Podcast
Questions and Answers
What are common symptoms associated with divergence excess?
What are common symptoms associated with divergence excess?
Which method is preferred for measuring the amount of base-out prism needed for divergence insufficiency?
Which method is preferred for measuring the amount of base-out prism needed for divergence insufficiency?
Which vision therapy includes home therapy options?
Which vision therapy includes home therapy options?
What should be corrected in any significant refractive error for patients with divergence excess?
What should be corrected in any significant refractive error for patients with divergence excess?
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What does the presence of orthophoria or low exo deviation at near indicate in divergence excess?
What does the presence of orthophoria or low exo deviation at near indicate in divergence excess?
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What is a primary characteristic of divergence insufficiency?
What is a primary characteristic of divergence insufficiency?
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Which treatment is NOT recommended for divergence insufficiency?
Which treatment is NOT recommended for divergence insufficiency?
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What is used to measure fixation disparity in patients with divergence insufficiency?
What is used to measure fixation disparity in patients with divergence insufficiency?
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Which symptom is commonly associated with divergence insufficiency?
Which symptom is commonly associated with divergence insufficiency?
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What is a primary method to determine the additional plus needed for near vision?
What is a primary method to determine the additional plus needed for near vision?
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When should vertical prisms be prescribed in relation to therapy?
When should vertical prisms be prescribed in relation to therapy?
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Which treatment is specifically mentioned as part of home therapy for vision therapy?
Which treatment is specifically mentioned as part of home therapy for vision therapy?
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Which of the following is NOT a symptom of convergence excess?
Which of the following is NOT a symptom of convergence excess?
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What characteristic of a patient would indicate the need for vision therapy?
What characteristic of a patient would indicate the need for vision therapy?
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Which treatment approach is emphasized for managing divergence excess?
Which treatment approach is emphasized for managing divergence excess?
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What is typically observed in cases of convergence excess during distance vision assessment?
What is typically observed in cases of convergence excess during distance vision assessment?
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Which of the following symptoms are commonly associated with convergence excess?
Which of the following symptoms are commonly associated with convergence excess?
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What is the primary focus when determining the amount of vertical prism to prescribe?
What is the primary focus when determining the amount of vertical prism to prescribe?
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Which vision therapy method involves exercises such as the PHD exercises and Brock string?
Which vision therapy method involves exercises such as the PHD exercises and Brock string?
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Which statement about treatment options for convergence excess is accurate?
Which statement about treatment options for convergence excess is accurate?
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What observation would suggest a possibility of suppression in a patient with heterophoria?
What observation would suggest a possibility of suppression in a patient with heterophoria?
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Which therapy methodology utilizes tools like tranaglyphs and vectograms?
Which therapy methodology utilizes tools like tranaglyphs and vectograms?
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What is a common sign of convergence excess related to fusional vergences?
What is a common sign of convergence excess related to fusional vergences?
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What is the effect of high pain threshold on symptoms of convergence excess?
What is the effect of high pain threshold on symptoms of convergence excess?
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Study Notes
Divergence Insufficiency
- Symptoms produced only at distance.
- Prescriptions can be for distance tasks only or all the time.
- Lenses often ineffective.
- Prisms most effective treatment due to involuntary divergence.
- Amount of base-out prism determined using phoria measurement, Sheard’s criterion, or fixation disparity.
- Mallet unit measurement overestimates prism needs, use disparometer or Wesson Card instead.
- Prescribe minimum prism to relieve symptoms.
Convergence Excess
- Esophoria at near.
- Orthophoria or low to moderate esophoria at distance.
- Reduced negative fusional vergences / BI reserves.
- High AC/A ratio.
- Refractive error usually moderate to high hyperopia.
- Symptoms may be linked to accommodation dysfunction.
- High pain threshold, occlusion of one eye when reading, avoidance of near tasks, or suppression may lead to the absence of symptoms.
- Lenses effective due to high AC/A ratio.
- Prisms rarely required.
- Therapy includes office therapy and home therapy.
- Office therapy includes Tranaglyphs, Vectograms, and Vodnoy Rule (double aperture rule).
- Home therapy includes Brock string, Eccentric circles.
Divergence Excess
- Greater exo deviation (phoria or tropia) at distance.
- Orthophoria or low exo deviation (phoria or tropia) at near.
- Normal positive fusional vergence.
- Comitant deviation which can be intermittent.
- High AC/A ratio.
- Symptoms often associated with distance tasks.
- Absence of symptoms may indicate suppression or anomalous retinal correspondence (ARC).
- Lenses very beneficial in myopic patients with high AC/A ratio.
- Added minus lenses at distance can prove helpful.
- Avoid prescribing for low amounts of hyperopia.
- If vertical deviation is present, vertical prism should be prescribed first.
- Amount of vertical prism determined by associated phoria measured by fixation disparity measurement.
- Base-In prisms often ineffective.
- Therapy can include office therapy and home therapy.
- Office therapy includes Projected Tranaglyphs, Projected Vectograms.
- Home therapy includes Brock string.
Convergence Insufficiency
- Larger eso (phoria or tropia) deviation at distance.
- Orthophoria or small esophoria at near.
- Reduced negative fusional vergences / BI reserves.
- Normal or low AC/A ratio.
- Normal versions, and deviation is concomitant.
- Often associated with intermittent diplopia.
- Diplopia disappears with rest.
- Symptoms may include headaches, ocular fatigue, nausea, dizziness, train and car sickness, blurred vision, poor accommodative facility, and photophobia.
- Correct any significant refractive error.
- Prescribe maximum plus to best visual acuity for hyperopia.
- Therapy can include office therapy and home therapy.
- Office therapy includes Tranaglyphs, Vectograms, and Vodnoy Rule (single aperture rule).
- Home therapy includes PHD exercises, Brock string.
General Notes
- Therapy usually involves 12-24 visits.
- The number of visits depends on the severity of the condition, the age of the patient, their motivation, and compliance with home therapy procedures.
- Vision therapy comprises office therapy and home therapy.
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