Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
146 Cards in this Set
- Front
- Back
|
What are the 5 things we use to assess deviation?
|
Comitancy, frequency, direction, laterality, magnitude at near and far.
|
|
|
Name 7 treatment options for strab
|
None, lenses, prisms, occlusion, VT, pharmacological, EOM surgery
|
|
|
What is the criteria for a cosmetic cure?
|
Within 10-12 prism diopters of ortho
|
|
|
*What are the 5 criteria for a functional cure?
|
1) Clear, comfortable, single BV at all distances in all DAFs up to normal NPC. 2) Stereopsis 3) Normal motor fusion ranges. 4) <1% turning with diplopia awareness. 5) Allowance for prism in spectacles up to 5 prism total.
|
|
|
(T/F) The treatment cutoff is 10 years old for amblyopia treatment.
|
F. No age ceiling.
|
|
|
How does EF change amblyopia prognosis?
|
Lowers
|
|
|
How does deprivation amblyopia change amblyopia prognosis?
|
Lowers
|
|
|
How does latent nystagmus change amblyopia prognosis?
|
Lowers
|
|
|
How does starting treatment at older age (>6 y/o) change amblyopia prognosis?
|
Lowers
|
|
|
How does a later onset (> 1 year) change amblyopia prognosis?
|
Increases
|
|
|
How does a shorter duration change amblyopia prognosis?
|
Increases
|
|
|
How does FEH change amblyopia prognosis?
|
Increases b/c parents notice sooner and are more compliant.
|
|
|
How does prior surgery change amblyopia prognosis?
|
decreases
|
|
|
What increases prognosis: Comitant or noncomitant?
|
Comitant
|
|
|
What increases prognosis: intermittant or constant?
|
Intermittant is better
|
|
|
What increases prognosis: XT, vertical, ET?
|
XT > ET > Vertical
|
|
|
What increases prognosis: Magnitude
|
No difference, except affects VT treatment
|
|
|
What increases prognosis: Laterality
|
No difference, except unilateral can cause amblyopia
|
|
|
What is the effect of AC on prognosis for ET and XT?
|
Significantly reduces prognosis for ET. But not much for XT b/c can covary.
|
|
|
What affect does more vs. less motor fusion have on prognosis?
|
More is better.
|
|
|
*What are the 3 big factors affecting prognosis for a functional cure for strabismus?
|
Direction, frequency, sensory fusion status.
|
|
|
What is sensory fusion?
|
How input from 2 eyes are combined into a single percept.
|
|
|
What is motor fusion?
|
How eyes move in response to disparate retinal stimuly to obtain simultaneous stimulation of corresponding retinal areas so sensory fusion can occur.
|
|
|
What is the definition of Normal Sensory Fusion?
|
Foveal images of both eyes combine into a single unitary percept.
|
|
|
What are the 3 prereqs for normal sensory fusion?
|
NC, no peripheral suppression, no significant amblyopia
|
|
|
What 3 things prevent normal sensory fusion?
|
AC, peripheral suppression, significant amblyopia
|
|
|
What is more favorable for prognosis of strabismus? Accommodative ET or Nonaccommodative ET?
|
Accommodative ET
|
|
|
What is more favorable for prognosis of strabismus? Intermittant or constant frequency?
|
Intermittant is better
|
|
|
In what order does this increase prognosis? Stable 2nd degree fusion, stereopsis, NC
|
NC, Stable 2nd degree fusion, stereopsis
|
|
|
What conditions have the 3 highest functional success rates? Which one is way low?
|
IET (70%), IXT (60%), CXT (50%). CET (29%)
|
|
|
Why is the functional success rate so high for IET?
|
B/c a lot are accommodative.
|
|
|
What 3 types of pts can we treat in primary care?
|
Amblyopia, IET (NC), IXT
|
|
|
What 3 types of pts can we treat in secondary care?
|
CET (NC), CXT (NC/AC), CET (AC)
|
|
|
What is meant by eye aiming, turned eye, reduced vision in doctor speak?
|
EF, strabismus, amblyopia
|
|
|
Name 4 types of passive treatment
|
Lenses, Prisms, Occlusion, Surgery
|
|
|
Name an active treatment
|
VT
|
|
|
What 4 kinds of VT are appropriate?
|
Ocular motility, Accommodative, sensory fusion, motor fusion
|
|
|
What are 2 kinds of pharmacologica Tx?
|
Miotics, Cycloplegics (atropine)
|
|
|
*When do we prescribe prisms or add +/- lenses?
|
If BV can be stabilized in free space.
|
|
|
Write the entire treatment chart!
|
Do it!
|
|
|
What 5 deficiencies would we treat for phase 2?
|
Amblyopia, pursuits, saccades, EF, accommodation
|
|
|
Do we try to fix peripheral or central suppression first?
|
Peripheral before central
|
|
|
In what phase do we try to improve vergences?
|
Phase 3
|
|
|
What is the first step in treatment?
|
Determine corect optical correction
|
|
|
What technique do we use to get a basis for our optical correction?
|
Cycloplegic refraction
|
|
|
What are 4 considerations we should remember?
|
Type and magnitude of ametropia, age, direction and size of deviation, predicted effect on sensory and motor fusion.
|
|
|
Spectacle correction of ametropia will always improve VA.
|
Maybe, maybe not!
|
|
|
Name 4 good things that spectacle correction can do?
|
Clear up retinal image, improve eye alignment, improve sensory fusion, improve motor fusion
|
|
|
How does uncorrected myopia affect eye alignment at distance? Near?
|
No effect. More exo.
|
|
|
How does corrected myopia affect eye alignment at distance? Near?
|
No effect. More eso.
|
|
|
How does uncorrected hyperopia affect eye alignment at distance? Near?
|
More eso for both.
|
|
|
How does corrected hyperopia affect eye alignment at distance? Near?
|
More exo for both.
|
|
|
If accommodation is poor, should we Rx more or less aggressively to correct hyperopia?
|
More aggressively.
|
|
|
(T/F) Uncorrected aniso can decrease sensory fusion.
|
T
|
|
|
(T/F) Uncorrected myopia can decrease sensory fusion at distance.
|
T
|
|
|
What is the general astigmatism Rxing guideline?
|
Fix full astigmatism to increase distance and near VAs and enhance sensory fusion.
|
|
|
(T/F) Aniso pts have equal accommodative demands for OD and OS.
|
F
|
|
|
Which eye drives accommodation with uncorrected anisometropia?
|
The eye with the least refractive error.
|
|
|
What is the general aniso Rxing guideline?
|
Rx full aniso
|
|
|
(T/F) If a hyperopic pt has aniso, it is recommended to cut equally in both eyes.
|
T
|
|
|
What solution is there to improve aniseikonia?
|
Contact Lenses
|
|
|
(T/F) Size difference is more important that equal clarity and stimulus to accommodate more.
|
F. Equal clarity and stimulus is more important.
|
|
|
(T/F) For eso pts, push plus
|
T.
|
|
|
(T/F) For exo pts, give least plus.
|
T
|
|
|
Name 4 reasons why we might Rx a bifocal lens for strab/amblyopia?
|
1. Reduce angle D at near (for high AC/As). 2. Equalize distance and near angle Ds (for Ets and DE XTs) 3. Help accommodative problems. 4. Interim Rx leading to full plus at distance.
|
|
|
How high should the bifocal height be for different ages?
|
0-2 is intermediate SV or bifocal? 3-5 is midpupil. 6-8 is lower pupil margin. >=9 is lower lid margin or PALs
|
|
|
What is the goal of our general amblyopia Rxing strategy?
|
Provide best retinal imagery
|
|
|
What is the general amblyopia Rxing strategy?
|
Full myopia, astigmatism, aniso. (Can symmetricallly cut hyper). Modify sphere to reduce angle D.
|
|
|
What measurement technique do we get our best retinal VA from?
|
Cycloplegic refraction
|
|
|
How do we prescribe for Ets: Hyperope, myope, aniso, astig, CE?
|
Most plus, least minus to BVA, Full Rx, Full Rx, Bifocal
|
|
|
Name 3 strategies to use when pt can't accept full plus
|
1) Cut distance plus and give add 2) Cyclotherapy (cyclo initially) 3) Gradual Srx change
|
|
|
At what age do we start considering cutting plus for hyperopic ETs? Why? What option do we have so they can read?
|
>= 7 y/o because they start reading blackboards. Bifocals.
|
|
|
How do we prescribe for XTs: Hyperope, Myope, Aniso, Astig
|
Cut plus. Full correction (can overminus, especially if <7 y/o). Full Rx. Full Rx.
|
|
|
What should be fixed when a pt has both? ET or Hyperopia?
|
Eso
|
|
|
What is more important? Allowing emmetropization or normal BV development?
|
BV development
|
|
|
Up to what time period does emmetropization occur?
|
18 months.
|
|
|
What is the purpose of corrective/neutralizing prism?
|
Stabilize normal sensory fusion by eliminating vergence demand
|
|
|
What is the purpose of relieving prism?
|
Stabilize normal sensory fusion by reducing vergence demand
|
|
|
What is the purpose of overcorrecting prism?
|
To disrupt AC.
|
|
|
What is the purpose of Inverse/Training prism?
|
Increase vergence demand to increase fusional vergence ability
|
|
|
What is the purpose of inverse/Cosmetic prism?
|
Improve cosmesis of strabismus
|
|
|
What is the purpose of yoked prism?
|
To stabilize BV by directing eyes into specific gaze
|
|
|
What is the purpose of sector prism?
|
Decrase vergence demand in specific fog.
|
|
|
(T/F) Strabismus is only a motor fusion or sensory fusion problem
|
F. Can be both as well!
|
|
|
Define sensory fusion.
|
Process by which stimuli seen separately by 2 eyes are combined into a single percept.
|
|
|
Define motor fusion.
|
Movement of 2 eyes in response to disparate retinal stimuli to maintain simultaneous stimulation of coresponding retinal areas so sensory fusion can occur.
|
|
|
What are the 3 prerequisites of normal sensory fusion?
|
NC, No peripheral suppression, No significant amblyopia
|
|
|
What is normal sensory fusion?
|
When OD and OS foveal images combine into unitary percept.
|
|
|
Name 3 things that prevent normal sensory fusion?
|
AC, Peripheral suppression, significant amblyopia.
|
|
|
What kind of pts do we normally prescribe prism form?
|
Patients with normal sensory fusion.
|
|
|
Name 3 types of strabismic pts with normal sensory fusion.
|
Intermittant, most noncomittant deviations, constant but normal fusion.
|
|
|
What kind of pts is prism best for?
|
Pts with normal sensory fusion.
|
|
|
What 2 kinds of prism do we usually rx for strabs with normal sensory fusion?
|
Corrective or Relieving prism
|
|
|
Prisms are prescribed based on ______ and ______.
|
Dissociated measure, associated measure
|
|
|
Name 2 ways that we rx prism based off dissociated measure?
|
Simple percent of magnitude, Residual Vergence Demand (Caloroso)
|
|
|
What are the Residual Vergence Demands for Esos?
|
4-6 prism
|
|
|
What are the Residual Vergence Demands for Exos?
|
10-15 prism
|
|
|
What are the Residual Vergence Demands for Hypers?
|
2-4 prism
|
|
|
If rxing prism based off associated measures, what do we aim for if the pt has diplopia or suppression?
|
Normal BV
|
|
|
If rxing prism based off associated measures, what do we aim for if the pt has no/low stereopsis?
|
Increased stereopsis.
|
|
|
What is the Fusion Prism Rule?
|
Rx the smallest prism to 1) eliminate diplopia (either free space or W4D), 2) eliminate head posture 3) Get clear, comfortable single binocular vision.
|
|
|
What test can check to see if a strab pt is a good candidate for prism correction? What type of correspondence does the pt have?
|
Prism adaptation test. AC
|
|
|
How does correcting prism and prism titration work?
|
Rx corrective prism. Remove 2-4 prism at a time. Monitor angle of deviation and sensory fusion.
|
|
|
What 2 qualities make a pt a good candidates for corrective prism and prism titration?
|
NC and normal peripheral sensory fusion pts.
|
|
|
(T/F) Only Rx for primary verticals
|
T
|
|
|
How do we Rx for small intermittant verticals? (4 tests)
|
Rx associated phoria using Bernell Test lantern, Wesson card, Disparometer, Saladin
|
|
|
(T/F) Muscle palsies and AV syndromes pts are comitant strabs.
|
F.
|
|
|
What 3 things should doctors be concerned about when helping noncomitant deviation pts?
|
1) Neurologic/Systemic implications 2) Restoring of function (BV & head tilt) 3) Avoid secondary contractures.
|
|
|
(T/F) We should measure prism only with the head straight for comitant deviations.
|
F. Measure with both compensatory and straight head positions.
|
|
|
(T/F) The prism magnitude Rxed for noncomitant strabs is usually the full amount to straightent the head.
|
F. Between head straight & tilt.
|
|
|
When should we consider increasing prism over the affected eye?
|
If UA muscle.
|
|
|
What is the difference between primary deviation and secondary deviation?
|
Sound eye fixates. Paretic eye fixates.
|
|
|
(T/F) When splitting prism, put more prism in the affected eye. Do not split them 50/50.
|
T
|
|
|
(T/F) LR palsies often resolve on their own.
|
T
|
|
|
What 2 things can we do to ensure the MR muscle doesn't lose elasticity when a pt has a recent LR palsy?
|
1) Eye exercises. 2) Patch good eye a few hours at night.
|
|
|
(T/F) Yoked prisms can fix side-to-side head tilts.
|
T
|
|
|
What are the 4 options for noncomitant deviations?
|
Fusion prisms, yoked prisms, 2 pairs of glasses, sector prism.
|
|
|
What 2 cases would we Rx prism for pts with abnormal sensory fusion?
|
Cosmetics. Overcorrecting for AC.
|
|
|
What 2 things could happen if we Rx prism for pts with abnormal sensory fusion?
|
1) No therapeutic effect 2) Prism adaptation.
|
|
|
(T/F) Prism adaptation with pts with abnormal sensory fusion is difficult to reverse.
|
F. Just take away prisms.
|
|
|
What is the largest amount of prism we can typically add for cosmetic prisms?
|
7-9 diopters.
|
|
|
(T/F) Cosmetic prisms are good for pts with good prognosis for functional cures.
|
F.
|
|
|
(T/F) BI prism moves the eyeball further in.
|
F. It moves eye out.
|
|
|
(T/F) NC pts w/ good VA may prism adapt.
|
F. AC pts may adapt.
|
|
|
The eye behind a cosmetic prism moves out 1 mm for every ____ prism diopters.
|
8
|
|
|
What normal sensory patient types should I consider prism in?
|
Constant, intermittant, Noncomitant
|
|
|
What normal sensory patient types should I consider prism in in my initial Rx?
|
Constant, intermittant, Noncomitant
|
|
|
What types of AC pts should I consider prism in?
|
Cosmetic. Overcorrecting prism to eliminate AC.
|
|
|
What types of AC pts should I consider prism in my initial Rx?
|
Cosmetic only.
|
|
|
Name 2 types of clip-on prisms.
|
Sunglass clip ons, E-Clips
|
|
|
Name 2 reasons why clip-on prisms are a good choice.
|
Intermittant. Only need prism for certain activities.
|
|
|
What is the total amount of prism we can have with no rx? How much in each lens?
|
24 diopters. 12 diopters.
|
|
|
If a pt has a -5.00 Rx, what amount of prism can I ground in each lens?
|
10 each for 20 total.
|
|
|
(T/F) Ground in prism should be split equaly between eyes.
|
T.
|
|
|
Name 2 things that improve cosmetics of ground-in prism.
|
Edge treatments & AR coat.
|
|
|
What is the range of Fresnel prisms?
|
1-40 diopters.
|
|
|
Name 2 disadvantages of fresnel prisms?
|
Reduced acuity, reduced contrast sensitivity. Visibility of ridges.
|
|
|
(T/F) Fresnel prisms are best split between 2 eyes.
|
F. B/c we want to keep one eye with good vision.
|
|
|
We should put Fresnel prism over the (BU/BD) eye to reduce _____.
|
BD. Overhead reflection.
|
|
|
Conventional slab off adds (BU/BD) prism. Reverse adds (BU/BD) prism
|
BU. BD.
|
|
|
What is the range for slab off prism?
|
1.5 to 7 prism diopters.
|
|
|
What kind of prism is great for SO palsies?
|
Slab-Off prism
|
|
|
How many prism diopters can we add to SCLs? RGPs?
|
<=4 prism diopters. 3-4 prism diopters.
|
|
|
What direction must the prism be in CLs?
|
BD
|
|
|
(T/F) When prescribing prism, give the least amount that gives stereo.
|
F. Give minimum amount that gives best stereo.
|
|
|
For yoked prisms, if my bases are to the right, my eyes will turn ____.
|
Left.
|
