1
Q
A
2
Q
What are the 4 dissociated tests of alignment?
A
Cover Test, Modified Thorington, Maddox Rox, Von Graefe Phoria
3
Q
Which EOM muscle is inserted furthest from the limbus?
A
B. Superior rectus
4
Q
What is the primary action of the inferior oblique?
A
D. Excyclotorsion
5
Q
Your patient suffers from a complete CN 3 palsy. Which muscle would NOT be affected?
A
C. Lateral Rectus
6
Q
According to Sherrington’s Law, which muscles are correctly paired?
A
C. Right superior oblique, Right inferior oblique
7
Q
Your patient performed DEM test and scores the following: 10th% on vertical, 12th% on adjusted horizontal, 50th% on H/V ratio, and 30th% on errors. What DEM type is present?
A
C. Type 3
8
Q
What are the 4 dissociated tests of phoria?
A
Cover Test, Maddox Rod, Modified Thorington, Von Graefe Phoria
9
Q
What correction should be used for all alignment tests?
A
Best correction, near correction for presbyopic patients or those with a hx of accommodative issues
10
Q
What is the standard testing distance for all alignment tests?
A
40 cm
11
Q
Testing purpose for all alignment tests
A
“To determine how well your eyes are working together”
12
Q
What is the only test that can differentiate between a strabismus and heterophoria and measures horizontal and vertical deviations?
A
Cover test
13
Q
Advantage to cover test
A
It’s an objective test
14
Q
What is a disadvantage to cover test?
A
Difficult to detect very small deviations < 3
15
Q
Why is head positioning important in cover test?
A
To ensure patients head is straight
16
Q
Cover test target
A
Single letter 1-2 lines above BCVA of poorer seeing eye
17
Q
How can underaccommodation impact cover test?
A
OVERestimates EXO UNDERestimates ESO
18
Q
How can overaccommodation impact cover test? Why?
A
UNDERestimates EXO OVERestimates ESO Accommodation and convergence go hand in hand and therefore underestimate EXO
19
Q
What 3 things can you determine on unilateral cover test?
A
Presence of a tropia and its direction (strabismus), Frequency (intermittent vs. constant), Laterality (right vs. left vs alternating)
20
Q
What two things can you determine on alternating cover test?
A
Presence of a phoria and its direction, Magnitude (how much prism to neutralize)
21
Q
You perform unilateral cover test, and the right eye moves up and in when you cover the left eye. What type of deviation is present?
A
C. Left Hypertropia, Right Exotropia
22
Q
On alternating cover test, you observe that the left eye moves out and down when you move the occluder to the right eye. How do you neutralize this deviation?
A
C. BO prism over OS, BU prism over OD
23
Q
Does it matter what eye horizontal prism is over?
A
No
24
Q
Does it matter what eye vertical prism is over?
A
25
How long should you hold the occluder in front of the eye before moving on cover test?
2-3 seconds
26
Expected Cover Test findings at distance
1 ∆ esophoria - 3 ∆ exophoria 1 EP, ortho, 1 XP, 2 XP, 3 XP
27
Expected Cover Test Findings at near
Orthophoria - 6 ∆ exophoria Ortho, 1 XP, 2XP, 3XP, 4XP, 5XP, 6XP
28
How should cover test be recorded?
Frequency (C or I) Laterality (R, L, A) Direction (X, E, Hyper, or Hypo) Type (T, P)
29
Maddox rod is another way to measure a ____________ in free space
Phoria
30
What are some advantages to Maddox rod?
Quick in free space Minimal equipment
31
What is a disadvantage to Maddox rod?
Penlight stimulus is a poor accommodative target
32
Ideally, what eye will patient hold the Maddox rod over?
Right eye
33
How should lighting be when performing maddox rod?
Dim lighting
34
How should the red lines be oriented when measuring horizontal phoria? And how will the patient perceive them?
Oriented horizontally, patient will perceive line as vertical
35
How should the red lines be oriented when measuring vertical phoria? And how will the patient perceive them?
Oriented vertically, patient will perceive line as horizontal
36
When performing maddox rod, the patient should appreciate a white light and red line.
_______________ line for measuring horizontal deviation ______________ line for measuring vertical deviation Vertical Horizontal
37
When performing Maddox rod OD with the red lines oriented horizontally, the patient perceives a red line to the right of the white light. What deviation is present? What can correct?
Uncrossed eso Use BO prism
38
When performing Maddox rod OD with the red lines oriented horizontally, the patient perceives a red line to the left of the white light. What deviation is present? What can correct?
Crossed exo Use BI prism
39
When performing Maddox rod OD with the red lines oriented vertically, the patient perceives a red line above the white light. What deviation is present? What can correct?
Left hyper Use BD over OS or BU or OD
40
When performing Maddox rod OD with the red lines oriented vertically, the patient perceives a red line below the white light. What deviation is present? What can correct?
Right hyper Introduce BD over OD or BU over OS
41
A patient reports intermittent eyestrain and headaches at distance, worse after prolonged computer use. Distance visual acuity is 20/20 OU. A Maddox rod test is performed at 40 cm. A red Maddox rod is placed over the right eye with the cylinders oriented horizontally. The patient reports seeing a vertical red line to the left of the white fixation light. What is the patient's binocular alignment at distance?
A. Right exophoria B. Right esophoria C. Exophoria D. Esophoria
42
What prism would you use to quantify?
C. Exophoria BI prism
43
What is the Modified Thorington distance phoria measuring distance
10 feet (3m)
44
What is the Modified Thorington near phoria measuring distance
40 cm
45
What instructions should you give the patient when performing modified Thorington?
Ask where the streak passes on the graph in relation to the white light
46
The patient reports that they are having difficulty visualizing the red line on modified Thorington.
What can you do? Cover each eye to help demonstrate to the patient what they should be seeing. Cover the other eye
47
Patient states that the vertical red line is intersecting the number 4 on the right side and the horizontal line is between the white dot and 2 upward. What would you record?
4 ∆ EP 1 ∆ L Hyperphoria
48
Why is Von Graefe Phoria testing not the most reliable test?
Prism adaptation and Phoropter-induced proximal accommodation
49
Target used for distance and near during VG Lateral phoria testing
1 letter target 1-2 lines above BCVA of poorer seeing eye block of letters at near
50
What prism is stable and used to induce 2 images during VGP testing?
Dissociating prism
51
What prism is gradually modified and will be used to measure Phoria magnitude?
Measuring Prism
52
What is the measuring and dissociating prism when performing horizontal phoria?
Measuring: 12 ∆ BI Dissociating: 6 ∆ BU
53
What is the measuring and dissociating prism when performing vertical phoria?
Measuring: 6 ∆ BU Dissociating: 12 ∆ BI
54
What should you ask the patient when performing VGP?
ask how many targets are present and their relation to each other. There should be one up to the right and the other down to the left
55
When performing lateral LVGP, the patient reports that the targets are initially vertically aligned, what is the problem? And what will you need to do?
Your measuring prism is aligned to the lateral deviation, so increase BI to 20 prism diopters or flip to BO prism
56
When performing lateral LVGP, the patient reports that the targets are initially horizontally aligned, what is the problem? And what will you need to do?
Your dissociating prism is not enough, flip orientation and use BD rather than BU
57
What instructions should you give the patient when performing LVGP?
To focus on the lower target and tell you when the two letters line up like buttons on a shirt
58
In LVGP, reduce BI prism at a rate of no more than ______ prism diopters per second
2
59
If the targets overlap each other at the endpoint when performing LVGP, what should you do?
Increase dissociating prism
60
When performing VGPs what will be your final finding that you record?
The average of the two values the patient reports.
61
If the two findings are not within ______ ∆, you should re-emphasize the instructions
3 ∆
62
You are performing Von Graefe and find that the patient reports vertical alignment with the prism oriented as the following over OD...
6 ∆ base-out and 4 ∆ base-out at near. What do you record for your final finding? Near: 5 ∆ EP
63
You are performing Von Graefe and find that the patient reports vertical alignment with the prism oriented as the following over OD...
2 ∆ base-in and 1 ∆ base-out at distance. What do you record for your final finding? Distance: 0.5 ∆ XP
64
You are performing Von Graefe and find that the patient reports vertical alignment with the prism oriented as the following over OD...
12 ∆ base-in and 10 ∆ base-in at near. What do you record for your final finding? Near: 11 ∆ XP
65
In VVGP, reduce the _____ prism until the targets are aligned in what way
BU, until the targets are aligned horizontally like headlights on a car
66
After performing LVGP you get results of 12 ∆ base-in and 10 ∆ base-in at near. You proceed to determining the vertical deviation. What are concerns with your set-up?
How do you troubleshoot this issue? The patient will end up fusing the targets when measuring vertical phoria due to their lateral phoria being the same in magnitude as the dissociating prism for VVGP. Increase BI to 20 ∆ or switch to BO
67
Excepted Von Graefe phoria findings for presbyopes
8 ∆ exophoria +/- 3 ∆
68
Von Graefe Phoria can be used to determine a gradient ________ by measuring through additional lenses and comparing to the phoria with habitual correction in place.
AC/A
69
Von Graefe Phoria - Gradient AC/A
With + added, patient will become more ______ and less ______ More exo, and less eso
70
Von Graefe Phoria - Gradient AC/A
With - added, patient will become more ______ and less ______ More eso, and less exo
71
What are your 4 DISSOCIATED tests of phorias?
Cover Test Maddox Rod Modified Thorington Von Graefe Phorias
72
How is dissociation performed? Using what?
an occluder, Maddox rod or prism
73
What is known as the discrepancy between the point of convergence and target of regard (vergence inaccuracy)?
Fixation Disparity
74
If the fixation disparity exceeds PFA, then what will occur?
Diplopia
75
Eso Fixation Disparity = eyes are more ______________ than the target of regard
Converged
76
Exo Fixation Disparity = eyes are less _____________ than the target of regard
Converged
77
Fixation disparity is an ______________ test, that measured ocular alignment under binocular or fused conditions
Associated
78
Phoria testing is a __________________ test (measures ocular alignment when fusion is broken).
Dissociated
79
Fixation disparity is measured in what?
Minutes of arc
80
Stereo is measured in _______________
Seconds of arc
81
Phoria shows how alignment is and Vergences show what?
How well the patient can compensate for the alignment.
82
Are associated and dissociated phorias in the same direction?
Yes
83
Paradoxical fixation disparity occurs when the associated and dissociated phorias are in the ______________ directions
Opposite
84
What is the amount of prism required to reduce fixation disparity to zero?
Associated phoria
85
How may associated phoria differ from measured dissociated phoria?
EXO tend to be less with associated ESO tend to be more with associated
86
What is the only clinical assessment of vergence and accommodative interactions under binocular conditions for both distance and near.
Fixation disparity
87
What is a disadvantage to fixation disparity?
It does not provide direct information about accommodation or ocular motor disorders
88
What is the x-intercept of the fixation disparity curve related to?
Amount of prism that reduces fixation disparity to zero - associated phoria
89
What is the y-intercept of the fixation disparity curve related to?
Amount of fixation disparity present with no prism in place
90
As the Vergence demand is altered, the amount of fixation disparity may change.
An increase in BO prism = increase in _______ fixation disparity EXO
91
As the Vergence demand is altered, the amount of fixation disparity may change.
An increase in BI prism = increase in _______ fixation disparity ESO
92
As BI prism is added, the FD becomes more ______ (begins to diverge) until fusion is lost
Eso
93
As BO prism is added, the FD becomes more ______ (begins to under converge) until fusion is lost
exo
94
_______ slope indicates a stable Vergence system
Flat
95
_______ slope indicates an unstable vergence system
Steep
96
What type of fixation disparity is most common with a sigmoid shape? Patients asymptomatic
Type I
97
What type of fixation disparity shoes an ESO disparity?
Type 2
98
What type of fixation disparity shows an EXO disparity?
Type 3
99
What type of fixation disparity is most common with sigmoid shape? Patient asymptomatic.
Type 1
100
What type of fixation disparity denotes an unstable binocular system?
Type 4
101
As I increase BO, ____ fixation disparity decreases.
ESO
102
As I increase BI, ____ fixation disparity rises.
ESO
103
As I increase BI, ___ fixation disparity decreases.
EXO
104
AS i increase BI, ___ fixation disparity rises.
EXO
105
For symptomatic patients, prescribing based on the ______ associated phoria is an acceptable way to determine the proper amount for prism unlike with ____ deviations.
Vertical, horizontal
106
What are the 6 types of fixation disparity testing?
Wesson fixating card
Saladin card
Sheedy disparometer
Bernell lantern
AO vectographic slide
Mallet unit
107
What is fixation disparity measurements performed with?
Polarized vernier lines
108
What is the target for Wesson fixation disparity?
Polarized series of colored vertical lines (OS) and a vertical arrow (OD)
109
What does it mean if the results on Wesson fixation disparity card is a misalignment of arrows and lines?
The pt has a fixation disparity
110
Fixation disparity is an _____ test.
Associated
111
What is the X-intercept on the fixation disparity curve
Associated phoria
112
What is the y-intercept on the fixation disparity curve?
FD with no prism in place
113
What is the disparity between the visual and anatomical(pupillary) axes of the eye?
Angle kappa
114
What angle is the disparity between the pupillary axis and the line of sight?
Angle lambda
115
What the fixation point is far, the line of sight and visual axis are______
Almost identical
116
When testing angle Kappa which corneal light reflex should you look at first?
The non-amblyopic eye to see what normal is
117
if the corneal reflex is nasal, what deviation is present and what is the angel kappa?
EXO posture, positive angle Kappa
118
If a temporal corneal reflex is seen, what deviation is present and what is the angle kappa?
ESO posture, negative angle kappa
119
If the corneal reflex is inferior on OD, what deviation is it?
Vertical deviation suggesting a right hypertrope
120
What is angle kappa measured in?
Millimeters
121
What angle kappa is seen in most eyes?
Positive
122
1 mm angle kappa= ___ prism diopters
22
123
What is the test that examines the visual axes binocularly at near?
Hirschberg
124
What is the test that uses prism to determine the deviation magnitude seen in hirschberg?
Krimsky test
125
Which eye do you place the prism in front of for the krimsky test?
Fixating eye until corneal light reflex is equal in both
126
What is the Buckner test?
Gross assessment of eye alignment, RE, amblyopia, and media opacities using the DO
Looking at red reflex
127
What is the testing distance for Brcukner test?
2 feet
128
During the Bruckner test the brighter eye is the ____ eye
Abnormal
129
A white red reflex suggest what?
leukocoria- white pupil
Block 15
flashcards
Decks in class (15)
# Cards
-
Intro To CL63
-
Post Seg: Diagnostic Approach To Retinal Disease51
-
Ant Seg: uvea/sclera Anatomy Review49
-
Ant Seg: Embryology20
-
Ant Seg: Orbital Anatomy Review12
-
Ant Seg: Evalutions Of Orbital Disorders26
-
Post Seg: Diagnostic Approach To Retinal Disease6
-
Post-seg: Retinal Physiology And Psychophysics32
-
CL: Contacts Len Care, Solutions, Insertions, And Removals45
-
CL: Soft Lens 1: Sphere/Asphere101
-
BVM: Introduction13
-
BVM: EOMs105
-
BVM: Alignment129
-
CL: Contact Lens Care9
-
Post- Seg: Diabetic Retinopathy56
