QUESTIONS TO PONDER FOR LAB INTRODUCTION

 

1. You introduce a occluder over a patient’s right eye. After two seconds, you remove the occlusion and note that the right eye is out approx. 15 prism diopters. Over one second later, you observe that the right eye adducted while the left eye was stationary. What is your assessment based on this information? Large exoPHORIA with a slow recovery, probably will experience an intermittent XT’ with more stress to the system

2. You introduce an occluder to a patient’s left eye. The right eye abducts and takes up fixation. On uncover, you notice no immediate movement, but just before you introduce the occluder to the left eye, the patients left eye abducts and their right eye adducts. On covering and uncovering the left eye, you observe no movement. What is your assessment based on the information provided? Alternate constant esotropia with O.S. dominant fixation

 

3. Some say that dynamic retinoscopy (in particular, MEM) is a useful tool to detect nearpoint anisometropia or astigmatism before an incorrect prescription is given. Describe how MEM could detect uncorrected astigmatism in a patient the techniques of dynamic retinoscopy allow you to "scope" in two meridians. If the patient has an uncorrected astigmatism, the lag of accommodation would be different for the two meridians. Cylindrical correction should equalize the lag of accommodation.

 

4. The term "plus acceptance" has been described recently in class. Can you define this concept in your own words? Is it good or bad? The ability to relax accommodation to plus lens application. Some plus acceptance is part of a healthy BV system, as long as the lag of accommodation remains in normal ranges.

 

5. If a patient has a lag of accommodation of +1.25 through his BVA, answer the following questions:

a. is this an acceptable lag of accommodation? NO

b. if the lag of accommodation through +1.00 probe lenses was +1.25, what can be said about plus acceptance? complete plus acceptance

c. if the lag of accommodation through +1.00 probe lenses was +0.25, what can be said about plus acceptance? zero plus acceptance

 

 

6. a. What is the expected kinetic cover test results for an accommodative insufficiency?

positive

b. What is the expected kinetic cover test results for an accommodative excess?

negative

c. What happened when you repeated the KCT with -4.00 lenses? What changes must happen to the "patient" to keep the target clear as it moves inward?

 

  • It was hoped that through a -4.00 lens, we could mimic an accommodative insufficiency. With a 6.5 diopter accommodative demand, it would be difficult to avoid under accommodating

    To keep the target clear, the patient must increase accommodative output. Even the worst accommodative insufficiency case will accommodate far more accurately during a KCT, as the target moves towards the patient ‘s nose. The increase in accommodative accuracy will be reflected by an eso shift (secondary to accommodative convergence)

     

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    7. Was there any difference between results of monocular accommodative facility and binocular accommodative facility results? Why is this so?

     

    Vergence control comes into play under binocular conditions; it will take longer to clear AND FUSE the target!

    8. Was there any difference between results of binocular accommodative facility without suppression checks and binocular accommodative facility through a bar reader results? Why? YES!!!!

    Pathological suppression; less contrast; retinal rivalry