EF And ARC Therapy Flashcards Preview

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Flashcards in EF And ARC Therapy Deck (51):
1

Simultaneous prism cover test (SPCT)

A variation of CT to measure deviation
-estimates the deviation
-the amount of estimated prism is placed over the deviated eye as the occluder is placed over the fixating eye
-repeat, increasing the prism until no shift is seen as the prism and the occluder are introduced
-prism goes over the deviated eye

2

Eccentric fixation

-monocular sensory adaptation
-amblyopic eye using a non fovea point
-localization, size, steadiness
-in degrees or prism diopters

3

ARC

-binocular sensory adaptation
-fovea of fixating eye and non fovea of non fixating eye have common visual direction (under binocualr conditions)
-objective angle, subjective angle, angle of anomaly
-in prism diopters

4

Is EF the same as ARC?

No

5

Normal correspondence

Objective angle equals the subjective angle and the angle of anomaly is 0

6

Anamalous correspondence

Objective angle does not equal the subjective angle and the angle of an anomaly does not equal 0

7

Harmonious ARC

Objective angle equals the angle of anomaly, the subjective angle equals 0

8

Unharmonious ARC

Objective angles is greater than the angle of anomaly, objective angle is greater than the subjective angle

9

Which actually gets us some type of binocualr vision

ARC
-EF does not

10

EF is evaluated with

Visuoscopy
Haidinger brushes
After image transfer

11

ARC is evaluated with

W4D
Bagolini lenses
Red lenses
Amblyopscope/synoptophore
After image transfer (angle of anomaly)
Haidinger brushes (angle of anomaly)

12

Classification of EF

-central or eccentric
-steady or unsteady
-location (nasal, temporal, superior, inferior)
-magnitude

13

Embeddness of ARC

Most natural (mildly) to the most artifical (deeply embedded: smaller angles)
-bagolini
-vertical prism to alignment (red lens)
-W4D
-after image test

14

Mildly embedded ARC

-about 80% of cases
-comprises of moderate angles, large angles or variable angles
-present only on bagolini
-no treatment for ARC is required
-strab can be treated with prisms, VT and/or surgery

15

Deeply embedded ARC

-smaller angle
-more stable angle
-early onset
-rarely possible to eliminate ARC
-Present on 3-4 test

16

Moderately embedded ARC seen on ___- ARC tests

2

17

Goals of treatment: criteria for cure

Cosmesis

Floms criteria
- functional cure
-almost cure
-moderate improve
-some improvement
-no improvement

18

Goal of treatment: cosmesis

This is to decrease the sizeto make it less noticeable

19

Functional cure

-clear single BV at all D and gazes
-stereopsis and normal vergence ranges
-deviation can occur (1% of the time), but when it occurs diplopia must occur
-may have prism (~5Pd) in the glasses to assist with fusion

20

Almost cure

-clear single BV
-some stereopsis
-deviation can occur (5% of the time), but diplopia must occur
-may have large amount of prism to assist with fusion

21

Moderate improvement

-improvement in any of the 2 above
-amblyopia is present
-eccentric fixation

22

Some improvement

Improvement of only one thing

23

No improvement

Found in micro tropia

24

Better prognosis ARC

-exotropia (better if they have NRC vs ARC)
-intermittent (XT or ET)
-larger angles
-older children
-mildly imbedded (seen on bagolini)

25

Worse prognosis ARC

-esotropia (better if the patietn has NRC vs ARC)
-constant
-smaller angles (ARC is easily developed), smaller angles of anomaly
-younger shildren (<3)
-deeply imbedded

26

Floms functional or almost cure is more likely for

All of the “better” prognosis ARC pateitns

27

Why is it sometimes recommended not treating ARC

It gives them some BV

28

Ttreatment for ARC

-decision to treat is based on the embeddness
-depending on the embeddness, you wither want to: eliminate ARC to reestablish nornal BV (NRC) with cosmesis or further embed ARC

29

Mana gent plan of strab

-determin the Dx
-create plan
-commiunuaite concditin and management plan to patietns
-discuss pros and cons of the different treatment options, if applicable

30

Treating ARC requires

Time, money, dedication

31

Results in many cases of ARC treatment

Eye strain, diplopia (sometimes intractable)

32

If you want to treat ARC, best things to do

-refer to s a BV specialist
-difficult to recommend therapy if a cure can not be achieved in a year. If it is a referral, you could do a trial of a couple of sessions to determine if there is a chance for improvement

33

Treating ARC in post surgical cases

If they result in HARC (which is some form of peripheral BV). VT can be recommended if ARC is mildly embedded

34

What is contraindicated for ARC therapy

Horror fusionis
-they will never fuse

35

Management plan for ARC

-optical management
-added lenses
-prism (ONLY EVER FOR NRC)
-occlusion
-VT
-pharmacological managemtn
-surgical management

36

Prism and ARC

Only used to improve the angle in patietns with NRC

In ARC-prism to break ARC

37

Goal of treatment of ARC: eliminate ARC to reestablish normal BV

-prism and disruptive techniques
-occlusion
-VT
-surgery

38

Prism and disruptive techniques for ARC

Lenses and prisms
-with correcting, overcorrecting, reverse or vertical prisms
-crease instability of the angle
-not sure of the efficacy
-poor compliance, discomfort/diplopia
-difficult to do this all day ebvcsue of sontant diplopia


By overcorrecting, the patietn now has to use vergences to prevent diplopia and move the image

39

Prism over correction for ARC

Works well with younger children to disrupt ARC by stimulating the laten NRC localization

Phase I: over correct by about 15pd, for as long during the day

This includes diplopia so the latent NRC localization can manifest

Consider cosmetic concerns
Consider rotleratce of the initial diplopia
Monitor patietn closely because of prism adaptation (same say 2.5x the objective angle)

40

Phase 2 of prism correction of ARC

After a few months and when NRC is repeatedly seen on after I mage, the needed power will be equal to the objective angle

Vergence therapy can be started
Prism can be gradually reduced as the patietn appears to habe mroe fusional vergence
If the angle is still large, surgery can be soldiered

41

Occlusion therapy for ARC

-ARC development is prevented if occlusion is started early enoug
-no evidence to show if it is effective for an already established ARC
-occlusion for amblyopia is done before occluding for ARC
-total occlusion for 24 hours on alternative day basis
-poor compliance

42

Reasons to use occlusion for ARC

-to disrupt ARC localization and prevent reinforcement
-to break suppression
-to treat amblyopia

Method and schedule off occlusion depends on age, condition

43

Constant total occlusion and ARC

For children with constant strabismus that started before the age of 7

Be cautious in cases of intermittent strab because occlusion strab can result

44

Binasal occlusoin in ARC

Can be used in children with ER to prevent and treat any ARC

Allows
-alternator monocular fixation
-equal VA
-use of peripheral fields
-full abduction to break ARC

Consider
-active children
-children with large head movements for fixation

45

VT for ARC

-anti suppression therapy, amblypscope, stereoscopes can be used
-this forces the strab eye to fixate
-work on motor ranges as well

46

Surgery for ARAC

-some pateitns may report NRC after surgery, especially those with mildly embedded ARC
-NRC, ARC covariance or paradoxical UHARC may result after surgery because of the new alignment

47

Width of the occluder in binasal occluder

Larger in the fixating eyes

48

Other treatment considerations for ARC

-major amblyoscope is a good closed-space instrument (less natural). After there is training here, skills are transferred into open space
-it is to elicit bifvoeal NRC localization by stimulating latent NRC
-done in addiction to constant total occlusion or prism (to disrupt ARC)
-use the amblyoscope first before doing free space skills

49

Free space skills for ARC

Binocualr luster (R/G fusion) training: should report mixture of the colors or rivalry

50

If the patietn reports a split field repsosne in BV luster training

Prognosis for treatment is poor because the ARC is deeply imbedded

Pateitn instructed to maintain luster while targets are introduced to the periphery, plus lenses are introduced, etc

51

Other training for free space skills in ARC

Afterimage training
Haidinger brush training
Bagolini training