Visual Efficiency and Diagnosing

Question 1

What can we prevent if we diagnose and treat vergence and accommodative anomalies early enough? (3)

Answer 1

1)Prevent accommodative esotropia
2)Prevent decompensation into other strabismus
3)Prevent academic/learning disability

Question 2

What are 7 common signs and symptoms of Vergence and Accommodative Anomalies?

Answer 2

1) Blurred Vision
2) Headaches
3) Astheopia
4) Fatigue
5) Diplopia
6) Motion Sickness
7) Loss of concentration

Question 3

What binocular anomalies have to do with a LOW AC/A ratios? (2)

Answer 3

Convergence Insufficiency
Divergence Insufficiency

Question 4

What binocular anomalies have to do with NORMAL AC/A ratios? (3)

Answer 4

Fusional vergence dysfunction
Basic exophoric
Basic esophoria

Question 5

What binocular anomalies have to do with a HIGH AC/A ratios?

Answer 5

Convergence Excess
Divergence Excess

Question 6

What signs would you see with someone who has a Convergence insufficiency? (5)

Answer 6

1) Exo at near
2) Ortho or low exo in distance, high exo at near
3) Receded NPC
4)Reduced PFV (mostly at near)
5) Low AC/A

Question 7

What is the most common non-strabismus binocular vision disorder?

Answer 7

Convergence insufficiency

Question 8

What is a Pseudo-CI? What can you do differentiate from a true CI?

Answer 8

Pseudo-ci presents like a CI at near by having large exophoric at near. You can determine this by giving the patient plus. If the exophoric is lessened when adding plus, the patients eyes are able to converge more which is a Pseudo CI. A real CI exophoric would be made worse by the addition of plus.

Question 9

What signs would you see with someone who has a Divergence insufficiency? (4)

Answer 9

1) Greater eso at distance than near
2) Reduced BI vergence testing at distance
3) Low AC/A
4) Normal version (ie no paresis/palsy)

Question 10

What is the least common and least studied non-strabismus binocular vision disorder?

Answer 10

Divergence insufficiency

Question 11

What must you rule out when testing for divergence insufficiency?

Answer 11

Must rule out pathology. Including brainstem tumors, vascular conditions. Must refer out for MRI.

Question 12

What signs would you see with someone who has a Convergence Excess? (4)

Answer 12

1) Esophoria at near (greater than distance)
2) Ortho or low eso at distance
3) Reduced NFV (do not like to diverge)
4) High AC/A

Question 13

What kind of patients is convergence excess common in?

Answer 13

School-aged patients and in presbyopes

Question 14

What signs would you see with someone who has a Divergence Excess? (5)

Answer 14

1) Greater exophoria at distance than at near
Okay at near, problem at distance (happens with students studying for boards)
2) May see IXT at distance (intermittent)
3) Normal stereo at near
(good near point)
4) Typically normal PFV; greater amts give better near control
5) High AC/A

Question 15

What signs would you see with someone who has a Fusional Vergence Dysfunction? (5)

Answer 15

1) Reduced PFV and NFV (tight BI/BO values)
2) Normal AC/A
3) Normal phoria at both distance and near
4) May have reduced vergence facility

Question 16

What signs would you see with someone who has a Basic Esophoria? (3)

Answer 16

1) Normal AC/A
2) Eso approximately the same at distance and near
3) Reduced NFV at both distance and near (can’t diverge well)

Question 17

What binocular abnormalities are shown in patients that suffer a concussion/ neurological impairement?

Answer 17

Basic Esophoria

Question 18

What signs would you see with someone who has a Basic Exophoria? (3)

Answer 18

1) Normal AC/A
2) Exo approximately the same at distance and near
3) Reduced PFV at both distance and near (important to test all 4 vergence ranges (both BI and BO both distance and near)

Question 19

What does recovery on BI and BO indicate?

Answer 19

stamina of visual system