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Questions and Answers
A low AC/A ratio is typically managed with prism as the primary treatment.
A low AC/A ratio is typically managed with prism as the primary treatment.
False (B)
In a case of divergence insufficiency, the near vision is typically better than the far vision.
In a case of divergence insufficiency, the near vision is typically better than the far vision.
False (B)
A high AC/A ratio is associated with under-correction in myopes.
A high AC/A ratio is associated with under-correction in myopes.
False (B)
The formula FH = MH - AH is used to calculate the difference between the manifest hyperopia and the axis hyperopia.
The formula FH = MH - AH is used to calculate the difference between the manifest hyperopia and the axis hyperopia.
In a case of divergence excess, the near vision is typically better than the far vision.
In a case of divergence excess, the near vision is typically better than the far vision.
Vision therapy is the primary treatment for a patient with a high AC/A ratio.
Vision therapy is the primary treatment for a patient with a high AC/A ratio.
A low MEM is associated with a lead of accommodation.
A low MEM is associated with a lead of accommodation.
In a case of esophoria, the near vision is typically better than the far vision.
In a case of esophoria, the near vision is typically better than the far vision.
The VT 14 is a test used to assess vertical lag and horizontal lead.
The VT 14 is a test used to assess vertical lag and horizontal lead.
Maximum plus at distance is a vision therapy technique used to treat hyperopia.
Maximum plus at distance is a vision therapy technique used to treat hyperopia.
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Study Notes
Examination Findings
- Case #1 presented various levels of hyperopia (+1.25D to +2.25D) and visual acuity from 20/30 to 20/20.
- High MEM indicated a lag of accommodation; low BI at far and near with esophoria was noted.
- Normal near point of convergence (NPC) measured between 6-10 cm, typically correlating with exophoria.
Clinical Findings
- Basic Exophoria: Found in both distance and near testing, ranged from 1/2 exo to 6 exo.
- Examination showed symptoms including burning and tearing, inability to sustain concentration, and decreased reading comprehension over time.
- Key measurements indicated low PRA and NRA alongside reduced negative/positive fusional vergence (NFV/PFV).
Management Recommendations
- Vision therapy emphasizing maximum plus lenses to correct the phoria.
- Bifocals may be suggested for near tasks; prism therapy could alleviate symptoms.
- Overminus or undercorrection strategies depending on the patient's hyperopic or myopic status.
Case #2 Observations
- Increased hyperopia (+1.25D to +2.25D), with visual acuity observed at similar levels (20/25 to 20/30).
- Divergence Excess Exophoria noted; a higher degree of exophoria at near compared to distance.
- Management techniques include maximum plus at distance and prism therapy, maintaining normal MEM and PAC conditions.
Key Takeaways
- Monitor phoria tests consistently after refractive adjustments to evaluate improvement.
- Symptoms of asthenopia (visual discomfort) observed include intermittent blur and visual fatigue throughout the day.
- Correcting prisms employed to address deviations, with attention to the type of phoria (exo vs. eso).
Additional Considerations
- Low BO test results indicate potential convergence insufficiency; divergence insufficiency marked by low BI test results.
- Always confirm the diagnosis with multiple tests, ensuring to compare induced phoria at both near and far distances.
- Recovery points should be evaluated differently than break points to ascertain visual stability.
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