9 - management of non-strabismic BV and accommodative disorders

What is the effect of having uncorrected anisometropia?

1. decreased stereopsis

2. risk of developing accommodative esotropia

3. risk of amblyopia (≥0.50 D)

4. aniseikonia

What is the effect of significant uncorrected RE?

1. amblyopia

2. decreased functional ability

3. under or over accommodation

4. may increase phoria → ↑ fusion demand

What should you do after prescribing significant RE to someone with BV/accommodative problems or high hyperopia (for first time wearer)?

have them return in 4-6 weeks to re-evaluate binocular vision/accommodative function

What are the indications for prescribing added plus?

1. low AA

2. high lag

3. accommodative insufficiency

4. accommodative fatigue

5. convergence excess

6. basic eso (depending on AC/A)

What should you consider when prescribing added plus?

1. AC/A

2. phoria

3. pt's ability to wear lens → plus lens and BO findings

4. bifocal vs single vision

what is the goal for prescribing added plus for a high lag?

normalization of response

what is the goal for prescribing added plus for a high gradient AC/A?

ortho or small phoria

what is the goal for prescribing added plus for a reduced NRA/PRA?

equal NRA/PRA range

what are the indications for prescribing added minus?

1. high exophoria

2. divergence excess

3. basic exo

What should you consider when prescribing added minus?

1. phoria and AC/A

2. accommodative ability

3. NFV ability

4. age (full time were for kids only)

5. amount needed for support → use smallest amount possible

6. is an add required at near

How much added minus is prescribed?

amount necessary to fuse/increase stimulus to convergence, NOT the amount to neutralize the deviation → typically 1-2D in kids

What was the conclusion of the overminusing for IXT patients study?

1. was helpful while patient was overminused → however benefit not maintained after tapering overminus

2. patient who were overminused had a greater myopic shift than those who were not

What are the indications for prescribing prism?

1. horizontal deviations with low to normal AC/A

2. primary vertical deviation

when in treatment is prism prescribed?

1. as a support to begin therapy

2. alternative to therapy

3. at the end of therapy

What are the goals of prescribing relieving prism?

1. reduce vergence demand

2. relieve symptoms in some binocular anomalies

What are the disadvantages of relieving prism?

1. does not address accommodative or oculomotor dysfunction or vergence infacility

2. cosmesis

3. image distortion

4. limit of prism in glasses (14-15pd total)

5. prism adaptation

6. dependence on prism

What patients adapt to prism (angle increases after wearing prism)?

1. good sensory and motor fusion

2. some patients with strab and suppression/AC

How do you test for prism adaptation before you prescribe?

have patient wear prism for at least 30 mins, then retest

What are the methods in determining how much horizontal prism to prescribe?

1. associated phoria/fixational disparity

2. saladin's 1:1 rule for esophores

3. Sheard's criterion

4. Percival's criterion

R/G muscle balance light or CT for strabs

What is the associated phoria?

the amount of prism that reduces FD to zero

how to prescribe horizontal prism using associated phoria?

have pt close eyes for 1-2 sec and then open to see if lines are aligned

What is Saladin's 1:1 rule for esophores?

Rx BO prism to make esophoria = BI recovery

BO prism to prescribe = (esophoria - BI recovery)/2

Who should you use Saladin's 1:1 rule for

1. basic esophores

2. divergence insufficiency

What are the methods for prescribing vertical prism?

1. associated phoria

2. equalizing vergence ranges

how to treat a vertical fixation disparity with a horizontal deviation

1. eval and correct vertical

2. test horizontal with vertical prism in place

What are the indications for vision therapy?

CI

CE

divergence excess

divergence insufficiency

vergence infacility

accommodative excess

accommodative infacility

accommodative insufficiency

basic exo

basic eso

vertical

REVIEW SLIDE 29 of lecture 9

do it now

lmao do it