By Carole Bowden, Simmons, Norris, Joanne Masters, Noble, Cunliffe, Richard R. Suminski, Jack J. Kanski, Anne Bolton, Ettinger, R. Muller, Roger, Devinksy
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Additional info for Binocular Vision & Orthoptics
Give clear, preferably written. instructions (see Chapter 3). Explain that a course of exercises is necessary to prevent future regression, with four to six visits to the practice at 2-weekly intervals (weekly if a child). General instructions to the patient: • The exercises should be done two or three times a day for 3-5 minutes • The eyes need to be relaxed after each session by looking into the distance or closing them for a few seconds. Treatment plan A suggested treatment plan is as follows (see also Chapters 3 and 6): 1 2 3 4 5 1 Correct any refractive error Treat to overcome the suppression Treat to improve the convergence Treat to increase the convergent fusion range at near Teach voluntary convergence to prevent regression.
Cases of trauma (particularly whiplash injury) often have an associated accommodative insufficiency and, if the diagnosis is certain, these patients will need a reading addition with base-in prisms for near work. with reduced accommodation. It is frequently associated with Parinaud's syndrome (the inability to elevate or converge) where there is a lesion in the area of the pineal gland. Otherwise, the most common cause of convergence paralysis is head injury. Investigation Symptoms include crossed horizontal diplopia with increased separation at near.
By over-minusing in pre-presbyopic exophoria or by prescribing a near addition in convergence excess. Patients with a low ACj A ratio will not change their convergence very much under the influence of a change in accommodative demand, and exercises may prove to be necessary. 1 Phoria comparison method - calculation ACtA = Total chamW in conyerl:ence (4) Change in fixation distance (Dioptres) (YtPDx F) x 2 - (Dist Phoria - Near Phoria) F PD- Dist Phoria - Near Phoria F (Exo negative. 2 Heterophoria comparison method- calculation ence of accommodation.
Binocular Vision & Orthoptics by Carole Bowden, Simmons, Norris, Joanne Masters, Noble, Cunliffe, Richard R. Suminski, Jack J. Kanski, Anne Bolton, Ettinger, R. Muller, Roger, Devinksy