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Duane_White_Anomaly_Types Powered By Docstoc
					Duane White Anomaly Type                        Far Phoria   Near Phoria   AC/A          Far criteria         Near criteria   Sx                                      Tx
                                                                                                                                                                      1. plus add at near
Convergence excess                              normal       eso           high          meets                fails           at near                                 2. train NFV (very distant choice)
                                                                                                                                                                      1. train PFV
Divergence excess                               exo          normal        high          fails                meets           at dist                                 2. overminus (effective b/c of high AC/A)
                                                                                                                              at near
Basic eso                                       eso          eso           normal        fails                fails           hyperopia                               1. prism
                                                                                                                                                                      1. train PFV
                                                                                                                                                                      2. prism
Basic exo                                       exo          exo           normal        fails                fails           at near or dist                         3. overminus
                                                                                                                              at near
                                                                                                                              2ndary to uncorr ref err, reduced VA
                                                                                                                              due to meridional amblyopia,
                                                                                                                              anisekonia, suppression, vertical dev,
Reduced fusional vergence                       normal       normal        normal        meets                meets           etc.                                   1. train PFV & NFV
Normal                                          normal       normal        normal
                                                                                                                                                                        1. train PFV
                                                                                                                                                                        2. prism
Convergence insufficiency                       normal       exo           low           meets                fails           at near (even short duration)             lenses NOT an option (b/c of low AC/A)
                                                                                                                                                                        1. train amplitude of accomodation
                                                                                                                              at near                                   2. plus add at near equal to lag of
Pseudo-convergence insufficiency                normal       exo           low           meets                fails           phoria line not parallel to BI & BO lines accomodation
                                                                                                                                                                        1. prism
                                                                                                                                                                        2. train PFV
Divergence insufficiency                        eso          normal        low           fails                meets           at dist                                   lenses NOT an option (b/c of low AC/A)

Plan of Attack                                                             Added Lens Power
1. classify AC/A ration                                                    1. plus to make near phoria = far phoria           add=phoria chg/AC/A
2. det if pt meets criteria at dist & at near                              2. plus to make near phoria ortho                  add=near phoria/gradient AC/A
3. det prism based on max amt b/w 2 dist                                   3. plus equivalent to associated phoria
4. lens efficacy greatest with high AC/A                                   4. plus to meet Percival's criteria at near        add=prism/AC/A
5. training tx of choice only to inc PFV                                   5. plus to equalize NRA-PRA interval
6. test for prism adaptation                                               6. plus from MEM ret
                                                                           *** when in doubt, Rx +1.25D

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