5 - diagnosis of accommodative disorders

What tests give you information about alignment?

1. phoria at distance + near

2. fixation disparity

3. AC/A ratio

4. CA/C ratio

What tests directly test PFV?

1. BO vergence range

2. NPC

3. Vergence facility with BO

What tests indirectly test PFV?

1. binocular accommodative facility when looking through plus lenses

2. NRA

3. accommodative response (binocular)

What tests directly test NFV?

1. BI fusion range

2. vergence facility with BI

What tests indirectly test NFV?

1. binocular accommodative facility with minus lenses

2. PRA

3. accommodative response (binocular)

What tests directly test accommodative ability?

1. monocular AA

2. monocular accommodative facility

What tests indirectly test accommodative ability?

1. accommodative response

2. binocular accommodative amplitude

3. binocular accommodative facility

4. NRA/PRA

What tests give you information about ocular motor skills?

1. DEM

2. NSUCO

3. Visagraph/Readalyzer

What is the CT finding and AC/A for convergence insufficiency?

CT: exo greater at near

AC/A: low

What is the CT finding and AC/A for convergence excess?

CT: eso greater at near

AC/A: high

What is the CT finding and AC/A for divergence excess?

CT: exo greater at distance

AC/A: high

What is the CT finding and AC/A for divergence insufficiency?

CT: eso greater at distance

AC/A: low

What is the CT finding and AC/A for basic exo?

CT: similar exo + distance and near

AC/A: normal

What is the CT finding and AC/A for basic eso?

CT: similar eso + distance and near

AC/A: normal

What findings would suggest fusional vergence dysfunction?

reduced fusional ranges and/or facility with orthophoria or small phoria

What are the common symptoms of accommodative insufficiency?

1. blurred near vision

2. headaches

3. discomfort/difficulty concentrating with near work

4. words moving on page

5. avoidance

What are common signs of accommodative insufficiency?

1. low amplitude of accommodation

2. decreased binocular and monocular accommodative facility with minus

3. high lag

4. low PRA

what are common signs of accommodative insufficiency that are often associated with other BV problems?

1. esophoria at near → often primary problem that causes AI

2. CI

3. exophoria at near (pseudo-convergence insufficiency)

What is the differential diagnosis for accommodative insufficiency?

1. pseudoconvergence insufficiency

2. basic exophoria

3. divergence excess

4. accommodative excess

5. accommodative infacility

6. accommodative paralysis

7. non-functional unilateral or bilateral accommodative dysfunction

What is the treatment for accommodative insufficiency?

1. correction of RE

2. therapy or plus lenses

What are the common symptoms of accommodative excess?

1. intermittent blurred vision at distance → worse at end of day

2. difficulty relaxing focusing

3. frequent Rx changes

4. headaches/asthenopia with near work

What are the common signs of accommodative excess?

1. variable findings (VA, ret, and refraction findings)

2. plano or accommodative lead

3. decreased monoc + binoc accommodative facility with plus

4. low NRA

5. low BI blur at near

What binocular vision problems is accommodative excess associated with?

1. may cause eso deviation

2. may be due to convergence insufficiency

What is the differential diagnosis for accommodative excess?

1. convergence excess

2. basic esophoria

3. accommodative insufficiency

4. accommodative infacility

5. non-functional bilateral or unilateral accommodative dysfunction

What is the treatment for accommodative excess?

1. correction of RE

2. take breaks + look at distance

3. therapy

short course cycloplegics if severe

What are the common symptoms of accommodative infacility?

1. blur

2. difficulty focusing one distance to another

What are the common signs of accommodative infacility?

1. decreased monocular and binocular accommodative facility with plus and minus

2. low NRA and PRA

What is the below expected value for monocular accommodative facility for 8-12 year olds?

What are the differential diagnoses for accommodative infacility?

1. accommodative insufficiency

2. accommodative excess

3. convergence excess

4. basic esophoria

5. non-functional bilateral or unilateral accommodative dysfunction

What is the treatment for accommodative infacility?

1. correction of refractive error

2. therapy

What are the common symptoms of accommodative fatigue (ill sustained accommodation)?

1. blurred near vision

2. eyestrain/fatigue with near work

3. difficulty concentrating during sustained near tasks

What are common signs of accommodative fatigue?

1. normal AA initially → decreases with repeat testing

2. low PRA

3. decreased monoc + binoc accommodative facility with minus lenses → rate decreases with over time

4. high lag of accommodation → may increase over time

What is the treatment for accommodative fatigue?

1. accommodative therapy

2. plus lenses