Stage 1: Free reading in Book ret (what kind of reflex will you see?)
free reading=patient comprehension with little effort
Reflex will be bright, whitish-pink
-neutral to low with motion movement
Stage 2: Easy Instructional Level in Book ret (what kind of reflex will you see?)
Easy Instructional Level=Comprehension with some effort
Reflex is bright pink
-neutral with minor shifts to with motion and against motion
Stage 3: Difficult Instructional Level in Book ret (what kind of reflex will you see?)
Patient has to work hard to maintain/achieve comprehension
- Reflex is reddish-pink
- fluctuating against motion (-0.25 to -1.25D)
Stage 4: Nonreading/complete frustration level
Comprehension is not possible (or if no effort is put forth/when patients are really tired)
- Reflex is dull, brick red
- High with motion
plus lenses are the tx of choice for what?
acc insufficiency/ill-sustained acc
VT is beneficial for:
acc excess/nfacility and vergence issues
CI patients will have: lag or lead?
lead
what is lens sorting?
Have them sort lenses based on how the image size looks to them (how magnified the image is for each lens)
what is the working dist for bell ret? procedure? (what gets moved, retscope or target?)
Working distance is 20” or 2D
Retinoscope always stays at the 20” WD, but the target will be moved closer to the patient
-note when reflex changes from with to against
what is the lens rock?
- look at near, start adding plus lenses, and see how their eyes feel (figure out starting point)
- Use flippers and have them clear the text for plus and minus
what is dist/near acc rock procedure if you want to work on flexibility? sustainability? amp?
monocular
- flexibility: have pt change from N to D or D to N after every letter (pts with acc infacility or spasm)
- sustainability: have pt switch from D to N or N to D less
- amplitude: try to get flexibility and sustainability working first, then move the near card closer after each cycle
what endpoint is ideal for amp training in VT?
half their amplitude of accommodation
at what point in bell ret does the reflex usually change?
15-18inch
what is the Bi-ocular accommodative rock?
Monocular fixation in a binocular field
Good for transitioning the patient from monocular to binocular accommodative rock
Have the patient wear R/G glasses
what is the red/red rock?
Can use (+) and (-) lenses at the same time
divergence excess is more common in what groups?
women and blacks
most common vergence abnormality:
CI (slightly more common in women)
-second most common is CE
