Freespace Testing 2

What 3 accommodative characteristics are evaluated when assessing BV function?

total accommodative amplitude

accommodative accuracy

accommodative facility

What subjective tests give us total accommodative amplitude?

push-up test

minus lens to blur

What subjective tests gives us accommodative accuracy?

BCC

What objective tests gives us accommodative accuracy?

Dynamic Retinoscopy (MEM or Nott)

Open-Field Auto-refraction

What subjective tests gives us accommodative facility?

flipper test

What is dynamic retinoscopy?

retinoscopy where accommodation is active

What is MEM (monocular estimation method) retinoscopy?

examiner uses lenses to find neutral at 40cm with MEM card

What is the purpose of MEM retinoscopy?

understand accommodative accuracy under typical near working conditions

What is the set up for MEM retinoscopy?

room lights on (moderate illumination)

appropriate size text MEM card on Ret

examiner at pts habitual working distance

pt in habitual or manifest

loose lenses

Who would you not perform MEM retinoscopy on?

presbyope

What do you not want to ask the patient to do during MEM retinoscopy?

keep the words clear

IF you start MEM retinoscopy and see neutral with no lenses in place, what does that mean?

patient is accommodative accurately and has no lag or lead

If you are doing MEM retinosocpy and see with motion with no lenses in place, what does that mean?

Patient has accommodative lag

If you are doing MEM retinosocpy and see with motion with no lenses in place, where is the FP?

behind the retinoscope

If you are doing MEM retinosocpy and see against motion with no lenses in place, where is the FP?

in front of the retinoscope

If you are doing MEM retinosocpy and see against motion with no lenses in place, what does that mean?

patient has accommodative lead

The lens needed to neutralize a patient during MEM retinoscopy is?

their accommodative lead/lag

What meridian do you scope in MEM retinosocpy? What is the orientation of the beam?

scoping horizontal meridian, beam is vertical

What is a normal MEM retinosocpy finding?

pl to +0.75D

What is an abnormal MEM retinoscpy finding?

>+0.75

any minus lens

What does it mean if you get different values in each eye on MEM retinoscopy

patients prescription is not balanced

If no phoropter balance techniques are working, what else can you do to balance a patient?

MEM retinoscopy

What is accommodative facility?

How quickly an individual can change their accommodation from one distance to another

What do patients with poor accommodative facility complain of?

blurry vision that eventually clears when switching from near to distance or vice versa

T/F: Accommodative facility can be trained?

true

What equipment is used when testing accommodative facility with flippers?

Hart chart (or near PD stick)

Suppression check (polarization and polaroid glasses, or R/G)

1 minute timer

Is accommodative facility usually performed binocularly or monocularly?

binocularly, unless abnormal finding

When testing accommodative facility binocularly, what are we also examining?

vergence

When looking through +2.00D during flipping test, what happens to accommodation and vergence?

patient relaxes accommodation (and diverges)

patient must use fusional convergence

When looking through -2.00D during flipping test, what happens to accommodation and vergence?

patient increases accommodation (therefore converges)

patient must use fusional divergence

What is one cycle in accommodative facility?

clearing both minus and plus lenses

When is a lens considered "cleared" in accommodative facility?

IF it is single and clear with no suppression

What are the testing conditions for accommodative facility?

20/30 target @40cm with suppression check

pt in habitual or trial frame, with polaroid glasses over

full room illumination

What are the expected results of binocular accommodative facility for a patient aged 13-30?

10cpm

What are the expected results of binocular accommodative facility for a patient aged 8-12?

5cpm

What do you do if a patient fails binocular accommodative facility testing?

test monocular

What does it mean if a patient fails binocular accommodative facility but passes monocular?

they have a problem with vergence

What does it mean if a patient fails binocular accommodative facility and fails monocular?

they have an accommodative issue

If a patient fails binocular accommodative facility and struggles with minus, but passes monocular, what does that mean?

they have problems with divergence

If a patient fails binocular accommodative facility and struggles with plus, but passes monocular, what does that mean?

they have problems with convergence

What are the main differences between binocular and monocular accommodative facility?

monocular uses an occulder, does NOT need suppression check

What is the normal result for monocular accommodative facility for ages 13-30?

11 cpm

What is the normal result for monocular accommodative facility for ages 8-12?

7cpm

What is an associated phoria?

the amount of prism needed to eliminate fixation disparity

What is Panum's fusional area?

the region of space which binocular single vision is possible

What is the fixation disparity?

deviation of eyes under binocular vewing conditions

A fixation disparity is common in who?

those with vertical phorias or large horizontal phorias

What are the testing conditions for fixation disparity/associated phoria with borish near card?

trial frame refraction (+add if presbyope) with polarized glasses on top

target at 40

loose prism to neutralize