Term
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Definition
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Term
| What happens with a Adie's tonic pupil? |
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Definition
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Term
| Define prevelence and incidence. |
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Definition
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Term
| what is the trend with age and hyperopia? |
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Definition
| hyperopia does not really increase with agem what happens is that the latient becomes manifest hyperopia cuz you loose the ability to accomidate. |
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Term
| What will determine how much a hyperope will change with age? |
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Definition
| The magnitude of hyperopia is described as the additional dioptric power of the converging lenses required to advance the focusing of light rays onto the retinal plane, while accommodation is relaxed |
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Term
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Definition
| the amount of hyperopia detected without the use of eye drops to simulate an eye at rest |
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Term
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Definition
| the amount of hyperopia detected with the use of eye drops to simulate an eye at rest |
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Term
| When checking for Manifest or Latient hyperopia, do we do this dry or wet? |
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Definition
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Term
| to “accept plus” and still see 20/20, the hyperopic patient ____ his accommodation, without cycloplegia, up to the amount of plus power before his eye. |
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Definition
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Term
| The pupil constriction and accomidation are under what autonomic system? |
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Definition
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Term
| What autonomics controls pupil dialation? |
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Definition
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Term
| How do you look for the latent hyperopia, dry or wet? |
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Definition
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Term
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Definition
}is that which can be overcome or “self-corrected” by accommodation
◦Patient accommodates and see well
◦If the Total hyperopia is facultative, the VA at distance without correction will be 20/20
◦We typically detect this with the dry refraction |
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Term
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Definition
}cannot be compensated with accommodation
◦Patient doesn’t have enough amplitude of accommodation to self-correct the discrepancy
◦We typically detect this in patient with <20/20 at distance uncorrected who then will see better, 20/20 with (+) |
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Term
| General rules for comfort for a hyperope |
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Definition
| The patient will be comfortable if he uses no more than half of his amplitude of accommodation |
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Term
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Definition
}Minimum expected AA:
◦AA = 15 – (0.25)(age)
*AA for most needs to be 2x the demand*
Recall optics: objects at 40cm will stimulate +2.50D of accommodative “demand” |
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Term
| What are the related hyperopic complaints for the <6 yrs age group? |
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Definition
| no complaints or failed vision screening due to esotropia |
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Term
| What are the related hyperopic complaints for the 6 to 20 yrs age group? |
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Definition
| asthenopia and/or headache, computer complaints, fatigue after 30’ of near work |
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Term
| What are the related complaints for the 20 to 40 age group for hyperopes? |
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Definition
| asthenopia as amp decreases and latent hyperopia becomes manifest |
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Term
| What are the related complaints for the >40 age group for hyperopes? |
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Definition
| more dependent on near Rx and decreased VA at distance, increased use of specs full time |
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Term
| Who are the hyperos who complain the most? |
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Definition
| thoes hyperopes who also have Against the Rule astigmatism. |
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Term
| What are 3 problems associated with hyperopia? |
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Definition
| Amblyopia, Esotropia and/or esophoria, and narrow angle glaucoma. |
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Term
| refractive Accom. esotropia. |
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Definition
}Correcting the hyperopia with plus eliminates the esotropia
}Cover test sc 45∆RET cc 8∆EP |
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Term
| What treatment is most successful with refractive Esotropia? |
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Definition
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Term
| What type of bifocals would you rx a child and where would you place it? |
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Definition
You want to use the D seg and place it higher than you would for an adult, so maybe bottum pupil.
For an older teen you may be able to use a progressive. |
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Term
| What are some fundus Changes with Hyperopia? |
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Definition
}Small eye results in crowding of the optic disc
}Normal number of NFL – axons trying to exit a small scleral canal
}Often will see tortuous retinal vessels and/or vessels that will “loop” around each other}Take home message: YES, you can look inside the eye and see certain findings associated w/ ametropia (myopes have unique finds as well) |
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Term
| What is the three eyed method? |
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Definition
for fogging
1.Do retinoscopy OD and leave the gross in place
2.Do retinoscopy OS and leave the gross in place
3.Redo OD - if you see additional with motion, continue to go back and forth between the two eyes until there is no further with motion |
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Term
| When do you use Humphriss Method? |
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Definition
◦Hyperopia
◦Latent nystagmus
◦Latent hyperopia
◦Accommodative spasms |
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Term
| What is the theory behind the Humphriss Method? |
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Definition
◦Accommodative response tends to relax after the foveal focus has been blurred (inhibited) to or beyond the MPMVA by +0.75D
◦This allows both eyes to be open, stabilizing the convergence and accommodative responses (AC/A) while only one eye can clearly see the BVA line |
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Term
| What is the procedure for the Humphriss Method? |
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Definition
1. After the retinoscopy VA checks, fog each eye to 20/40 monocularly over the net ret
2. Leaving both eyes open, step one eye down to the 20/20 and follow your normal JCC procedure to the MPMVA.
3. After the MPMVA place a +0.75 lens over this 1st eye and leave it open (do not occlude)
4. Start refracting the other eye starting with the step down, JCC to MPMVA.
5. After finishing the 2nd eye remove the +0.75 from the 1st and conduct the final step down (OU) to 20/15 as done with the traditional technique and take VAs.
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Term
| When would you use the Delayed Subjection? |
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Definition
| Lantent hyperopia, accomodative spasm. |
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Term
| what is the purpose of the Delayed Subjective |
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Definition
| to maximally relax a patient’s accommodation and subsequently stimulate the acceptance of plus |
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Term
| What are the indications of when you need to perform a "wet ret?" |
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Definition
| latent hyperopia is suspected; strabismus; accommodative spasm noted during retinoscopy or subjective; variable refraction; patient uncooperative; very young child |
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Term
| what is the protocal for putting in cycloplegic drops? |
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Definition
}2 drops of 1% cyclogyl, ten minutes apart
}Wait for 30 minutes |
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Term
| What are some problems w/ Cycloplegics? |
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Definition
}Dilated pupil makes retinoscopy difficult
}Concentrate on central 3-4 mm of cyclopleged ret reflex as peripheral reflex may look very distorted.
}Caution with cycloplegics:
◦ Down syndrome & Cerebral palsy can have higher risk for reaction, so only cycloplege if need to and consider using tropicamide. |
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Term
| What do you do when you Rx a hyperop with a greater Rx than they had before? |
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Definition
üShow all significant lens changes to the patient using trial lenses outside of the exam room.
*this is true for myopia as well as astigmatism* |
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Term
| When do you Rx bifocals or PALS to hyperopes? |
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Definition
}When the patient needs more + at near than at distance
}High eso at near
}Accommodative esotropia
}Latent hyperope with near symptoms |
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Term
| What are Dr. Carlson's Rules? |
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Definition
}Trial frame all hyperopic Rx changes
}If it’s not broken, don’t fix it
}Never give an Rx that makes VA worse
}Patient education is essential
}For children, Rx to prevent amblyopia and strabismus and to enhance binocular function
}For adults, Rx to improve comfort
Make an accurate diagnosis |
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