiency); you do BOTH (binocular= accomodation system + vergence system)
convergence stimulus= ? (equation)
= 10 x PD (in mm) / testing distance (in cm...add 2.7cm for specatcle plane)
"The first blur elicited on vergence ranges, known as the reserve, should be equal to or greater than twice the amount of phoria" is called what?
Sheard's postulate (for an eso pt, the reserves are BI ranges...)
what procedure is this: take near lateral phoria measurement and add +1.00D and re-measure, do again and take average. How many prism diopters should the phoria change per +1.00D of add?
gradient ACA ratio; 4 (pt is ortho, add +1.00, pt should now be 4 exo)
more plus on the wet refraction than on the subjective refraction indicates what?
a possible hyperopic latent component
what prescriptions should you especially trial frame for?
CL >/= +/-4.00D
SPECS >/= +/-6.00D
what are you supposed to put in the back lens well of the trial frame?
the largest sphere
on the trial frame there is a scale for vertex distance on the side. what does "0" really signify?
15mm
what tool measures vertex distance?
distometer
what is the first step in fitting the trial frame on a patient?
slipping the temples over the patients ears and adjusting them
if you are going to guesstimate someone's Rx, what's the sphere/cyl value for:
1) 20/25?
2) 20/40?
3) 20/80?
4)20/100?
1) .25 / .50
2) .75 / 1.00
3) 1.50 / 3.00
4) 2.00 / 4.00
how do you calculate the JND for a patient?
jnd= denominator of snellen acuity/100
what instrument do you use to find cyl when using a trial frame?
jcc
what are the average exophthalmometry readings for:
1) whites/hispanics?
2) african americans?
3) asians?
4) children?
1) 15-17mm (range: 12-20)
2) 17-19mm (2mm higher than white/hispanics) (range: 12-24)
3) range: 12-18mm
4) 14mm
males have exophthalmometry readings ~____mm higher/lower than women?
1; higher
Between ages 10-18 there's a ___mm increase in the exophthalmometry reading.
3
when a patient lays supine, how many mm are their eyes supposed to sink back?
1-3mm (won't happen in grave's patients)
a difference on ___mm between the eyes is bad
>/= 3
the unilateral cover test is testing for what? what about alternating cover test?
a tropia; a phoria
what do you use to neutralize an exophoria?
BI prism
what's the calculation for:
1) average accomodation for a certain age?
2) minimum accom for a certain age?
1) 18.5 - 1/3(age)
2) 15.5 - 1/4(age)
using donder's and duane's tables, what Amp of accom does this age have:
1) 10
2) 20
3) 30
4) 40
5) 50
1) 11 or 14
2) ~10
3) ~7
4) ~5
5) ~2.5
what are the norms for:
1) distance phoria?
2) near phoria?
1) 1 exophoria (0-2 exo)
2) 3 exophoria (2 eso-8 exo is normal)
what are the norms for:
1) distance NFV?
2) distance PFV?
1) x/7/4
2) 9/19/10
what are the norms for:
1) near NFV?
2) near PFV?
1) 13/21/13
2) 17/21/11
what are the norms for:
1) NRA?
2) PRA?
1) +2.00 (up to +2.50)
2) -2.37 (up to -4.00)
what are the norms for:
1) monocular "flippers" (accom facility)?
2) binocular "flippers"?
1) 11 cpm (with diff of 2cpm between eyes being significant)
2) 8cpm
what are the norms for gradient AC/A?
4 prism diopters per +1.00D
with dry eye, do most people have an aqueous deficiency problem or an evaporative problem?
evaporative (specifically a lipid deficiency)
what who things are the driving forces of dry eye?
tear hyperosmolarity and tear film instability
what does BITCH stand for?
the symptoms of dry eye: burning, itching, tearing, crusty debris, hyperemia
whats the most likely frequent cause of dry eye?
MGD (meibomian gland dysfunction)
what does SET stand for and what is it for?
scan, express, treat (MGD)
what does the mastrota paddle do?
often used for therapeutic expression in MGD
what level of therapy is:
1) punctal occlusion
2) preserved tears
3) non-preserved tears
4) corticosteroids
5) tetracyclines
6) punctal cautery
1) 3
2) 1
3) 2
4) 2
5) 3
6) 4
what patient is the parasol punctal occluder best for?
young patients with CL dry eye symptoms
what is the extend puntal occluder best for?
LASIK-assoc dry eye
The expected finding for the NRA is approximately +____D. A finding of +2.75D or higher may indicate that the patient is ______. A finding of less than +2.00D may indicate reduced ____________ ability.
+2.25; over-minused; positive fusional vergence (when more lenses are added, accomodative convergence is lost and fusional convergence must kick in)
Reduced PRA findings on a pre-presbyopic patient usually indicate reduced __________ ability.
negative fusional vergence (as minus lenses are added, accomodaive convergence has to be countered by negative fusional vergence to keep the target single) (for a presbyopic pt, the test could be limited by the accomodative ability of the patient OR reduced NVF)