Binocular And Accommodative Anomalies

Minus lenses are used to correct nearsightedness (myopia) by diverging light rays before they reach the eye, thus causing the image to focus correctly on the retina. When wearing minus lenses, the eyes need to accommodate in order to focus on near objects. This is because the lenses create a virtual image that appears closer than it actually is, requiring the eye muscles to adjust and increase the focusing power. Therefore, it can be concluded that minus lenses stimulate accommodation.

Lenses act on accommodative and fusion vergence. This means that lenses can help with both the ability to focus on objects at different distances (accommodation) and the ability of the eyes to work together to perceive depth and maintain single vision (fusion vergence). Therefore, the statement is true.

In dual chrome testing, the patient with accommodative spasm would complain of seeing red. Accommodative spasm is a condition where the muscles of the eye responsible for focusing become overactive, causing difficulty in adjusting the focus. In dual chrome testing, red and green colors are used to assess the patient's ability to accommodate and switch focus between the two colors. Due to the spasm, the patient may have a prolonged or excessive focusing on the red color, resulting in a complaint of seeing red.

The given statement is false. Managing a person diagnosed with CI (Convergence Insufficiency) with plus lenses is not the correct approach. Plus lenses are used to correct nearsightedness (myopia) by helping the eyes focus on distant objects. However, CI is a condition where the eyes have difficulty converging or working together to focus on near objects. The appropriate management for CI involves vision therapy exercises, such as convergence exercises, to improve the coordination and flexibility of the eye muscles. Using plus lenses would not address the underlying issue of CI.

A high NRA means that the patient is overcorrected with a minus prescription. This indicates that the patient's vision is being corrected beyond what is necessary, resulting in a prescription that is too strong for their eyes.

Over-minusing refers to overcorrecting myopia (nearsightedness) with a stronger prescription than necessary. PRA stands for Pupil Response Amplitude, which measures the response of the pupil to light. Over-minusing does not cause a low PRA; in fact, it can cause a higher PRA. Therefore, the statement that over-minusing causes a low PRA is false.

Divergence insufficiency is the least likely anomaly to improve from vision therapy. Divergence insufficiency is a condition where the eyes have difficulty moving outward, causing double vision when looking at distant objects. Vision therapy primarily focuses on improving eye coordination and movement, which would not directly address the problem of difficulty moving the eyes outward. Therefore, vision therapy is less likely to be effective in improving divergence insufficiency compared to the other anomalies listed.

The patient most likely has AI (Accommodative Insufficiency). This can be inferred from the given information that the patient has "2 mon flippers" and "4 binocular fails minus lenses." This suggests that the patient is having difficulty accommodating or focusing their vision, which is a characteristic of accommodative insufficiency.

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The correct answer suggests that the patient should be treated with prism. Prism is a type of lens that can be used to correct certain vision problems, such as double vision or eye misalignment. By using prism, the light entering the eyes can be redirected in a way that helps the patient see more clearly and comfortably. Therefore, treating the patient with prism can be an effective solution for their vision issue.

In divergence excess, the eyes tend to diverge more when looking at distant objects compared to near objects. This can lead to double vision or diplopia. Therefore, the patient needs to learn to see diplopia in stage 1, which means they need to learn to perceive and interpret the double images correctly. This will help them to better manage and cope with the double vision caused by divergence excess.

Stage 1 for someone suffering from a low NRA, binocular flippers, and lead of accommodation is smooth convergence at near. This means that the person is able to smoothly bring their eyes together to focus on objects that are near. This is in contrast to step convergence at near, which would involve the eyes moving abruptly and in a jerky manner when trying to focus on near objects. Smooth convergence at near is important for clear and comfortable vision when looking at objects up close.

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The correct answer is "Basic exo." This is because basic exotropia is a type of strabismus where one eye turns outward, away from the nose. In this condition, the eyes do not align properly, and one eye may appear to lead or be more dominant than the other in terms of accommodation, or the ability to focus on objects at different distances.

Based on the given information, the child has a phoria (resting eye position) of 3 exo at both distance and near. The cover test (CT) reveals an intermittent exotropia (XT) of 5 exo at distance, but ortho (aligned) at near. The near point of convergence (NPC) is normal, as there is no exophoria at near. The near point of accommodation (NPA) is also normal, as there is no esophoria at near. The accommodative amplitude (MEM) is slightly reduced at +.75, indicating a mild accommodative insufficiency. The AC/A ratio is normal at 2/1. Based on these findings, the correct answer is ISA, which stands for intermittent exotropia with a normal near point of convergence and accommodative insufficiency.

The correct answer is CI, B exo, AE. Differential diagnosis refers to the process of determining the possible medical conditions or diseases that could be causing a particular set of symptoms. In this case, someone with a low NRA (Near Response Amplitude) may have convergence insufficiency (CI), which is a condition where the eyes have difficulty working together when focusing on nearby objects. Additionally, they may have exophoria (B exo), which is a tendency for the eyes to turn outward. Lastly, they may have accommodative esotropia (AE), which is a condition where the eyes cross inward when focusing on nearby objects.

A bi prism is the correct answer because it is a type of prism that can be used to manage a patient with a low near reflex accommodative (NRA). Bi prisms can help improve near vision by changing the direction of light entering the eyes, which can help alleviate symptoms associated with a low NRA. This can be particularly beneficial for patients who have difficulty focusing on near objects or experience eye strain while reading or doing close work.

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The correct answer is AI, ISA, CE. This means that the person manages with plus lenses for astigmatism (AI), internal strabismus (ISA), and convergence insufficiency (CE). Plus lenses are often prescribed for these conditions to help correct the visual impairments associated with them.