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Accommodation Flashcards

(85 cards)

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1
Q

What is accommodation?

A

Changes in refractive power of the crystalline lens to allow clear vision over a range of distances

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2
Q

What happens during accommodation?

A

Ciliary muscle contracts and pulls choroid forward, zonules relax, lens becomes more convex

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3
Q

Why does accommodation decrease over time?

A

The lens becomes less flexible

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4
Q

How can we study the development of accommodation?

A

Retinoscopy, measure eyes; focal distance to stimulus distance aka accommodative error

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5
Q

When is accommodation accurate?

A

8-9 weeks old

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6
Q

T/F photorefraction estimates optical errors and accommodation

A

False, does not estimate accommodation

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7
Q

What did the Braddock study find about infant focus at two distances?

A

Infants see up close (75 cm) first and distance (150 cm) afterwards, both distances are 100% at 6-8 months

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8
Q

When does an accurate accommodative response develop?

A

At 2-3 months

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9
Q

Why do infants < 3 months old tend to over accommodate?

A

Target proximity, large depth of field, poor sympathetic innervation to ciliary muscle to relax accommodation

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10
Q

How can you test accommodation in infants/toddlers/school aged?

A

Near dynamic retinoscopy

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11
Q

How can you test accommodation in school aged children?

A

Amplitude of accommodation, FCC, near ret, NRA/PRA

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12
Q

What are the amplitude of accommodation methods?

A

Push up, pull away, minus lens all subjective and monocular

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13
Q

T/F you can test amps uncorrected

A

FALSE

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14
Q

Which amp of accommodation method is more accurate?

A

Push up slightly more accurate than pull away at least

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15
Q

What is the procedure for minus lens amp of accommodation?

A

In phoropter, use 1 line above best VA at 40 cm, add minus lenses until patient reports first slight sustained blur

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16
Q

Where do you have to start with young children on the minus lens procedure?

A

-3.00 over Rx since they have a large amount of accommodation

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17
Q

How do you calculate the amp of accommodation in a minus lens test?

A

Take the diopter power from lenses at first sustained blur and add working distance for the 40 cm (2.5 D) or even 30 cm and 3 D

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18
Q

What is the average amp according to Hofstetter?

A

18.5-1/3(age)

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19
Q

What is the minimum amplitude according to hofstetter?

A

15-1/4(age)

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20
Q

What does the Swedish study say about hofstetter norms?

A

They are overestimated by 2 D, new standard would be hofstetter - 2

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21
Q

What is the purpose of NRA/PRA?

A

To measure fusional convergence and divergence, also looks at accommodation

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22
Q

How do you perform PRA?

A

Minus lenses OU with convergence set at 40 cm, maintain single and clear vision, lenses will increase accommodative convergence

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23
Q

How do you perform NRA?

A

Add plus lenses OU, convergence set at 40 cm, maintain single and clear vision, relax accommodation, will decrease accommodative convergence

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24
Q

What is a normal NRA value?

A

+2.00

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25
What is a normal PRA value?
-2.37
26
What is the Harmon distance?
Comfortable reading distance, “middle knuckle on fist to elbow”
27
Where does one focus with the ideal lag of accommodation?
Behind the target
28
What is the purpose of FCC?
To determine the lag of accommodation or add subjectively
29
What is the FCC procedure?
FCC card, +/- 0.50 lenses, see which lines are darker
30
If the horizontal lines are darker in FCC what does that mean?
Lag of accommodation, add plus lenses until patient reports the lines are clear
31
What does it mean in the vertical lines are darker for FCC?
Lead of accommodation
32
What is the expected FCC result?
+0.25 to +0.75
33
What is the purpose of near ret?
To determine the need for a near vision correction/add over the distance Rx
34
Is near ret objective or subjective?
Objective
35
What is the objective equivalent to FCC?
MEM/Nott
36
What is the goal of streak ret?
Neutrality and finding astigmatism axis
37
What is the goal of spot ret?
Allows more light from retina, better color, brightness, and you can observe 2 meridians simultaneously
38
What equipment is needed for MEM?
MEM Cards, Ret, looses lenses, current Rx
39
What is the procedure for MEM?
Perform at Harmon’s distance or 16 inches while patient reads words on appropriate reading level cards with both eyes open wearing appropriate Rx, examiner estimates the dioptric value of motion and dips lenses in front of the eye for 1/5th of a second
40
What is expected from MEM?
+0.25 to +0.75
41
What is a concern for MEM?
Unequal reflexes, lag >+0.75, against motion
42
How do you Rx for near after MEM?
Add plus spheres binocularly until MEM results within expected values
43
If there is against motion on MEM do you add minus lenses?
NO
44
What equipment do you need for bell retinoscopy?
Wolff wand, ret, yard stick or measuring tape, probe lenses
45
What is the procedure for bell ret?
Patient wears Rx, start with target and ret at 20 in/50cm then move target closer, then move target away from patient
46
What should you observe on bell retinoscopy?
With motion that decreases until neutral then against motion as accommodation localized closer than the ret, once the target is moved further away, will see with motion again
47
T/F bell retinoscopy uses lenses?
False, it uses different target distances
48
How do you record bell ret results?
As a fraction of the range of neutrality ex: 15/16 which means w/ to against and then back to with and is recorded in inches
49
What do you do if the bell ret is abnormal?
Recheck with probe lenses, if against and check with probe is still against there is no further testing
50
What does bell ret compare?
Accommodative response to accommodative stimulus (distance from ret to patient and distance from target to patient)
51
T/F on bell ret, when there is a neutral reflex, accommodation is at the plane of the retinoscope
True
52
What is the difference between AR and AS?
The lag
53
What is expected for bell retinoscopy?
17-14 in with to against/16-18 inches against to with
54
What equipment is needed for book ret?
Book, ret, probe lenses
55
What is the procedure for book ret?
While patient reads with appropriate Rx, observe the reflex in each eye on the same passage looking for motion, color, brightness, symmetry
56
What reading level should the book be?
Start with easy material at least 2 grade levels below then move to more difficult things
57
T/F changes in color, brightness and motion are associated with cognitive demand and interest
True
58
What should you observe on book ret during free reading (desired)?
Whitish pink color, bright, neutral to low width motion (+0.50), little cognitive effort needed
59
What should you observe with easy instructional reading for book ret?
Pink, bright, with to against (-0.25 to +0.75), some cognitive effort
60
What should you observe with difficult instructional reading on book ret?
Reddish-pink, bright, with to against (-0.50 to +1.25), more effort and high cognitive demand
61
What should you observe with complete frustration or non reading on book ret?
Brick red color, dull, large with (+3.00), cognitive level is too difficult
62
What equipment is needed for Nott?
Ret, near cards, ruler/bar
63
What is the procedure for Nott?
Pt wears Rx, place near card at 40 cm and perform ret at the plane of the target, the examiner moves the retinoscope closer or farther until neutrality is achieved
64
What movement is need if Nott ret shows with movement?
Pt demonstrating a lag, move away
65
What do you record for Nott?
Target distance, distance ret was for neutrality (the difference between the two is the lag/lead)
66
T/F in Nott lenses are added
False, only the ret distance is changes
67
What is more difficult to estimate using Nott?
Larger lags/leads
68
T/F there is a non linear relationship between accommodative stimulus and response
True
69
As accommodative stimulus increase, accommodative response____
Increases but lags behind more and more each time
70
What is the stress point?
As a target moves toward a patient she reacts to the stress of the near target with a physiologic response
71
What equipment is needed for stress point?
Ret, Wolff wand, probe lenses, yardstick
72
What is the procedure for stress point?
Ret at 20 in/50 cm from patient’s eyes, move the target closer to the patient and look for a change in reflex brightness not motion, repeat with probe lenses
73
What change should you see in the retinal reflex during stress point testing?
Brightness dulls then returns to prior level of brightness
74
What is the stress point?
The distance where the reflex changes
75
What do plus probe lenses do to a stress point?
Shift the stress point closer because patient fixates without stress
76
What is the expected stress point of a child?
4 inches closer than Harmon distance
77
What is the expected stress point of an adult?
6 inches from the face
78
High lag may be related to which types of accommodative dysfunction?
Insufficiency and infacility
79
A high lag may correspond to what refractive conditions?
Uncorrected hyperope or myope, overminused
80
A high lag may coincide with what vergence dysfunction?
Esophore with poor ranges
81
A low lag may correspond to what accommodative dysfunction?
Accommodative spasm
82
A low lag may correspond to what refractive condition?
Overplussed
83
A low lag may be due to what vergence dysfunction?
Exophore with poor ranges
84
What is incorporated in “just look”?
No lenses, compare each eye for color brightness motion and quality, looking at target? Only target and not faces? What happens when target moved to the side? How stable is the reflex?
85
T/F the just look technique incorporates neutralization
False

Pediatrics (22 decks)

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