1
Q
What is vision training?
A
A structured program used to improve visual performance, mainly targeting motor fusion
It can also improve sensory fusion and simultaneous perception and is conducted by optometrists, orthoptists, and occupational therapists.
2
Q
What are the goals of vision training?
A
- Relieve symptoms
- Achieve stable, comfortable, clear binocular single vision (BSV)
- Improve accommodation
- Improve motor fusion (vergence control)
- Improve sensory fusion
These goals aim to enhance overall visual function.
3
Q
Which patients benefit from vision training?
A
- Asthenopia (eye strain)
- Diplopia or blur from accommodative/vergence dysfunction
- Binocular vision disorders (e.g. CI, AI)
- Traumatic brain injury
- Stroke
These conditions often involve binocular vision issues that can be improved through training.
4
Q
Why is vision training mainly focused on motor fusion?
A
Because vergence control is often the primary limitation in binocular vision disorders
Improving motor fusion stabilizes alignment, allowing sensory fusion to function.
5
Q
What aspects of binocular vision can be trained?
A
- Motor fusion (vergence ranges, control)
- Sensory fusion (fusion stability, suppression reduction)
- Simultaneous perception
Training these aspects enhances overall binocular function.
6
Q
What is the full binocular vision (BV) work-up sequence?
A
- Chief complaint and history
- Monocular VA and refractive error
- Binocular refractive status + aniseikonia
- Ocular deviation at distance
- Ocular deviation at near + AC/A ratio
- Motor fusion (distance and near)
- Sensory fusion
- Accommodation
This sequence helps assess and diagnose binocular vision issues.
7
Q
Why must refractive error be assessed before BV testing?
A
Uncorrected refractive error can cause or worsen binocular dysfunction
It must be corrected before interpreting BV findings.
8
Q
Why is AC/A ratio important in BV assessment?
A
It determines the relationship between accommodation and convergence
This helps diagnose conditions like convergence excess or insufficiency.
9
Q
What are the general management options for BV conditions?
A
- Do nothing (if asymptomatic)
- Refractive correction (glasses, contact lenses)
- Iseikonic or isogonal lenses
- Prism correction
- Amblyopia treatment
- Vision training
- Extraocular muscle (EOM) surgery
- Referral (e.g. physiotherapy, neuro rehab)
- Occlusion or blur/undercorrection of one eye
These options vary based on the patient’s condition and symptoms.
10
Q
Why can occlusion or blur be used in BV management?
A
It removes binocular interaction
This eliminates diplopia and symptoms when BSV cannot be achieved.
11
Q
When is “do nothing” an appropriate management?
A
When the patient is asymptomatic and well compensated
This applies even if a deviation is present.
12
Q
How does prism help in BV conditions?
A
It reduces the motor fusion demand by aligning images
This relieves symptoms without changing the underlying deviation.
13
Q
What must be considered before prescribing vision training?
A
- Clinical diagnosis and features
- Goal of therapy
- Patient age
- General health and medications
- Need for other treatments (glasses, surgery, amblyopia)
- Equipment availability
- Patient time commitment and compliance
- Whether treatment effects will be sustained
These factors ensure the appropriateness and effectiveness of the training.
14
Q
Why is patient compliance important in vision training?
A
Vision training requires repeated practice over time
Poor compliance leads to poor outcomes.
15
Q
Why must long-term effectiveness be considered?
A
Some improvements may regress without maintenance
Treatment should aim for stable, lasting changes.
16
Q
When should other treatments be done before vision training?
A
- Correct refractive error first
- Treat amblyopia first
- Consider surgery if deviation is large
This ensures training is effective and not limited by underlying issues.
17
Q
What is the principle of “zone of proximal development” in vision training?
A
Training tasks should be challenging but achievable
Difficulty is gradually increased to promote adaptation without overwhelming the patient.
18
Q
How should vision training be scheduled?
A
- Mainly home-based
- Reviewed every ~4 weeks
- Done in small, frequent sessions
This maximizes effect while minimizing fatigue.
19
Q
Why is full refractive correction required before vision training?
A
To ensure clear retinal image and accurate binocular input
This allows effective training.
20
Q
How long does vision training take to show results?
A
Usually several weeks
Most progress occurs through consistent home practice.
21
Q
How can compliance in vision training be improved?
A
- Positive reinforcement
- Real-time feedback
- Showing progress to patient
These strategies increase motivation and adherence.
22
Q
What is the correct sequence of a vision training programme?
A
- Monocular skills
- Accommodation
- Anti-suppression
- Refixation (voluntary vergence)
- Reflex fusional vergence
- Sensory fusion and stereopsis
Each stage builds on the previous one.
23
Q
Why must vision training follow a specific sequence?
A
Each stage builds on the previous
This ensures stable monocular control, clear focus, awareness of diplopia, voluntary control, automatic fusion, and stable binocular vision.
24
Q
Why are monocular skills trained first?
A
To improve fixation, pursuits, and saccades
This ensures accurate visual input before binocular training.
25
How are **monocular skills** trained?
* Pursuits: tracking patterns (e.g. figure-8)
* Saccades: jumping between targets or using prisms
## Footnote
These exercises enhance visual tracking and accuracy.
26
When is **monocular training** indicated?
* Fixation instability
* Poor tracking (ocular motility issues)
## Footnote
These conditions benefit from focused monocular exercises.
27
Why is **accommodation training** important?
Clear focus is required for stable binocular single vision (BSV)
## Footnote
It supports vergence function.
28
How is **accommodation** trained?
* Amplitude: push-up method (small letters)
* Facility: ± flipper lenses (jump focus)
## Footnote
These methods enhance the ability to focus at different distances.
29
When is **accommodation training** indicated?
* Accommodative insufficiency
* Accommodative infacility
* Any vergence disorder
## Footnote
It is often trained together with vergence.
30
What is **anti-suppression training**?
Training to increase awareness of diplopia
## Footnote
This helps the patient actively regain binocular alignment.
31
How is **anti-suppression training** done?
* Prism-induced diplopia
* Red filters
* Binocular rotation techniques
## Footnote
These techniques help the patient recognize and manage diplopia.
32
When is **anti-suppression training** indicated?
* Intermittent strabismus
* Monofixation syndrome
## Footnote
These conditions benefit from increased awareness of diplopia.
33
When is **anti-suppression training** contraindicated?
* Constant strabismus
* Presence of ARC
## Footnote
These conditions may not benefit from this type of training.
34
What is **refixation (voluntary vergence)** training?
Training the patient to detect diplopia and actively use vergence to regain bifoveal fixation
## Footnote
This helps improve binocular alignment.
35
How is **refixation training** performed?
* Prism flippers
* Binocular jump vergence tasks
## Footnote
These exercises encourage active engagement in managing diplopia.
36
When is **refixation training** indicated?
* Intermittent strabismus
* Decompensating phoria
## Footnote
These conditions require active management of binocular alignment.
37
What are the requirements for **refixation training**?
* NRC
* Reduced suppression (must perceive diplopia)
* Good accommodative facility
* Completion of earlier stages (anti-suppression + accommodation)
## Footnote
These prerequisites ensure the patient is ready for this training.
38
What is **reflex fusional vergence training**?
Training automatic vergence responses to small retinal disparities
## Footnote
This helps improve the ability to maintain binocular alignment.
39
What is the goal of **reflex vergence training**?
To meet:
* Sheard’s criterion (exo)
* Percival’s criterion (eso)
## Footnote
These criteria help assess the effectiveness of vergence training.
40
How is **reflex vergence** trained?
* Free space vergence tasks
* Instrument-based training
* Anaglyphic methods
## Footnote
These methods enhance automatic vergence responses.
41
When is **reflex vergence training** indicated?
* Bifoveal fixation
* NRC
* No suppression
## Footnote
These conditions are suitable for reflex vergence training.
42
How is it combined with other **training**?
Done alongside voluntary vergence training, with ongoing suppression checks
## Footnote
This ensures comprehensive management of binocular vision.
43
What is **sensory fusion and stereopsis training**?
Training to improve stability and quality of sensory fusion and depth perception
## Footnote
This enhances the overall binocular experience.
44
How is **sensory fusion** trained?
* Instruments
* Vectographs
* Appropriate fusion targets
## Footnote
These tools help improve sensory fusion capabilities.
45
When is **sensory fusion training** indicated?
* Stable bifoveal fixation
* NRC
* No suppression
* BSV present most of the time
## Footnote
These conditions are optimal for sensory fusion training.
46
What is the goal of this **final stage**?
To make binocular vision stable, comfortable, and automatic
## Footnote
This ensures effective and lasting visual function.
47
What do **STA** and **STC** stand for?
* STA = Stimulus to Accommodation
* STC = Stimulus to Convergence
## Footnote
These terms relate to how the visual system coordinates accommodation and convergence.
48
What is the goal of **STA** and **STC** in vision training?
To train the patient so their response matches both STA and STC, ensuring coordinated accommodation and vergence → stable binocular single vision.
## Footnote
This coordination is crucial for effective visual function.
49
How can **STA** and **STC** be trained?
* Coupled (free space) → STA = STC (natural viewing)
* Uncoupled → STA and STC placed at different planes → requires relative convergence/divergence
## Footnote
This training method helps improve visual coordination.
50
Why do we **uncouple** STA and STC in training?
To challenge and improve vergence flexibility and control, beyond normal viewing conditions → increases fusional reserves.
## Footnote
This method enhances the ability to adapt to varying visual demands.
51
What are examples of **free space (coupled)** vergence training?
* Brock string (beads)
* Jump vergence (jump ductions)
* Pencil push-up / push-away
## Footnote
These exercises are designed to improve vergence in a natural viewing context.
52
When do we use **free space vergence training**?
* Initial stage
* Patients struggling with fusion in normal viewing
## Footnote
Starting simple before progressing helps build foundational skills.
53
Why is **pencil push-up** considered least effective?
* Limited control of vergence demand
* Less precise stimulus
* Mainly mimics NPC
## Footnote
While convenient, it does not provide strong training effects.
54
Why is **Brock string** better than pencil push-up?
* Provides multiple fixation points
* Suppression awareness (physiological diplopia) → better feedback for fusion
## Footnote
This method enhances the training experience by offering varied visual stimuli.
55
What does **jump vergence (jump ductions)** train?
* Vergence facility
* Accommodation facility
## Footnote
This training involves rapid switching between targets to improve visual responsiveness.
56
What are examples of **uncoupled STA and STC training methods**?
* Free fusion cards
* Vectograms
* Binocular flippers
* Vodnoy aperture rule
* Prism training
* Stereoscopes (e.g. amblyoscope, Brewster stereoscope)
## Footnote
These methods help in training the visual system under varied conditions.
57
How do **prism bars** train vergence?
* Base-out → convergence
* Base-in → divergence
## Footnote
This alters STC while STA remains constant, providing a controlled training environment.
58
How do **stereoscopes** uncouple STA and STC?
* Amblyoscope: Mirrors adjust STC, Lenses adjust STA
* Brewster stereoscope: Target separation → STC, Plus lenses → STA
## Footnote
These devices allow for precise adjustments in visual training.
59
What are **free fusion target methods**?
* Laird cards
* Anaglyphic targets
## Footnote
These methods require voluntary fusion with separated images to enhance visual processing.
60
What are the main categories of **vergence training methods**?
* Adjustable targets (vectograms, anaglyphs)
* Aperture/septum methods (Vodnoy rule)
* Computer-based training
## Footnote
These categories encompass various approaches to improve vergence skills.
61
What does fusion with **prisms** represent?
The absolute STC → the convergence demand required to maintain fusion.
## Footnote
This concept is essential for understanding how prisms affect visual perception.
62
What is **TS (target separation)** in vergence training?
Distance between targets (cm):
* Positive TS → relative convergence
* Negative TS → relative divergence
## Footnote
Understanding TS is crucial for effective vergence training.
63
What happens in **convergence training** (STA vs STC)?
* STC is closer than STA
* Eyes converge more than accommodation demands
* Visual axes cross in front of the target
## Footnote
This training focuses on improving convergence abilities.
64
What does **convergence training** improve?
* Positive fusional vergence (PFV)
* Voluntary convergence
## Footnote
These improvements are critical for effective visual coordination.
65
What happens in **divergence training** (STA vs STC)?
* STC is further away than STA
* Eyes diverge more than accommodation demand
* Visual axes cross behind the physical target
## Footnote
This training enhances the ability to diverge effectively.
66
What does **divergence training** improve?
* Negative fusional vergence (NFV)
* Voluntary divergence
## Footnote
These skills are essential for maintaining visual clarity at distance.
67
Why is **near viewing** easier for vergence training?
Because fusional vergence ranges are larger at near, making fusion easier to achieve and maintain.
## Footnote
This principle is important for designing effective training programs.
68
What is the purpose of **vergence facility training**?
To improve:
* Voluntary control of vergence
* Speed of vergence changes
* Proprioceptive (kinaesthetic) awareness
## Footnote
This training enhances overall visual performance.
69
How is **vergence facility** trained?
* Prism flippers or jump vergence tasks
* Large jumps between convergence and divergence
* Typically 20–40 cycles, aiming to increase speed
## Footnote
This method focuses on rapid adjustments to improve visual flexibility.
70
What visual cues are used in **vergence training**?
* Diplopia
* Blur
* Suppression awareness
* SILO
* Float
* Motion parallax
## Footnote
These cues help patients recognize their visual status during training.
71
Why are **visual cues** important in training?
They help patients recognise when fusion is correct or breaking → allows active control of vergence.
## Footnote
This awareness is crucial for effective visual training.
72
What is **“float”** in vergence training?
The fused image appears to:
* Move closer during convergence
* Move further away during divergence
## Footnote
This phenomenon provides depth cues during training.
73
Why is **float** not always reliable?
* Not all patients perceive it
* Some perceive it in reverse
## Footnote
Individual differences can affect the perception of float.
74
What is **SILO**?
Small In, Large Out:
* Convergence → image appears smaller
* Divergence → image appears larger
## Footnote
This effect is related to how depth perception changes with vergence.
75
What causes **SILO**?
Fixed angular subtense on the retina while vergence changes perceived depth.
## Footnote
Understanding this concept is important for visual training.
76
Why is **SILO** not a reliable cue?
Because perception varies significantly between individuals.
## Footnote
This variability can complicate training outcomes.
77
What is **motion parallax** in vision training?
A depth cue where the fused image appears to move with or against head movement, depending on perceived depth.
## Footnote
This cue reinforces depth perception during training.
78
Why is **motion parallax** useful?
It reinforces depth perception and helps confirm correct vergence response.
## Footnote
This confirmation is vital for effective visual training.
79
What are **proprioceptive (kinaesthetic) cues** in vergence training?
The patient’s awareness of eye position and movement during convergence/divergence.
## Footnote
These cues help patients develop internal control over their visual system.
80
Why is **kinaesthetic awareness** important?
Real-world visual cues are subtle → patients need internal awareness to control vergence and accommodation.
## Footnote
This awareness is crucial for effective visual function.
81
What is **localisation** in vergence training?
Awareness of where the visual axes intersect (where the eyes are pointing).
## Footnote
This skill is important for accurate visual targeting.
82
How can **localisation** be trained?
* Using pointers or pen tips
* Asking patient to point to perceived target location
## Footnote
These methods enhance the patient's ability to accurately perceive visual alignment.
83
Where should visual axes intersect in different training types?
* Free space: on the physical target
* Convergence training (uncoupled): in front of the target
* Divergence training (uncoupled): behind the target
## Footnote
Understanding these intersections is key for effective training.
84
Why must patients differentiate **accommodation vs vergence**?
To avoid over-reliance on one system and achieve independent control, especially when cues are weak in real life.
## Footnote
This differentiation is crucial for effective visual processing.
85
How should instructions be given to patients?
Use kinaesthetic language:
* “Pull your eyes together”
* “Relax your eyes”
## Footnote
Clear, specific instructions enhance patient understanding and compliance.
510 BV
flashcards
Decks in class (14)
# Cards
