Case Analysis and Diagnosis of Nonstrabismic BV Disorders (M1)

Question 1

For the graphical analysis of binocular vision, what is the marking made for dissociated phoria? 1. BO and BI blur? 2. Break? 3. Recovery? 4

Answer 1

1. x
2. circle
3. square
4. triangle

Question 2

What are the benefits to graphical analysis of binocular vision?

Answer 2

1/ helps show relationships

2. helps identify data that doesn’t fit

Question 3

What are the disadvantages to graphical analysis of binocular vision?

Answer 3

1. fails to evaluate some areas
   2 fails to identify common binocular vision anomalies
2. inefficient
3. relies on guidelines for diagnosis or management

Question 4

What areas of binocular vision are not evaluated in graphical analysis?

Answer 4

accommodative facility, fusional facility, fixation disparity, lag, and eye movements

Question 5

What common binocular vision anomalies does graphical analysis fail to identify?

Answer 5

accommodative excess, accommodative infacility, accommodative fatigue, fusional vergence dysfunction, and ocular motor dysfunction

Question 6

Do esophores prefer glasses with prism or without? 1. Exophores? 2

Answer 6

1. with

2. without

Question 7

What is the best indicator of symptoms for esophores? 1. Exophores? 2

Answer 7

1. slope of fixation disparity curve

2. Sheard’s criterion

Question 8

What is done during the analytical analysis of OEP?

Answer 8

1. checking (compare data to expecteds)
2. chaining (group high and low findings according to rule)
3. case typing (diagnosis)

Question 9

What are the concepts of OEP analytical analysis?

Answer 9

1. visual anomalies occur as an adaptation to visual stress

2. vision problems can be prevented with appropriate intervention

Question 10

What values are in the Morgan’s system group A? 1. Group B? 2. Group C? 3

Answer 10

1. BI break at dist., BI blur at near, BI break at near, PRA, amplitude
2. BO blur and break @ dist, BO blur and break @ near, binocular cross-cylinder, monocular cross cylinder, NRA
3. phoria, AC/A ratio

Question 11

What is the advantage to Morgan’s system of normative analysis?

Answer 11

groups of data are evaluated

Question 12

What are the disadvantages to Morgan’s system of normative analysis?

Answer 12

1. does not include all clinically significant findings

2. some binocular, accommodative, and oculomotor problems are not identified

Question 13

What are the clinically significant findings not included in Morgan’s system of normative analysis?

Answer 13

accommodative facility, vergence facility, acommodative response, fixation disparity, eye movement skills

Question 14

What are the binocular, accommodative, and oculomotor problems not identified in Morgan’s system of normative analysis?

Answer 14

accommodative infacility, vergence infacility, fixation disparity, eye movement inefficiency, accommodative spasm

Question 15

What are the advantages to fixation disparity analysis?

Answer 15

1. binocular test

2. effective for prescribing prism for some binocular vision anomalies

Question 16

What are the disadvantages to fixation disparity analysis?

Answer 16

accommodation & eye movements not directly evaluated

Question 17

For a case analysis, what are the sources of direct info about PFV?

Answer 17

1. BO fusion range
2. NPC
3. vergence facility with BO

Question 18

For a case analysis, what are the sources of indirect info about PFV?

Answer 18

1. Binocular accommodative facility when looking through plus lenses
2. NRA
3. accommodative response

Question 19

For a case analysis, what are the sources of direct info about NFV?

Answer 19

1. BI fusion range

2. Vergence facility with BI

Question 20

For a case analysis, what are the sources of indirect info about NFV?

Answer 20

1. binocular accommodative facility with minus lenses
2. PRA
3. accommodative response

Question 21

For a case analysis, what are the sources of direct info about accommodative ability?

Answer 21

1. monocular accommodative amplitude
2. monocular accommodative facility
3. accommodative response

Question 22

For a case analysis, what are the sources of indirect info about accommodative ability?

Answer 22

1. binocular accommodative amplitude
2. binocular accommodative facility
3. NRA/PRA

Question 23

What is Duane’s classification of a patient with a low AC/A ratio and greater exophoria at near than at distance?

Answer 23

convergence insufficiency (CO)

Question 24

What is Duane’s classification of a patient with a low AC/A ratio and greater esophoria at distance than at near?

Answer 24

divergence insufficiency (DI)

Question 25

What is Duane's classification of a patient with a normal AC/A ratio and about the same amount of esophoria at distance and near?

Answer 25

basic esophoria

Question 26

What is Duane's classification of a patient with a normal AC/A ratio and about the same amount of exophoria at distance and near?

Answer 26

basic exophoria

Question 27

What is Duane's classification of a patient with a high AC/A ratio and greater esophoria at near than at distance?

Answer 27

convergence excess (CE)

Question 28

What is Duane's classification of a patient with a high AC/A ratio and greater exophoria at distance than at near?

Answer 28

divergence excess (DE)

Question 29

What is the condition with reduced fusional ranges and/or facility with orthophoria or a small phoria?

Answer 29

fusional vergence dysfunction

Question 30

What are common etiologies of BV disorder symptoms?

Answer 30

1. aniseikonia 2. cyclophoria 3. latent hyperopia 4. fixation disparity

Question 31

What is the limit to be considered a low amplitude of accommodation?

Answer 31

2D or more below the lower limit for a patients age

Question 32

What is the CITT definition for convergence insufficiency?

Answer 32

1. 4 more exo at near than at distance 2. Receded NPC (≥ 6cm) 3. Insufficient positive fusional vergence (Fails Sheard’s Or minimum positive fusional vergence < 15pd BO break or blur)

Question 33

What is the first line treatment approach for the treatment of symptomatic CI in children 9 to 17?

Answer 33

office based vergence and accommodative therapy with home reinforcement

Question 34

What is a possible management of an adult presbyope with CI?

Answer 34

PAL with BI prism at near only

Question 35

What are triggers to divergence excess?

Answer 35

1. inattention 2. fatigue 3. illness 4. daydreaming

Question 36

What are the possible etiologies of a vertical phoria?

Answer 36

1. hyperorbit (small deviations) 2. improper EOM insertion 3. secondary to lens extraction 4. vertical rectus anomalies 5. oblique dysfunction 6. skew deviation (supranuclear) 7. CN III px 8. CN IV px 9. ocular myasthenia 10. IO or SO overaction

Question 37

What are the things to consider if diagnosis from initial analysis is unclear?

Answer 37

1. accuracy and reliability of test results 2. nonfunctional etiology 3. effect of time of day 4. malingering

Question 38

What are the things that should be presented to the patient when talking about their BV disorder?

Answer 38

1. Explain in laymen’s terms 2. Link any signs and symptoms 3. Explain common symptoms 4. Explain no symptoms with signs 5. Demonstration 6. Once have complete diagnosis explain proposed treatment plan and give options