Accommodation Dysfunction

Question 1

What is the MEM test used to measure?

Answer 1

Accommodative response

Question 2

T or F: When a patient has a large lag of accommodation, this could influence the AC/C gradient findings.

Answer 2

True

Question 3

What is the key finding for accommodation insufficiency?

Answer 3

Reduced accommodation amplitude

Question 4

T or F: In accommodation excess, the patient will have more problems clearing minus.

Answer 4

False

Question 5

T or F: in ill-sustained accommodation, the patient’s accommodative amplitude will be lower than expected.

Answer 5

False - they just can’t maintain it

Question 6

What is the accommodation system’s resting point?

Answer 6

About 1 D

Question 7

T or F: In accommodation infacility, the patient’s NRA and PRA will be within the normal limits.

Answer 7

False - they generally have a hard time “releasing” accommodation

Question 8

T or F: In accommodation insufficiency, the patient will have more problems to clear the (-) portion of the test

Answer 8

True - they have a lack of accommodation to be able to clear the minus

Question 9

T or F: the MEM and FCC findings are used to determine the near Rx.

Answer 9

True

Question 10

Esophoria could be found as a sign in which accommodative dysfunctions?

Answer 10

Accommodative excess

Accommodative insufficiency

Question 11

Diplopia is a symptom of which accommodative dysfunction?

Answer 11

Accommodation excess

Question 12

In accommodation excess, the results of all the tests that measure the patient’s ability to relax accommodation will be:

Answer 12

Lower than normal

Question 13

In accommodation excess, the results of all the tests that measure the ability to stimulate accommodation will be:

Answer 13

Higher than normal

Question 14

In accommodation insufficiency, the results of tests that measure the ability to stimulate accommodation will be:

Answer 14

Lower than normal

Question 15

Measuring NRA forces a patient to use what, in order to maintain single vision?

Answer 15

Positive fusional vergence (PVF)

Question 16

If a patient has a normal 4:1 AC/A ratio and the NRA result is +2.50, how many D of fusional convergence would the patient use to maintain fusion?

Answer 16

10 Pd (2.5D of stimulus, so 2.5*4 = 10)

Question 17

While testing PRA minus lenses are used. Therefore accommodation will ___, and convergence will ___.

Answer 17

Increase

Increase

Question 18

While testing NRA plus lenses are used. Therefore, accommodation will ___, and convergence will ___.

Answer 18

Decrease

Decrease

Question 19

If there is a +1.75 lag on MEM, the findings on the +/- 2.00D accommodative facility test will likely be ___, especially on the ___ portion of the test.

Answer 19

Low

Minus (-)

Question 20

If there is a +1.50 lag on MEM, it is likely that the PRA findings will be ___, and the NRA findings will be ___.

Answer 20

Low

Normal or high

Question 21

During the accommodative test battery we find: a lead of accommodation, low NRA, high PRA. Which phoria posture is likely present?

Answer 21

Eso - with a lead of accommodation, they are overaccommodating, which will likely cause convergence. Low NRA, because they are over accommodating, so adding more plus lenses won’t work well.

Question 22

If we find a lead of accommodation, low NRA, and high PRA, would the expected AC/A ratio be low, normal, or high?

Answer 22

High - they can and will accommodate like crazy

Question 23

Which accommodative conditions show symptoms at distance?

Answer 23

Accommodative spasm

Accommodative excess

Question 24

What are the signs of accommodation infacility?

Answer 24

Normal or high accommodation amplitude
Low PRA
Low NRA
Failure to clear (-) on facility test

Question 25

What are the signs of accommodation excess?

Answer 25

Normal or high accommodation amplitude
Low NRA
Low lag or a lead of accommodation
Failure to clear (+) on facility test

Question 26

What are the 8 types of accommodation?

Answer 26

Chromatic accommodation
Positive relative accommodation
Negative relative accommodation
Meridian accommodation
Absolute accommodation
Physiological accommodation
Consensual accommodation
Convergence accommodation (CA/A)

Question 27

In accommodative insufficiency, what would you expect for accommodative amplitude?

Answer 27

Low

Question 28

In accommodative insufficiency, what would you expect for PRA?

Answer 28

Low - they can’t accommodate to adapt to the added minus lenses

Question 29

In accommodative insufficiency, what would you expect during the facility test?

Answer 29

Trouble clearing (-)

Question 30

Which phoria posture at near would likely be seen in accommodative insufficiency?

Answer 30

Esophoria at near

Question 31

In accommodative insufficiency, what would you expect with MEM and FCC?

Answer 31

Higher than usual (>+0.75), since they are can’t accommodate as well, there will be a lag of accommodation

Question 32

In ill-sustained accommodation, what would you expect to see for accommodative amplitude?

Answer 32

Normal if only done once

Reduced if done repeatedly

Question 33

What would you expect to get during PRA in ill-sustained accommodation?

Answer 33

Low - probably would come in and out of focus (just a guess)

Question 34

In ill-sustained accommodation, what would you expect to see during the facility test?

Answer 34

Trouble clearing (-), that gets worse as you continue

Question 35

What phoria posture at near would you likely see in a patient with ill-sustained accommodation?

Answer 35

Eso

Question 36

In ill-sustained accommodation, would you expect FCC and MEM to be low, normal, or high?

Answer 36

High - they will have a larger lag than normal, since they struggle to accommodate

Question 37

In accommodative excess, what tests would you get low results in?

Answer 37

MEM/FCC - lead of accommodation, since they are overaccommodating all the time
NRA - they won’t like plus lenses/have a hard time relaxing it

Question 38

In accommodative excess, what would you expect when testing mono and binocular accommodation facility?

Answer 38

Trouble clearing (+)

Question 39

In accommodative infacility, what would you expect to see with NRA and PRA?

Answer 39

Low result for both

Question 40

What results would you expect from the accommodation facility test on a patient with accommodative infacility?

Answer 40

Can’t clear either (+) or (-) 2.00D