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Flashcards in Midterm Review Deck (97):
1

What are the 3 parts of a good case history?

1. Interview
2. Questionnaire
3. Summary

2

This is the visual needs of the patient's daily life.

Visual demands

3

This is the ability of the vision to keep up with visual demands.

Visual Efficiency

4

When determining the patient's chief complaint, what 6 criteria should be evaluated?

- F - frequency
- O - onset
- L - location
- D - duration
- A - associated factors
- R - relieving factors

5

BV disorders can create negative effects in children and working adults by what 3 things?

1. All assoc. w reading, computer work
2. Poor academic/work performance
3. Interfere w/ sports and career decisions

6

BV disorders can create negative effects in retired adults by what 3 things?

1. Difficulty reading/computer work
2. Avoidance of reading or other nearpoint activities
3. Interfere w/ distance activities (dissociated phorias)

7

This vergence is our physiological resting position. What is the resting position?

- Tonic Vergence
- 1xp +/- 2

8

This vergence is used in awareness of a near item; contributes up to 70% of vergence demands for near tasks

Proximal vergence

9

Is proximal vergence related to accommodation?

No

10

This type of vergence adds to tonic and proximal vergence to align a near stimulus.

Accommodative Vergence

11

With a WD of 40 cm, accommodative vergence will contribute to how much accommodation?

~1.25D (half of the stimulus)

12

This is reflexive vergence that maintains binocular alignment

Fusional Vergence

13

These two components alter vergence level to achieve fusion. What are they?

PFV and NFV
- this only applies when other vergence is not enough

14

PFV makes the patient ______.

converge

15

NFV makes the patient _______.

diverge

16

This type of vergence is stimulated by retinal disparity.

Fixation Disparity Vergence
- primarily responsible for maintaining binocularity
- improves vergence accuracy

17

What is the compensatory vergence for esophoria?

NFV - esophoric eyes sit in, NFV diverges the eyes out

18

What is the compenstory vergence for exophoria?

PFV - exophoric eyes sit out, PFV converges eyes in

19

This is how much accommodation is necessary to achieve clear vision when looking from far to near.

Accommodative demand

20

Calculate the accommodative demand for a patient viewing an object at 40 cm.

AD = 100/40 = +2.50D

21

This is how much do the eyes have to converge to maintain single binocular vision when looking from far to near.

Convergence demand

22

Calculate the convergence demand at a 40cm WD and 60mm pupil diameter.

CD = (10 * 60mm)/(40cm)
CD = 600/40
CD = 15 D

23

If a patient has a convergence demand of 15D, but undercompensates, what fusional vergence is needed to compensate

PFV

24

If a patient has a convergence demand of 15D, but overcompensates, what fusional vergence is needed to compensate?

NFV

25

This allows eyes to converge the required amount for a given WD with no fusional vergence?

AC/A

26

What is the expected value of gradient AC/A?

4/1 +/- 2pd

27

Calculate the gradient AC/A:
- CT (N) = 3EP
- CT +1 = 4XP

(+3EP - (-4XP))/1 = 7/1

28

What is the expected value of calculated AC/A?

5pd +/- 2pd

29

Calculate the calculated gradient AC/A:
- IPD = 60mm
- WD = 40cm
- CT (N) = 10 XP
- CT (D) = 2 XP

AC/A = IPD(cm) + WD(m)[CT(N)-CT(D)]

AC/A = 6 + .4(-10-(-2))
AC/A = 2.8/1

30

This is a questionnaire used for CI suspect patients.

CISS - CI Symptom Survey

31

What are the symptomatic scores for children and adults?

Children = Score of 16 or above
Adults = Score of 21 or above

32

What 4 ways can we assess motor alignment?

1. Cover Test
2. Von Graefe
3. Modified Thorington
4. Fixation Disparity

33

What direct tests assess PFV?

1. Step Vergence
2. Smooth Vergence
3. Vergence Facility

34

What indirect tests assess PFV?

1. NPC
2. NRA
3. BAF c plus
4. MEM

35

What direct tests assess NFV?

1. Step Vergence
2. Smooth Vergence
3. Vergence Facility

36

What indirect tests assess NFV?

1. PRA
2. BAF c minus
3. MEM

37

What direct (monocular) tests assess accommodation?

1. Acc.Amps
2. MAF

38

What 2 tests are used to assess accom. amps?

1. Donder's push up/away
2. Minus Lenses

39

Donder's overestimates one's accommodation by how much?

2D

40

Minus lenses underestimates one's accommodation. What must be added to the amount of minus the patient can sustain?

-2.50
- Ex: First blur at - 6.00
- Amps = -6.00 + (-2.50) = -8.50

41

What are the indirect (binocular) tests of accommodation?

1. MEM
2. NRA/PRA
3. BAF

42

What is the expected value of MEM?

0.50 +/- 0.25D

43

If a patient has a High MEM (> +0.75D), what is happening to their accommodation?

- underaccommodating
- lag of accommodation

44

If a patient accommodates behind plane of MEM card, what type of motion will the examiner see?

with motion

45

If a patient accommodates in front of MEM bard, what type of motion will examiner see?

Against motion

46

What are the 4 types of non-strabismic binocular & accom. vision problems?

1. Fixation issues
2. Saccades
3. Pursuits
4. Accommodation

47

What are the SxS of fixation issues?

Symps = Oscillopsia
Signs = nystagmus, saccadic intrusion

48

What are the symptoms of saccadic issues?

Symps:
1. Loss of place/uses finger
2. Slow reading speed
3. Short attn span
4. Difficulty copying from board

49

What are the signs of saccadic issues?

1. Poor performance on readalyzer
2. Score below 15% on DEM
3. Low score on NSUCO

50

What are the SxS of pursuit issues?

Symps:
- excessive head movement
- Poor performance in sports
- Possible reading diff.
Signs = Low score on NSUCO

51

This assesses the flexibility in the link between accom. and vergence

NRA/PRA

52

What is the purpose of NRA/PRA

to determine if an add is needed / if the system is balanced

53

What are the expected values of NRA/PRA?

NRA = +2.00 +/- 0.50
PRA = -2.37 +/- 1.00

54

The end-point of PRA is determined by what 3 factors?

1. Amplitude
2. NFV
3. AC/A ratio

55

Binocular Disorder:
- higher XP at near
- reduced NPC
- reduced BO
- VF = slow BO, low cpm
- Low NRA
- BAF, fails +
- Low MEM

Convergence Insuffiency

56

What is the primary issue of a pseudo CI?

Accommodative issue

57

How will the testing differ for a pseudo CI vs. a true CI?

- All accommodative testing will be low
- low on minus testing
- true CI would be low on plus

58

Binocular Disorder:
- greater EP at near
- Low BI
- VF = slow BI, low cpm
- Low PRA
- BAF, fails (-)
- High MEM

Convergence Excess

59

What is the treatment for a CE?

- Provide patient with an add (plus)
- use NRA/PRA data to determine how much

60

Binocular Disorder:
- no assoc. w/ phoria
- Low BI/BO
- Reduced VF
- Fails + and - on BAF
- Passes + and - on MAF
- Low NRA and PRA

Fusional Vergence Dysfunction

61

What's the best treatment option for FVD?

Vision therapy

62

Binocular Disorder:
- greater XP at distance
- often IXT at distance
- Tests in PFV group will be low at distance but normal at near (low BO, Low VF BO)
- high AC/A

Divergence Excess

63

Binocular Disorder:
- equal mag XP at d and n
- tests in PFV will be low at distance and near
- reduced NPC
- Low NRA
- Low MEM
- Fails (+) BAF

Basic Exophoria

64

Binocular Disorder:
- high EP at distance
- Low BI at distance
- low VF, BI

Divergence Insufficiency

65

Binocular Disorder:
- Equal mag EP at d and n
- Low BI at d and n
- Low VF at d and n
- Low PRA
- BAF, fails -
- High MEM

Basic Esophoria

66

What conditions are found with low AC/A?

1. CI
2. DI

67

What conditions are found with high AC/A?

1. CE
2. DE

68

What conditions are found with normal AC/A?

1. Basic XP
2. Basic EP
3. FVD

69

Accom. Cond:
1. Low Amps
2. Low PRA
3. Fails - on MAF/BAF
4. High MEM (lag)

Accom. Insufficiency

70

What is the treatment for an AI?

-Prescribe plus (an add)
- depends on NRA/PRA or MEM data

71

What are the DD of an AI?

1. Ill-sustained accom.
2. Accom. paralysis
3. Unequal accom.
4. Pharmacological
5. Neuro

72

What is the main difference between an AI and Ill-sustained accom?

Patient will have normal amps

73

Accom. Cond:
- Low NRA
- Fails (+) on MAF/BAF
- Low MEM (lead)

Accom. Excess

74

What is the tx for AE?

Vision therapy

75

What are the DD of AE?

1. Accom. Spasm
2. Pseudomyopia
3. Disease

76

This is having difficulty changing accommodative response from one distance to another.
- low NRA and PRA
- fails both + and - on MAF/BAF

Accom. Infacility

77

What are the visual-verbal observations for saccades?

1. DEM
2. King Devick

78

Which test differentiates between a saccadic problem and automaticity (name-calling) problem?

DEM

79

DEM Interpretation: Normal horizontal, normal vertical, normal ratio

Type 1

80

DEM Interpretation:
Abnormal horizontal, normal vertical, abnormal vertical

Type 2 - oculomotor dysfunction

81

DEM Interpretation: Abnormal horizontal, abnormal vertical, normal ratio

Type 3 - automaticity problem

82

DEM Interpretation:
Abnormal horizontal, abnormal vertical, abnormal ratio

Type 4 - Mixed problem

83

When testing 2 different reading levels on the readalyzer, what does it mean if testing is still poor when dropping a level?

Oculomotor dysfunction

84

When testing 2 different reading levels on the readalyzer, what does it mean if testing is better when dropping a level?

Reading problem

85

What are the 4 types of monocular cues?

1. Motion Parralax
2. Accommodation
3. Angular Declination
4. Pictorial Monocular cues

86

What are the 3 types of motion parallax?

1. Kinetic Depth Cue
2. Near Object Fixation
3. Distant Object Fixation

87

This type of motion parllax is produced by relative motion of 2 or more objects.

Kinetic Depth Cue

88

In this type of Motion paralax, far objects move with head movement.

Near object fixation

89

In this type of motion parallax, near object move opposite of head movement.

Distant object fixation

90

What are the 2 perceptual factors associated w/ accomodation?

1. Proximity or size of object
2. Perspective

91

This is when the object makes an angle w/ the horizon; the visual system uses this angle to determine object distance.

Angular Declination

92

What layer of the striate cortex receives the primary input from the parvo and magnocellular LGN layers?

Layer 4C
- magno (ventral) = 4c alpha
- parvo (dorsal)= 4c beta

93

On the cortical neuron dominance histograms, what categories are monocular? Which eye? Which category is binocular?

category 1 = contralateral eye
category 7 = ipsilateral eye
Category 4 = binocular

94

What layer of the striate cortex dont ocular dominance columns go through?

Layer 4

95

This is the period during which the visual system can be influenced by environmental manipulation

Critical/Sensitive period

96

What is the critical period in humans?

7-9 years of age

97

In monocular deprivation, what happens?

- Most cortical cells were monocular and responsive only to the non-deprived eye