Post on 31-Dec-2015
description
Vicki Leung, O.D.
23161 Ventura Blvd, Suite 201 Woodland Hills, CA(818) 591-8860dr.leung@eyedocs.org
The Optometric Examination
Visual Acuity
Measuring Visual Acuity
Whole Chart – Standard
ES L
T O ZB P L OD F G AD A O SE G N U SF Z B D R
Measuring Visual Acuity
Line T O Z
F Z B D R
DEFOAE
Measuring Visual Acuity
LetterF
G
E
A
The Optometric Examination
Basic Binocular Vision Testing– Cover Test– Near Point of Convergence– Stereopsis
If Strabismus is present, a Strabismus Evaluation is indicated and should be performed by an eye doctor who evaluates and treats strabismus patients.
The Optometric Examination
Refraction– Objective methods: Retinoscopy and auto-
refraction– Subjective methods: Interactive with the patient,
“Which is better, one or two?”
Nystagmus patients may have high amounts of astigmatism that can go uncorrected. It is important to correct it.
The Optometric Examination
Eye Health ExaminationExternal Eye Examination
Internal Eye Examination
Treatment of Idiopathic, Congenital Nystagmus
The comprehensive management for the nystagmus patient should include treatment of all associated conditions, as well as improve the characteristics of the nystagmus wave form.
Considerations for treatment:
1. Proper refraction and full correction GlassesPrisms Contact Lenses
Treatment of Idiopathic, Congenital Nystagmus
2. Addressing binocular vision concerns
Glasses
Prisms
Contact lenses
Vision therapy
Treatment of Idiopathic, Congenital Nystagmus
3. Surgery
Strabismus Surgery
Nystagmus dampening surgery
Treatment of Idiopathic, Congenital Nystagmus
4. Vision Therapy - The Goal of Vision Therapy is not to dampen the nystagmus, but rather to improve visual acuity.
DEFINITIONS
ASTIGMATISM A refractive condition in which light rays do not focus at a single point, rather focus at 2 lines. Therefore, it requires 2 separate powers to bring both lines in focus to a single point.
AMBLYOPIA Any eye that doesn’t see 20/20, or for certain cases, a difference between eyes that is greater than 2 lines of acuity.
LAZY EYELaypersons term for amblyopia but many mistakenly use it to describe an eye turn.
DEFINITIONS
STRABISMUSAny eye turn, in or out, up or down, intermittent or constant. Can have a combination of directions (i.e. in and up)
– ESOTROPIA - Right or left eye turning inward (or alternating between eyes), can be a constant or intermittent turn.
– EXOTROPIA - Right or left eye turning outward (or alternating between eyes), can be a constant or intermittent turn.
– HYPERTROPIA – Right or left eye turning upward.
DEFINITIONS
DEPTH PERCEPTIONPerception of relative or absolute difference in distance of objects from the observer. Can occur with or without binocular vision. Perception of a third dimension.
STEREOPSISBinocular visual perception of three dimensional space, based on retinal disparity.
BINOCULAR VISIONPertaining to using both eyes simultaneously, so that each eye contributes to the image seen.
VISION THERAPY / ORTHOPTICSThe teaching and training process to improve visual perception and coordination of the 2 eyes. Goals include improving visual acuity, elimination of strabismus, comfortable binocular vision.
Vision Therapy
Traditional Vision Therapy (can be done both at home and at the doctor’s office)– Fusional Vergence Training– Anti-suppression Training
Brock String Tranaglyph R/G trainers
– Accommodation (focusing) Training
Vision Therapy
Foveation Tasks– Vertical line counting (may start at oblique angles)
Vision Therapy
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Vision Therapy
Foveation Tasks– Letter Counting Tasks
Vision Therapy
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Conclusions
Home Vision Therapy can be used to supplement or replace office-based therapy.
Home VT is designed to address binocular vision deficiencies as well as increase foveation, which generally leads to increased visual acuity.
A decrease in amplitude , frequency or intensity of the nystagmus does not necessarily lead to increased visual acuity.
Conclusions
Patients report successful treatment based on improved quality and comfort of vision.
Subjective improvement seems to be greater than the measured visual acuity.