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Block 5 > Clincal: Accomodation Testing W Phoropter > Flashcards

Clincal: Accomodation Testing W Phoropter Flashcards

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1
Q

Blurry images at near stimulates _____.

A

Accomodation

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2
Q

what is the near triad

A

Accommodation
Convergence
Constriction

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3
Q

Amplitude of accommodation is the

A

Total possible increase in power due to accommodation

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4
Q

The maximum amplitude is greatest in ____ and gradually decreases with ___.

A

Childhood, age

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5
Q

Most common accommodation issue

A

Presbyopia

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6
Q

What is presbyopia?

A

Gradual loss of accommodation

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7
Q

Average age of presbyopia onset

A

Early 40s

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8
Q

What changes happen to the lens hat cause presbyopia?

A

Lens becomes thicker, less elastic, more brittle with age

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9
Q

Symptoms of presbyopia:

A

-blurry near vision
-eye strain
-eye fatigue
-headaches
-hold stuff really far away to read it

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10
Q

How can we treat presbyopia?

A

Need separate optical correction for tasks
-ADD plus power
- bifocals, trifocals, progressive lens, readers
-contact lenses - multifocal, monovision

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11
Q

Non optical treatments fro presbyopia

A

Prescription eye drops (ex. Vuity, Qlosi)

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12
Q

What is an accommodative stimulus?

A

A stimulant that causes divergent rays to come into the eyes instead of parallel (focuses behind retina *)

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13
Q

Accommodation can be stimulated by either:

A

-a target closer than optical infinity
-minus lens

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14
Q

Near objects produce ____ rays

A

Divergence

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15
Q

How can we calculate how much a target causes a person to accommodate

A

1/ (distance of target in meters =0.0254 meters Diopters

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16
Q

Method using a near target to test accommodation

A

Push up and pull away method

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17
Q

Push up and pull away is monocular or binocular?

A

Monocular

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18
Q

Describe push up method

A

Pt focuses on a letter and is instructed to keep in clear. Slowly move the letters closer to the pt until the pt repots blue

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19
Q

Describe pull away method

A

Pull the fixation stick away form the patient until they report that the letter is clear

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20
Q

What do you do after measuring the points that the pt reports for push up or pull away method

A

Measure the distance and plug it into formula

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21
Q

Minus lenses: stimulus to accommodation = exact ____ ___ of the lens used

A

Dioptric power

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22
Q

Near target and minus lenses: combined method

A

You have a letter at a certain distance and use a minus lens

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23
Q

A single letter is placed at 50cm and the pt is looking at it through a -1.00 D lens. What is the total stimulus to accommodation

A

100/50cm =2 cm 2.00D(near target)
-1.00 D = 1.00D(minus lenses)
Total demand = 3.00D

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24
Q

Sheard’s minus lens to blur test

A

Meaures amplitude of accommodation using minus lenses and a near target

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25
Sheard’s minus lens to blur test: monocular or binocular?
Monocular
26
Sheard’s minus lens to blur test: pt looks through ____ correction in the phoropter
Distance
27
Sheard’s minus lens to blur test: make sure you change the wings of the phoropter to ___
Near
28
Sheard’s minus lens to blur test: target
Vertical line of letters or block of letters, 20/30 in size at 40cm
29
Sheard’s minus lens to blur test: explanation of test to pt
I am going to make some changes. Try to keep the letters on the chart clear but let me know when they start to get blurry
30
Sheard’s minus lens to blur test: procedure
1. Occlude eye 2. Add minus, -0.25D at a time, until first sustained blur 3.Ask patient to try to make it clear, if they can, continue to add -0.25D 4. Pt can’t accommodate more 5. Record the amount of minus sphere(absolute value) PLUS 2.50D* b/c its at 40cm 6. Do other eye
31
What are two ways that give the expected monocular amplitude of accommodation for a person’s age?
-Donder’s table -Hofsetter’s formula
32
Hofstetter’s formulas: max, average, min
Max: 25-.4(age) Average: 18.5 - 0.3(age) Min: 15-0.25( AGE)
33
Inaccuracy of accommodation can happen because
People do not always accommodate the exact amount expected based on don the stimulus
34
Lead of accommodation
The pt’s accommodative response is greater thane the accommodative demand
35
Lag of accommodation
The patient’s accommodation response is weaker than the accommodative demand
36
Three tests to test accommodative function:
1. Fused cross-cylinder test(aka binocular cross-cylinder) 2. Negative relative accommodation and positive relative accommodation 3. And more ( learn later) whoops
37
Accommodation testing is done after
The distance subjective refraction
38
Accommodative testing proves date to calculate an
Alternative prescription for improved vision at near
39
Uses for accommodative testing
-Presbyopia -Latent hyperopes -Other accommodative problems
40
Near testing with the phoropter set up
-near point rod with the near card at 40cm -set to near PD -stand lamp if needed
41
Fused cross cylinder (FCC) measures
A pt’s accommodative response while viewing a near target binocularly *accuracy of accommodation
42
Uses for FCC
- determine a tentative add power - determine if patient is lead or lag
43
FCC lighting
DIMMMM
44
FCC auxiliary knobs are set to
+/- 0.50 DC OU
45
FCC target
Cross grid target on near card at 40cm
46
The cross- cylinder on the auxiliary knobs splits the ____ and ____ line images on the cross grid
Horizontal and vertical
47
FCC: if the parties accommodative response is accurate the horizontal and vertical liens will appear ___
Equally blurred
48
FCC: if the patient reports the horizontal lines are sharper, they are
Under accommodating Lag in accommodation
49
FFC: patient reports the vertical lines are sharper, they are
Over-accommodating Lead of accommodation
50
FCC: instructions to pt
Which liens are shaper or more distinct? Those are going up and down or side to side
51
FCC: If patient reports horizontal lines are clearer at start, you add
+0.25D binocularly and ask again
52
FCC: You keep adding plus until the pt says what?
Reversal of their responses (not on equal!)
53
FCC: if the patient starts the test with saying the vertical looks clearer, your first step is to
Dim the lights further
54
FCC: if pt keeps saying vertical liens looks clearer, you’ll add
-0.25 D until they say horizontal or at -1.00D
55
FCC: recording example
FCC: -0.50D lead of accommodation
56
FCC: For presbyopia patients over the age of 50; add at least _____ to the phoropter before beginning in the test
+1.00D OU
57
FCC excepted findings for young patients
+0.25D to +0.75D
58
Negative relative accommodation and positive relative accommodation (NRA/PRA) test a pts ability to
Increase and decrease accommodation under binocular conditions and a fixed state of convergence
59
NRA/PRA is monocular or binocular
Binocular
60
NRA/PRA uses:
- refine a tentative ADD power - analyze a patient’s accommodative function
61
NRA is always performed ____
First (before PRA)
62
NRA uses ___ lenses to blur binoncularly
Plus -relaxing accommodation
63
PRA uses ___ lenses to blur binocularly
Minus
64
NRA/PRA room illumination
Bight, stand lamp on na pointed at near car
65
NRA/PRA: near card at __ with ___ letters
40 cm, 20/30 letters
66
NRA/PRA: pre- presbyopia patients use ____ subjective refraction
Distance
67
NRA/PRA: presbyopic patients use tentative ___ prescription from FCC
Near
68
NRA procedure
1. Direct patient to look at 20/30 line on the near card and confirm that the letters are clear 2. Add +0.25D at a time binocularly asking each time if the letters still appear clear or blurry 3. Continue until the first sustained blur 4. Note total amount of plus power added
69
PRA procedure
After NRA: 1. Return to the initial power in the phoropter and confirm letters are clear again 2. Add -0.25D at a time bionocularly, following the same steps, until first sustained blur 3. Note total amount of minus added
70
NRA/PRA recording
Record NRA first, then PRA Record the net amount of plus
71
NRA/PRA: Non-presbyopia expected findings
NRA: +2.00 (+/-0.50) PRA: -2.37 (+/-1.00)
72
NRA/PRA: presbyopes expected findings
Varies NRA: the sum tentative add and NRA result should not exceed +2.50 NRA and PRA should be balanced (same absolute value)
73
If the NRA is greater than PRA, it indicates the patients may need
An add
74
If the NRA is greater than PRA+2.50, the patients has ___ hyperopia or they are ______
Latent, over minuses
75
If the PRA is less than -1.37D, the patient may have reduced _____ _ _____
Amplitude of accommodation
76
If the PRA is greater than -3.37D, the patient is able to
Accommodate more than 3d and the true endpoint may be very high
77
You choose a tentative add based on what three factors?
-age -FCC result - amplitude based
78
Amplitude based for tentative add is based on the results of
Amplitude testing (push up, pull away, or minus lens to blur test
79
Amplitude based uses the concept that patients should use ___ ____ ___ of their accommodative amplitude to view near targets
More than half of
80
(NRA + PRA)/2+ ADD owner used =
Final ADD
81
What is the estimated add for ages 40-42?
+0.75
82
What is the estimated add for ages 43-45?
+1.00
83
What is the estimated add for ages 46-47?
+1.25
84
What is the estimated add for ages 48-50?
+1.50
85
What is the estimated add for ages 51-52?
+1.75
86
What is the estimated add for ages 53-55?
+2.00
87
What is the estimated add for ages 56-57?
+2.25
88
What is the estimated add for ages 58-60?
+2.50

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