Questions To Ponder For Lab 3

 

1. If a patient has a lag of accommodation of +1.25 with habitual correction and a +1.00 lag through a +1.00 probe lens:

  • A. what does this say about the pt's acceptance of plus? Would you recommend an add for this patient? Why or why not? Plus acceptance can be mathematically calculated:
    •

    Probe lens (D) &emdash; Change in MEM result between two trials (D)

    +1.00 D - 0.25 = 0.75 D plus acceptance

  • B. Would you try a different probe lens? YES!!!!! Because the lag is still unacceptably high

     

    •

    2. With which accommodative dysfunction types would you start monocular accommodative therapy with plus lens/plano accommodative rock? Why?

     

    Acc. Insuff./Ill Sustained Acc. The general idea is to begin a pt. with something they can do; then rock them in the more difficult direction.

    3. With which accommodative dysfunction types would you start monocular accommodative therapy with minus lens/plano accommodative rock? Why?

     

    Acc. Excess/Acc. Infac. The general idea is to begin a pt. With something they can do; then rock them in the more difficult direction.

    4. You are performing red/red rock on an eight year old patient. As you place the red lens of R/G glasses over the patient's right eye, which eye will see the black printing on the red acetate sheet? If a +2.00 lens was worn over the left eye and a -1.50 lens was worn over the right, what would happen as the patient shifted attention from the acetate sheet to the white cards?

    a. O.D. b. the patient would have to RELAX accommodation by 3.5 diopters

    5. Why is it important to complete two trials when completing the Red/Red Rock procedure? What’s with all that lens shifting?!?! Both eyes need to "lead the charge" with both positive and negative accommodative efforts

     

     

     

    CASE REPORT

    A eighteen year old female enters your office with complaints of distance blur. She also reports that her eyes seem to "get tired late in the afternoon". She experiences some headaches as well.

    ........STOP AND THINK.......What other questions should you ask at this point????

    - onset/clinical course

    - change in near point activities/occupation

    -is distance blur constant, or only in afternoon

    - any near blur

    - any diplopia

    - any recent sinus infection/ allergies, etc.

     

    ........STOP AND THINK.......What are the possible DX at this time? Should an add be prescribed at this point? Should vision therapy be prescribed at this point?

     

    Accommodative Excess

    NO

    LIKELY NECESSARY

    In A Vision Therapy Sequence...

    A. Which of the following do you think would be most difficult for our patient?

    1. reading a near Hart chart @ 10cm.

    2. shifting fixation to a 20/20 size distance hart chart

    3. clearing a -2.00 lens monocularly

    4. clearing a +2.00 lens monocularly

    B. What level of therapy should begin accommodative therapy?

    1. monocular

    2. transitional

    3. binocular

    4. integrated

    C. If our pt. has problems clearing the distance Hart chart, which of the following would make the task less stressful for the pt?

    1. allow her to bring the near card in closer

    2. allow her to walk a step closer to the distance card (2)

    3. bring the near card away from the pt. (1)

    4. bring both charts closer to the pt.

    5. utilize +2.00 lenses in conjunction with the distance card