Binocular And Accommodative Anomalies
Questions and Answers
- 1.
What is the differential diagnosis for someone with a low NRA? (Choose 3)
- A.
CI
- B.
DI
- C.
B eso
- D.
CE
- E.
B exo
- F.
AI
- G.
AE
Correct Answer(s)
A. CI
E. B exo
G. AEExplanation
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.Rate this question:
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- 2.
A patient with divergence excess should be treated to...
- A.
Learn suppression in stage 1
- B.
Learn to see diplopia stage 1
- C.
Learn facilitative convergence stage 1
- D.
Learn to suppress stage 2
- E.
Learn facilitative divergence stage 1
Correct Answer
B. Learn to see diplopia stage 1Explanation
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.Rate this question:
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- 3.
What is stage 1 for someone suffering from a low NRA , binocular flippers, and lead of accommodation
- A.
Step convergence at near
- B.
Smooth divergence at near
- C.
Smooth convergence at near
- D.
Step divergence at near
Correct Answer
C. Smooth convergence at nearExplanation
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.Rate this question:
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- 4.
Who would you expect to have a lead in accommodation
- A.
Basic exo
- B.
Basic eso
- C.
Accommodation insuf.
- D.
Divergence excess
Correct Answer
A. Basic exoExplanation
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.Rate this question:
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- 5.
You manage a person diagnose with CI with plus lenses
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
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.Rate this question:
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- 6.
CT: 3xp CT:3 ep' NRA : 2.00 PRA: 1.75 MEM:+ .75 flippers: 7 cpd binocular 11 cpd monocular
- A.
Treat with prism
- B.
Treat with vt
- C.
Teat with lenses
Correct Answer
C. Teat with lenses -
- 7.
What is treatment step 2 for someone who is suffering from a lead in bcc? (Choose 3)
- A.
Normalize convergence amplitude
- B.
Normalize divergence amplitude
- C.
Normalize convergent facilities
- D.
Normalize divergence facilities
- E.
Normalize divergence and convergence at will
- F.
Normalize accommodation stimulation
Correct Answer(s)
B. Normalize divergence amplitude
C. Normalize convergent facilities
D. Normalize divergence facilities -
- 8.
Over minus to a patient causes a low PRA
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
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.Rate this question:
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- 9.
You will manage a patient with a low NRA
- A.
Bo prism
- B.
Plus lenses
- C.
Visual therapy
- D.
Bi prism
Correct Answer
D. Bi prismExplanation
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.Rate this question:
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- 10.
Bo prism at far: 8/17/11 BI prism at far x/3/3
- A.
Treat with vision therapy
- B.
Treat with prism
- C.
Treat with minus lenses
- D.
Manage with BI prism
Correct Answer
B. Treat with prismExplanation
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.Rate this question:
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- 11.
PRA
- A.
Causes a relaxation of the ocular muscles thus stimulating accom.
- B.
Causes a stimulation of accommodation thus indirectly causing the eye to diverge.
- C.
Causes a stimulation of accommodation thus indirectly causing the eye to converge.
- D.
Causes the stimulation of the ocular muscles thus relaxing accommodation
Correct Answer
B. Causes a stimulation of accommodation thus indirectly causing the eye to diverge. -
- 12.
A high NRA means...
- A.
Patient has CE
- B.
Patient is under minus
- C.
Patient is over minus
- D.
Patient has CI
Correct Answer
C. Patient is over minusExplanation
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.Rate this question:
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- 13.
You manage with plus lenses for...( choose 3)
- A.
AI
- B.
ISA
- C.
CI
- D.
CE
- E.
DI
- F.
DE
- G.
AE
- H.
B eso
- I.
B exo
Correct Answer(s)
A. AI
B. ISA
D. CEExplanation
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.Rate this question:
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- 14.
Flippers : 2 mon 4 binocular fails minus lenses. What does the patient most likely have
- A.
AE
- B.
CE
- C.
ISA
- D.
AI
- E.
A Infacility
Correct Answer
D. AIExplanation
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.Rate this question:
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- 15.
Which anomaly is least likely to improve from vision therapy
- A.
Basic exo
- B.
Basic eso
- C.
Divergence excess
- D.
Divergence insufficiency
- E.
Accommodation insufficiency
Correct Answer
D. Divergence insufficiencyExplanation
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.Rate this question:
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- 16.
Lenses act on accommodative and fusion vergence
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 17.
A 8 year child comes in with his family who is complaining that he trouble reading. His last eye exam was 2 years ago and the pt. va at the time was noted to be 20/30 sc 20/20 cc at far and 20/ 20sc and 20/20 cc at near. Anterior and posterior segment are unremarkable. During the exam you decided to perform binocular testings. Here are your results phoria at distance: 3 exo phoria at near: 3 exo CT at dist. 5 exo CT at near: ortho BI at far: x/4/2 BO at far: 7/17/10 BI at near: 12/21/13 BO at near: 17/20/10 NRA: 2.25 PRA: 2.50 MEM: +.75 ac/a 2/1 flippers: 7 binocular & 5 monocular.
- A.
CI
- B.
ISA
- C.
AI
- D.
DI
- E.
AE
- F.
B exo
- G.
B eso
Correct Answer
B. ISAExplanation
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.Rate this question:
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- 18.
Minus lenses stimulate accommodation
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
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.Rate this question:
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- 19.
Patient with accommodative spasm would complain of seeing what during dual chrome?
- A.
Red
- B.
Green
Correct Answer
A. RedExplanation
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.Rate this question:
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