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Orthoptics Introduction test

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Orthoptics Introduction test

  1. 1. ORTHOPTICS INTRODUCTION & INDICATIONS PRATYUSH DHAKAL
  2. 2. INTRODUCTION  WHAT IS AN ORTHOPTIC EVALUATION  It is a systemic and step by step phenomenon of evaluation of the efficacy of eye muscles during normal binocular eye movements to maintain binocular fusion.  It leads to an idea of Accomodative, Vergence or Fusional Vergence Anomalies and provides a guideline to treat the causes and rectify it by practice of some orthoptic exercises accordingly.
  3. 3. INDICATIONS  Basic questions to be answered..  Whether the patient has binocular single vision.  Whether the patient has diplopia  Whether the patient has suppression.  Ocular alignment and status of accomodation.
  4. 4. INDICATIONS MAIN C/O OF PATIENTS  HEADACHE Detailed history should be taken..  Duration  Whether it persists for few minutes or continues for long hours.
  5. 5. INDICATIONS  Time of Onset  Is the headache associated only during reading time or any sort of near work.  During watching system for continuously.  Increases while going out in sun, associated with pain around eyebrows.  How it gets relieved
  6. 6. INDICATIONS  INTERMITTENT BLURRING OF VISION DURING READING  The patient complains of sudden blurring of vision after 1-2 hours of reading.  Gets worsened after stressful work.  Associated with headache.
  7. 7. INDICATIONS  INTERMITTENT DIPLOPIA  Cases of intermittent diplopia should be ruled out as a need for orthoptic evaluation.  As it indicates an Intermittent Divergent Squint.
  8. 8. INDICATIONS  DIFFICULTY TO FOCUS AT DISTANCE & NEAR SIMULTANEOUSLY  Some patients complains of difficulty to focus at a near object immediately after looking at a distant object.  This might gives an indication of accomodative defect.  We need to check the accomodative facility after doing NRA & PRA and MEM findings.
  9. 9. INDICATIONS  BLURRING OF VISION MORE AT DISTANCE THAN NEAR  This may be a case of Divergence Insufficiency.  It should be always ruled out with Divergence Paralysis where the patient will have the same problem for distance & near both.  Sometimes the patient complains of an inward turning of eyes during distance vision.
  10. 10. INDICATIONS  SPLITTING OF IMAGES WHILE MOVING AN OBJECT FORWARD  This is a case of Convergence Insufficiency.  Fusional Vergence needs to be checked to rule out Fusional Anomalies along with convergence insufficiency.  Accomodative component should also be ruled out.
  11. 11. INDICATIONS  INWARD TURNING OF EYES & FATIGUE WHILE READING  This may indicate a case of Accomodative Excess or Convergence excess.  May lead to accomodative spasm or may be a case of Pseudomyopia.  Parents often complain that the child is doing lot of mistakes while writing.
  12. 12. INDICATIONS  CLINICAL SIGNS..  We will get a varying reflex in this situations.  Normally a case of pseudomypia.  Patient will accept a high minus.  Due to over accomodation.  MEM value will show a low value or lead in accomodation.
  13. 13. indications  Gross reduction in Near Vision.  Patient finds difficult to read the N6 line.  If it is a convergence excess then NFV will be low, but we will get a normal MEM value or a little high MEM.
  14. 14. ORTHOPTIC EVALUATION STEP BY STEP
  15. 15. Orthoptic evaluation WORTH 4 DOT TEST  Habitual Correction  Red-green goggles  Both for distance and near.
  16. 16. Orthoptic evaluation  3 green RE-Suppression  2 red LE-Suppression  5 lights - Diplopia
  17. 17. ORTHOPTIC EVALUATION  MADDOX ROD TEST for detection of distance phoria
  18. 18. Orthoptic evaluation  MADDOX ROD – PHORIA  Patient’s Habitual Correction.  RE-Maddox Rod.  Fixation light or pen torch.  Both distance and near.  Measure vertical and lateral phoria.  Increasing prisms kept infront of other eye till orthoposition.
  19. 19. Orthoptic evaluation  NEAR POINT OF CONVERGENCE  Maintaining fusion  Pentip or Fixation target in RAF  Target double  Subjectively & Objectively  Should be checked recurrently  To see if there is a recede of NPC
  20. 20. ORTHOPTIC EVALUATION  AMPLITUDE OF ACCOMODATION  Normally with a RAF rule  First binocularly then monocularly  Binocularly-Accomodative response with convergence  Hofster Formula= 18.5 – (0.3 * Age)
  21. 21. Orthoptic evaluation TESTS DONE  PUSH UP  NEGATIVE LENS TO BLUR
  22. 22. ORTHOPTIC EVALUATION PUSH UP  N6 target  Move the target  Target should be blur  Note in dioptre
  23. 23. Orthoptic evaluation  NEGATIVE LENS TO BLUR  N6 target @ 40cm  Monocularly  Subjective correction  Add minus lenses  Report to blur
  24. 24. Orthoptic evaluation NEGATIVE RELATIVE ACCOMODATION  N6 target given  Add plus lens binocularly  0.25 – 0.50 clicks  Note first sustained blur  Normal value of NRA is +2.50 DS
  25. 25. Orthoptic evaluation POSITIVE RELATIVE ACCOMODATION  N6 target given  Add minus lens binocularly  0.25-0.50 clicks  Note first sustained blur  PRA value related with NFV value measured in Step Vergence test.
  26. 26. Orthoptic evaluation Some basic terms NFV : NEGATIVE FUSIONAL VERGENCE It measures the amount of divergence of the patient’s eyes to maintain binocular fusion in presence of a stimulus (minus lens) PFV : POSITIVE FUSIONAL VERGENCE It measures the amount of how much the patient’s eyes converge to maintain fusion in presence of a stimulus( plus lens)
  27. 27. Orthoptic evaluation DYNAMIC RETINOSCOPY  With static correction  Dynamic card attached to to retinoscope  Room light on  Fixate on dynamic card or read aloud  Strongly active accomodation.
  28. 28. Orthoptic evaluation DYNAMIC RETINOSCOPY (Contd..)  Neutralise both the meridians  Static – Dynamic = Lag of accomodation.  +0.25 to +1.00 normal  Above +1.00D – lag  Minus - lead
  29. 29. Orthoptic evaluation ACCOMODATIVE FACILITY  Dynamics of accomodative response  N6 target given  Flippers close to eyes  Flip when target clears  First plus lens side kept  Select according to NRA PRA value.
  30. 30. Orthoptic evaluation ACCOMODATIVE FACILITY  Flipper or accomodative rock  Monocularly and binocularly  No. of flips per minute is noted  Monocularly 12cpm for +/- 1.50D
  31. 31. Orthoptic evaluation STEP VERGENCE TEST  Horizontal prisms arranged together in increasing steps.  First Base-In then Base-Out  For distance and near both  6/60 or 6/36 fixation target  Base-in for Near (NFV value) correlated with PRA value.
  32. 32. Orthoptic evaluation FUSIONAL RANGE  Fusional Range(Synaptophore)  Abduction and adduction  Fusion slide  +7 to -10 degree
  33. 33. Orthoptic evaluation AC/A RATIO Ratio of Accomodative Convergence and Accomodation. AC/A Ratio = IPD(cm) + W.D in mt*(Near phoria –Distance Phoria)
  34. 34. Orthoptic evaluaTION BROCK STRING  Look at the 1st bead - V shape  2nd bead – X shape  3rd bead – A shape
  35. 35. Orthoptic evaluation LIFE SAVER CARD CAT CARD
  36. 36. ORTHOPTIC EVALUATION ACCOMODATIVE HART CHART
  37. 37. Orthoptic evaluation TAKE HOME MESSAGE  ‘’Giving a proper orthoptic treatment and follow up report results in rapid cost effective and permanent improvement in visual skills”

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