Monocular & Binocular Push-Up

What is the objective of Monocular & Binocular Push-Up?

• To increase accommodative amplitudes

• Kinesthetic awareness of accommodation

What is recorded for monocular push ups?

• Recorded in diopters

• Observed ease/difficluty of activity

• Modifications: supports such as larger prints

What equipment is used for monocular push ups?

• Fixation stick with small letters/numbers or near HART chart

• Ruler (cm/diopters)

• Eye patch/occluder

What is the procedure for monocular push ups?

1. Pt holds target at arm’s length

2. Pt slowly brings towards eye, keeping target in focus/clear

3. Once blurs, move back slightly until just clears

4. Hold for 5-10 seconds, then attempt to bring closer, maintaining clarity

5. Pt slowly moves target until arm’s length position is reached

6. Repeat, decrease print size as patient is able

What are the endpoints/goals for monocular push ups?

• equal monocular abilities

• Blur value reached at average age expected (18.5-0.3(age))

What are some notable features of monocular push ups?

• Often home activity

• Often 10 repetitions = 1set

What is the procedure for binocular push ups?

• Pt will slowly bring target towards eye, keeping target clear and single

• When pt can no longer keep target single, slightly push target back until it is single

• Hold target single for 5-10 seconds.

• After pt has maintained single, bring target slightly closer, maintaining single vision

• Next, have them slowly move target back to their arm’s length starting position while maintaining single and returning to clear

• Repeat procedure for a number of cycles instructed

When performing binocular push ups, what is emphasized?

Keeping target clear as long as possible, then work on keeping single.

What is the goal of binocular push ups?

<6cm break from forehead

How is suppression check in binocular push ups?

• red/green targets on paddle with red/green glasses

• Index card on wall 6-8 feet away from patient (physiologic diplopia)

What are some supports you can give the patient for push ups?

• Suggest pt try and get the feeling of looking close and crossing their eyes

• Have pt touch the object that they are trying to fuse/clear. This is kinesthetic feedback that can help them achieve single vision

• For accommodation: larger font

• For voluntary convergence: use binocular minus lens to stimulate accommodative convergence

How does AC/A ration and P.D. affect push ups?

• If AC/A is equal to P.D., push-up therapy is of no value for the fusional demand will remain the same as the target is brought closer

• If the AC/A is less than the pt’s P.D., positive fusional vergences will be stressed as the target is brought closer

• If AC/A is greater than P.D., negative fusional vergences will be stressed by push-up procedure.