High AC/A Conditions

divergence excess

high AC/A & exophoria at distance

convergence excess

high AC/A & orthophoria at distance

convergence excess

high AC/A & esophoria at distance

yes

are lenses able to make a significant change in the phoric posture of a patient with a high AC/A?

normal

if the distance & near phoria are w/in 5^ of each other, the AC/A is _______

low

if the near phoria is more than 5^ more divergent than the distance phoria, the AC/A is ______

high

if the near phoria is more than 5^ more convergent (more eso) than the distance phoria, the AC/A is _______

high

if the distance phoria is more than 5^ more divergent (more exo) than the near phoria, the AC/A is ______

1. ortho - low eso

2. greater eso at near

3. high

4. low BI, high BO

5. mildly reduced BI

6. reduced, slow w/ BI

7. low

8. low binocular, slow w/ minus

9. high lag (sometimes)

10. reduced binocular (sometimes)

describe the trend of results for the following tests for a patient with convergence excess:

1. phoric posture at distance

2. phoric posture at near

3. AC/A

4. near vergence range testing

5. distance vergence range testing

6. vergence facility

7. PRA

8. accommodative facility

9. MEM/Nott/BCC

10. NPA

1:1, Percival’s

for a patient w/ a convergence excess, which criteria are not met at near?

plus

for a patient with a convergence excess, emphasize ______ for the distance Rx

1. added plus at near

2. VT

3. prism

what are the treatment options for a convergence excess patient in order?

emphasis on BI recovery at near

what is the focus of VT for a convergence excess patient?

plus at near

for a convergence excess patient, typically VT is done in conjunction with what?

NFV amplitude

VT for a convergence excess patient is aimed to normalize the _________

1. high exo

2. lower exo

3. relatively normal

4. relatively normal

describe the trend of results for the following tests for a patient with divergence excess:

1. distance phoric posture

2. near phoric posture

3. vergence range testing

4. accommodative findings

increases

for a DE patient, the deviation frequency _______ w/ fatigue & inattention

proportion, magnitude

for a DE patient, the __________ of the deviation rather than the ________ can be diagnostic

vertical deviation

for a DE patient, when the eye deviates, in 50% of cases there is a __________

rarely

how often do DE patients experience diplopia?

myopes

DE is most common in patients w/ what refractive error?

high, normal

for a DE patient, the calculated AC/A is _______ & the gradient AC/A is __________

fusional convergence after-effects & proximal convergence artificially elevate the calculated AC/A ratio

why is the calculated AC/A ratio high while the stimulated AC/A ratio is normal for a divergence excess patient?

simulated divergence excess

• divergence excess type

• near deviation magnitude approaches that of the distance deviation magnitude following 30-45min of occlusion

• consistent w/ the gradual loss of fusion convergence after-effect

true divergence excess

• divergence excess type

• near deviation remains significantly less than the distance deviation despite occlusion

minus

you should emphasize ______ in the distance Rx for a divergence excess patient

1. VT

2. surgery

3. observation

what are the 3 most common treatments for a divergence excess patient?

1. BI prism

2. added minus lenses (not really)

3. part/full time patching

what are “other” treatments for a divergence excess patient?

high hyperopes

added minus lenses are not typically used for a DE patient unless for ________