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Midterm 1 Diagnosis Chart

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Midterm 1 Diagnosis Chart Powered By Docstoc
					                                                                                                                                                                                               VT Diagnoses 1

                                                                                   Test Findings
  Condition Group                Condition-Specific            Prevalence                                Direct Findings          Indirect Findings                 Symptoms                         Treatment
                                                                                      Group
                                                                                                                                                      *loss of place
                                                                                                                                                      *omission of words
                                                                                                        *↓ SCCO 4+                                    *skipping lines
                                                            20% of school         Ocular Motility       system                                        *re-reading
Deficiency of Pursuits and/or Saccades (379.58, 379.57)     age (higher in            Group             *↓ DEM                                        *difficulty copying from board           *VT
                                                            reading                                     * grade on                                    *excessive head movement
                                                            difficulties)                               Visagraph                                     *uses finger to keep place
                                                                                                                                                      *slow reader
                                                                                                                                                      *poor comprehension
                                                                                *Blurry vision at near and distance after near
                                                                                *eye fatigue
                                                                                *holds book close (inside Harmon’s distance)
                                                                                                                                                                                               *r/o nonfunctional
                                     As a group                  8-17%          *difficulty sustaining near tasks
                                                                                                                                                                                               causes
                                                                                *rubs eyes
                                                                                *red eyes
                                                                                *avoids near visual tasks
                                                                                                         *must have ↓            *↓PRA                               *Blurred near vision
                           Accommodative Insufficiency                                                   monocular amps          *↓ BAF (minus)                      *Difficulty with
                             (also, accommodative Ill-       Most common                                 *may have ↓MAF          *lag of                             attention and
                                     Sustained)                                                          (minus)                 accommodation                       concentration when
                                                                                                                                                                     reading
                                                                                                        *must have                                                                             *VT
                                                                                 Accommodative                                   *↓ NRA/PRA           *Asthenopia    *Intermittent near blur              *(+) lens
                                                                                                        decreased MAF                                                                          * plus
                             Accommodative Infacility       2nd most common          Group                                       *↓ BAF (+) and (-)   *HA            *Distance blur after                 maybe—
                                                                                                        (plus and minus)                                                                       lenses
  Accommodative                                                                                                                  difficult                           prolonged near work                  BF
   Dysfunctions
                                                                                                        *must have lead on
                                                              1%: lead on                                                        * ↓ NRA                             *Decreased/fluctuating               *(+) lens
                                                                                                        MEM
                              Accommodative Excess                MEM                                                            * ↓ BAF (+                          vision                               maybe
                                                                                                        *may have ↓ MAF
                             (also, spasm of near reflex)   2-10%: difficulty                                                    difficult)                          *Variable VAs and                    *visual
                                                                                                        (plus)
                                                               clearing (+)                                                                                          refraction (signs)                   hygiene
                                                                Very rare,
                                                                                                        amps reduced
                                                              secondary to
                            Paralysis of Accommodation                                                  (paresis) or absent
                                                             disease or head
                                                                                                        (paralysis)
                                                                 trauma
                                                                                                                                                                                         VT Diagnoses 2



 Condition                                                                               Test Findings
                            Condition-Specific                      Prevalence                            Direct Findings        Indirect Findings               Symptoms                      Treatment
  Group                                                                                     Group
                            *asthenopia and HA
                            *intermittent diplopia
                            *squinting, closing 1 eye
               As a group
                            *swimming words
                            *abnormal posture
                            *lack of symptoms for suppression, avoidance and occlusion
                                                                                                                                                                       *Moving
                                                                                                                                                                       words
                                                                                                                                                                                         *VT = #1
                                                                                                                                                                       *Sleepiness
                                                                                                                                                                                         75% patients
                                                                                                                                                                       while reading
                                                                                                                                                                                         achieved
                                                                                                         *exo at near (≥ 4pd)                                          *Difficulty
                                                                                                                                                                                         normalization or
                                                                                                         *↓PFV’                                                        concentrating
                                                                                                                                                                                         improvement in S/S/
                                                                                                         *↓ vergence facility                                          on
                                                                                                                                                                                         within 12 week
                                Convergence Insufficiency            8% --most                           (BO difficult)          *↓ NRA                                reading/poor
                                                                                                                                                                                         period
                                        (378.83)                      common                             *exo FD at near         *↓BAF (+ difficult)                   comprehension
                                                                                                                                                                                         *prism: not a good
                                                                                                         *FDC steep slope                                             *Pulling
                                                                                                                                                                                         treatment option in
                                                                                                         with BO and                                                   sensation
                                                                                                                                                                                         children
                                                                                                         adaptation with BI                                            around eyes
                                                                                                                                                                                         *PPU alone: no
                                                                                                                                                                       *Lack of
                                                                                                                                                                                         better than placebo
                                                                                                                                                                       symptoms but
                                                                                                                                                                                         therapy
                                                                                                                                                                       findings
 Vergence                                                                                                                                                              persist
Dysfunctions                                                                                                                                                           *suppression
                                                                                                         *exo at far (> 10                              *Asthenopia    is common, so
                                                                                                         pd)—may see IXT                                * HA           maybe
                                                                                          PFV Group      *less exo or ortho at                          * Diplopia
                  EXOs                                                                                                                                                 asymptomatic
                                                                                                         near                                           *Blur          *parents report
                                                                                                         *↓ PFV                                         *Symptoms
                               Divergence Excess (378.75)              0.03%                                                                                           outward eye       *VT
                                                                                                         *exo FD at far                                 worse at end   turn (XT) at
                                                                                                         *↓ 2nd degree fusion                           of day         far ting or
                                                                                                         at far (crossed)
                                                                                                                                                                       covering an
                                                                                                         central or diplopia
                                                                                                                                                                       eye in bright
                                                                                                         *suppression at far
                                                                                                                                                                       light
                                Basic Exophoria (378.42)
                                                                                                         *exo at far = near
                                                                                                         (within around 5
                                                                                                         pd)
                                                                                                                                                                                         *VT
                                                                                                         *↓ PFV’/PFV             *receded NPC
                                                                                                                                                                                         * Prism if large
                                                                                                         *↓vergence facility     *↓NRA
                                                                                                                                                                                         exo can decrease
                                                                       2.8%                              (BO difficult)          *↓ BAF (+) difficult
                                                                                                                                                                                         amount in far and
                                                                                                         *exo FD at distance     *↓ 2nd degree fusion
                                                                                                                                                                                         near
                                                                                                         and near                poor stereo
                                                                                                         *FDC: steep slope
                                                                                                         with BO and
                                                                                                         adaptation with BI
                                                                                                                                                                                    VT Diagnoses 3

 Condition                                                           Test Findings
                Condition-Specific            Prevalence                             Direct Findings     Indirect Findings         Symptoms                   Treatment              Condition Group
  Group                                                                 Group
                                                                                                                               * ↓ PRA
                                                                                                                               * ↓BAF (-) difficult
                                                                                                                               *stim accom =
                                                                                                         *eso at near (≥ 4     increased                                            *Consider Rx for
                                                                                                         pd)                   ACdouble unless                                     hyperopia
                                                                                                         *↓ NFV’
                                                                                                                               ↑NFV                                                 *Consider near
                                      Convergence Excess (378.84)        5.9%                            *↓vergence facility
                                                                                                                               (divergence)                                         plus
                                                                                                         (BI difficult)
                                                                                                                               *lag on MEM:           *Asthenopia                   *VT
                                                                                                         *eso FD at near
                                                                                                                               under-acc = ↓ AC       *HA
                                                                                                                               =↓eso = less have      *Blurred vision
                                                                                                                               to compensate for      *Words move on the page
                                                                                                                               *poor stereo           *Reads slowly
                                                                                                                                                      *Sleepiness while reading     * prism for
                                                                                                         *eso at far (> 10                            *Inability to concentrate     distance only
                                                                                                         pd) may see IET                             *Poor reading                 *VT harder to
                                                                                                         *less eso or ortho                           comprehension                 train
                      ESOs                                                             NFV Group         at near
                                                                      0.1 %--least                                                                                                  DDx: VI CN palsy
                                        Divergence Insufficiency                                         *↓ NFV
                                                                      common of                                                                                                     *r/o with version
                                               (378.85)                                                  *eso FD at far
                                                                       vergence                                                                                                     testing
                                                                                                         *↓ 2nd degree
                                                                                                                                                                                    *restrictions in
                                                                                                         fusion may have
 Vergence                                                                                                                                                                           EOM’s changes in
                                                                                                         more suppression
Dysfunctions                                                                                                                                                                        restrictions with
(continued)                                                                                                                                                                         gaze
                                       Basic Esophoria (378.41)                                          *Eso at far = near
                                                                                                         (w/in ~5Δ)                                   *Asthenopia
                                                                                                         * ↓ NFV/NFV’                                 *HA                           *prism
                                                                                                                               *↓ PRA
                                                                                                         * ↓ vergence                                 *Diplopia                     *VT
                                                                                                                               *↓BAF (- difficult)
                                                                         5.9%                            facility (BI                                 *Blurred vision               * Rx for hyperopic
                                                                                                                               *Lag on MEM
                                                                                                         difficult)                                   *symptoms worse at end of     * near +
                                                                                                         *Eso FD at D/N                               day
                                                                                                         *FDC: steep slope
                                                                                                         with BI
                                     Fusional Vergence Dysfunction                                       *Ortho or low                                *Asthenopia
                                                (368.30)                                                 phoria at far and                            *HA
                                                                                                         near                                         *Blurred vision
                                                                                                         *↓ PFV/PFV’                                  *Symptoms worse at end of
                                                                      not clearly     PFV and NFV        *↓ NFV/NFV’           *↓ PRA and NRA         day
                                                                                                                                                                                    *VT
                                                                      established        Group           *↓ vergence           *↓ BAF (+ and -)       *Reading slowly
                                                                                                         facility (BI and                             *Sleepiness while reading
                      Others
                                                                                                         BO difficult)                                *Inability to Concentrate
                                                                                                         *FDC very narrow                             *Poor reading
                                                                                                         (steep slope)                                comprehension
                                                                                                                                                      *Asthenopia
                                                                                                                               * ↓ PFV/PFV’
                                                                                                         * Vertical phoria                            *HA
                                                                                                                               *↓ NFV/NFV’
                                                                                     Vertical Fusional   *↓ Vertical                                  *Diplopia                     *Prism
     Vertical Phorias (378.43)                                            9%                                                   *↓ vergence facility
                                                                                     Vergence Group      fusional vergence                            *Car and motion sickness      *VT
                                                                                                                               (BI and BO
                                                                                                         *Vertical FD                                 *Loses places while reading
                                                                                                                               difficult)
                                                                                                                                                      *Head tilt
                                                                                                                                                                   VT Diagnoses 4

                                                                                    Added Lenses
                 Condition                       Corrected Refractive Error                                     Prisms                      VT                       Other
                                                                                 (better for high AC/A)

    Deficiency of Pursuits and Saccades


                         Accommodative
                                                                                   MEM: (+) lenses
                          Insufficiency

  Accommodative          Accommodative
                                                                              MEM: maybe (+) lenses--BF
   Dysfunction              Infacility

                         Accommodative
                                                                                MEM: maybe (+) lenses                                                             visual hygiene
                             Excess

                                 Convergence
                                                                                                          not good for children   #1 Tx (75% improvement)   PPU no better than placebo
                                 Insufficiency

                                 Divergence
              Exodeviations
                                   Excess


                                  Basic Exo                                                                   if large exo


 Vergence                        Convergence
                                                    for hyperopia (max +)           AC/A: near (+)
Dysfunction                        Excess

                                  Divergence
               Esodeviations                                                                                for distance only          harder to train           r/o VI CN palsy
                                 Insufficiency


                                  Basic Eso         for hyperopia (max +)           AC/A: near (+)


                    Fusional Vergence
                       Dysfunction


              Vertical Phorias

				
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