Clinical Management of Binocular Vision-5판

Cover
Title Page
Copyright
Dedicatin
Preface
Acknowledgments
Contents

SECTION I Diagnosis and General Treatment Approach

1. Diagnostic Testing
Determination of Refractive Error
Assessment of Nonstrabismic Binocular Vision Disorders
GENERAL CONSIDERATIONS
ASSESSMENT OF SIZE AND DIRECTION OF THE PHORIA OR FIXATION DISPARITY
DIRECT ASSESSMENT OF POSITIVE AND NEGATIVE FUSIONAL VERGENCE
INDIRECT ASSESSMENT OF POSITIVE AND NEGATIVE FUSIONAL VERGENCE
Evaluation of Sensory Status
GENERAL CONSIDERATIONS
EVALUATION OF SUPPRESSION
EVALUATION OF STEREOPSIS
Assessment of Accommodative Disorders
GENERAL CONSIDERATIONS
ASSESSMENT OF ACCOMMODATIVE AMPLITUDE
ASSESSMENT OF ACCOMMODATIVE FACILITY
ASSESSMENT OF ACCOMMODATIVE RESPONSE
Evaluation of Eye Movements
EVALUATION OF FIXATION STABILITY
Summary
STUDY QUESTIONS

2. Case Analysis and Classification
Review of Currently Available Analytical Approaches
GRAPHICAL ANALYSIS
ANALYTICAL ANALYSIS
MORGAN’S SYSTEM OF CLINICAL ANALYSIS (NORMATIVE ANALYSIS)
FIXATION DISPARITY ANALYSIS
INTEGRATIVE ANALYSIS APPROACH
TESTS EVALUATING POSITIVE FUSIONAL VERGENCE
TESTS EVALUATING NEGATIVE FUSIONAL VERGENCE
TESTS EVALUATING THE ACCOMMODATIVE SYSTEM
TESTS EVALUATING VERTICAL FUSIONAL VERGENCE
TESTS EVALUATING THE OCULAR MOTOR SYSTEM
MOTOR ALIGNMENT AND INTERACTION TESTS
Classification System of Common Accommodative and Nonstrabismic Binocular Vision Problems
BINOCULAR ANOMALIES
Analysis of Specific Groups
POSITIVE FUSIONAL VERGENCE GROUP DATA
SUMMARY
NEGATIVE FUSIONAL VERGENCE GROUP DATA
SUMMARY
ACCOMMODATIVE SYSTEM GROUP DATA
SUMMARY
VERTICAL FUSIONAL VERGENCE DATA
OCULAR MOTOR DATA
MOTOR ALIGNMENT AND TESTS OF ACCOMMODATIVE CONVERGENCE INTERACTION
Classification of the Vision Disorder and Identification of the Syndrome
Classification of Binocular Vision Disorders
CATEGORY 1: BINOCULAR VISION DISORDERS WITH A LOW AC/A RATIO
CATEGORY 2: NORMAL AC/A RATIO
CATEGORY 3: BINOCULAR VISION DISORDERS WITH HIGH AC/A RATIO
CATEGORY 4: VERTICAL ANOMALIES
Classification of Accommodative Anomalies
ACCOMMODATIVE INSUFFICIENCY
ILL-SUSTAINED ACCOMMODATION
ACCOMMODATIVE EXCESS
ACCOMMODATIVE INFACILITY (INERTIA OF ACCOMMODATION)
Classification of Ocular Motor Anomalies
CHARACTERISTICS
Case Analysis: Using the System
INITIAL TESTING: CASE HISTORY AND TESTING TO RULE OUT NONFUNCTIONAL ETIOLOGY
SIGNIFICANT PHORIA IS PRESENT AT DISTANCE OR AT NEAR
NO SIGNIFICANT PHORIA IS PRESENT
Summary
STUDY QUESTIONS

3. General Treatment Modalities, Guidelines, and Prognosis
Determination of “Successful Treatment”
SYMPTOM AND QUALITY OF LIFE QUESTIONNAIRES
General Treatment Sequences for Accommodative and Nonstrabismic Binocular Vision Anomalies
SEQUENTIAL MANAGEMENT APPROACH
Optical Correction of Ametropia
SIGNIFICANT DEGREES OF REFRACTIVE ERROR
CYCLOPLEGIC REFRACTION
SMALL DEGREES OF REFRACTIVE ERROR
MANAGING ANISOMETROPIA AND ANISEIKONIA IN NONSTRABISMIC BINOCULAR VISION DISORDERS
Added Lens Power (Minus and Plus)
Prism
HORIZONTAL RELIEVING PRISM
VERTICAL RELIEVING PRISM
PRISM USED AS AN AID TO BEGIN VISION THERAPY
PRISM USED WHEN VISION THERAPY IS INAPPROPRIATE OR IMPRACTICAL
PRISM USED AT THE CONCLUSION OF VISION THERAPY
Occlusion
Vision Therapy
RESEARCH EVIDENCE FOR THE EFFECTIVENESS OF VISION THERAPY FOR BINOCULAR VISION, ACCOMMODATIVE, AND EYE
MOVEMENT DISORDERS
DETERMINING THE NECESSITY OF VISION THERAPY
Surgery
Summary
STUDY QUESTIONS

4. Primary Care of Binocular Vision, Accommodative, and Eye Movement Disorders
Diagnosis
HISTORY AND SYMPTOMS
Diagnostic Evaluation
DETERMINATION OF REFRACTIVE ERROR
Assessment of Nonstrabismic Binocular Vision Disorders
GENERAL CONSIDERATIONS
ASSESSMENT OF SIZE AND DIRECTION OF THE PHORIA
ANCILLARY VERGENCE TESTING
Assessment of Accommodative Disorders
GENERAL CONSIDERATIONS
ASSESSMENT OF ACCOMMODATIVE AMPLITUDE
ASSESSMENT OF ACCOMMODATIVE FACILITY
ANCILLARY ACCOMMODATIVE TESTING
Primary Care Analysis of Common Accommodative and Nonstrabismic Binocular Vision Problems
BINOCULAR ANOMALIES
General Treatment Modalities, Guidelines, and Prognosis
BEST REFRACTIVE CORRECTION
ADDED LENS POWER (MINUS AND PLUS)
PRISM
PASSIVE THERAPY: OCCLUSION AND ATROPINE TREATMENT
HOME-BASED VISION THERAPY
ACCOMMODATIVE PROBLEMS: PATIENTS IN WHOM NO SIGNIFICANT PHORIA IS PRESENT
Summary
STUDY QUESTIONS

SECTION II Vision Therapy Procedures and Instrumentation

5. Introduction and General Concepts
Categorization of Vision Therapy Instrumentation and Procedures
CATEGORY 1: ANAGLYPHS AND POLAROID FILTERS
CATEGORY 2: LENSES, PRISMS, AND MIRRORS
CATEGORY 3: SEPTA AND APERTURES
CATEGORY 4: PAPER, PENCIL, AND MISCELLANEOUS TASKS
CATEGORY 5: STEREOSCOPES
CATEGORY 6: AFTERIMAGES, ENTOPTIC PHENOMENA, AND ELECTROPHYSIOLOGIC TECHNIQUES
General Principles and Guidelines for Vision Therapy
FEEDBACK MECHANISMS USED IN VISION THERAPY
Binocular Vision Therapy: Underlying Concepts
Binocular Vision and Accommodative Therapy: Specific Guidelines
OCULAR MOTILITY THERAPY: SPECIFIC GUIDELINES
ANTISUPPRESSION THERAPY: SPECIFIC GUIDELINES
Summary
STUDY QUESTIONS

6. Fusional Vergence, Voluntary Convergence, and Antisuppression
Fusional Vergence Procedures: Anaglyphs, Polaroids, and Liquid Crystal Filters
VARIABLE VECTOGRAMS
VARIABLE TRANAGLYPHS
NONVARIABLE TRANAGLYPHS
COMPUTERIZED BINOCULAR VISION THERAPY PROCEDURES
OFFICE-BASED COMPUTER VISION THERAPY SOFTWARE FOR BINOCULAR VISION
Fusional Vergence Procedures: Lenses, Prisms, and Mirrors
FLIP PRISM OR LOOSE PRISM
Fusional Vergence Procedures: Septa and Apertures
APERTURE RULE
MODIFIED REMY SEPARATOR
Fusional Vergence Procedures: Paper, Pencil, and Miscellaneous Tasks
ECCENTRIC CIRCLES, FREE SPACE FUSION CARDS A, AND LIFESAVER CARDS
LIFESAVER CARDS AND FREE SPACE FUSION CARDS B
Fusional Vergence Procedures: Stereoscopes
BREWSTER STEREOSCOPES
CHEIROSCOPE
WHEATSTONE STEREOSCOPE
Voluntary Convergence Procedures
BROCK STRING
BARREL CARD/3-DOT CARD
Antisuppression Procedures
BAR READER
TV TRAINER
RED/GREEN GLASSES AND PENLIGHT
VERTICAL PRISM DISSOCIATION
MIRROR SUPERIMPOSITION
Computer Home Therapy Procedures
HOME THERAPY SYSTEM
CAVT: COMPUTER VERGENCES PROGRAM—RANDOM DOT STEREOGRAMS
STUDY QUESTIONS

7. Accommodative Techniques
Anaglyphs, Polaroids, and Liquid Crystal Filters
RED–RED ROCK
COMPUTER ORTHOPTICS VTS3 LIQUID CRYSTAL SYSTEM: ACCOMMODATIVE PROGRAM
Lenses, Prisms, and Mirrors
LENS SORTING (MONOCULAR)
LOOSE LENS ROCK (MONOCULAR)
BIOCULAR LOOSE LENS ROCK
BINOCULAR ACCOMMODATIVE FACILITY
Paper, Pencil, and Miscellaneous Tasks
HART CHART DISTANCE-TO-NEAR ACCOMMODATIVE ROCK (MONOCULAR)
Computer Home Therapy Procedures
HOME THERAPY SYSTEM
STUDY QUESTIONS

8. Ocular Motility Procedures
Lenses, Prisms, and Mirrors
LOOSE PRISM JUMPS
Paper, Pencil, and Miscellaneous Tasks
HART CHART: SACCADIC THERAPY
LETTER AND SYMBOL TRACKING
VISUAL TRACING
ROTATOR-TYPE INSTRUMENTS
FLASHLIGHT TAG
COMPUTER SOFTWARE/ADVANCED TECHNOLOGY PROCEDURES
Afterimage Techniques
AFTERIMAGES
Computer Home Therapy Procedures
COMPUTER ORTHOPTICS
STUDY QUESTIONS

SECTION III Management

9. Low AC/A Conditions: Convergence Insufficiency and Divergence Insufficiency
Overview of General Management Principles for Heterophoria Associated with Low AC/A Ratio
PROGNOSIS FOR TREATING BINOCULAR VISION DISORDERS ASSOCIATED WITH LOW AC/A RATIOS
SUMMARY OF KEY POINTS IN TREATING PHORIA PATIENTS ASSOCIATED WITH LOW AC/A RATIOS
Convergence Insufficiency
BACKGROUND INFORMATION
CHARACTERISTICS
ANALYSIS OF BINOCULAR AND ACCOMMODATIVE DATA
DIFFERENTIAL DIAGNOSIS
TREATMENT
OFFICE-BASED VISION THERAPY
CASE STUDIES
SUMMARY AND CONCLUSIONS
Divergence Insufficiency
BACKGROUND INFORMATION
CHARACTERISTICS
TREATMENT
CASE STUDIES
Summary and Conclusions
STUDY QUESTIONS

10. High Accommodative Convergence to Accommodation Conditions: Convergence Excess and Divergence Excess
Overview of General Management Principles for Heterophoria Associated with High AC/A Ratio
PROGNOSIS FOR BINOCULAR VISION DISORDERS ASSOCIATED WITH HIGH AC/A RATIOS
SUMMARY OF KEY POINTS IN TREATING PHORIA PATIENTS ASSOCIATED WITH HIGH AC/A
Convergence Excess
CHARACTERISTICS
ANALYSIS OF BINOCULAR AND ACCOMMODATIVE DATA
DIFFERENTIAL DIAGNOSIS
TREATMENT
CASE STUDIES
SUMMARY
Divergence Excess
BACKGROUND INFORMATION
CHARACTERISTICS
DIFFERENTIAL DIAGNOSIS
TREATMENT
CASE STUDY
Summary and Conclusions

11. Normal AC/A Conditions: Fusional Vergence Dysfunction, Basic Esophoria, and Basic Exophoria
Introduction
Overview of General Management Principles for Heterophoria Associated with Normal AC/A Ratio
PROGNOSIS FOR THE TREATMENT OF BINOCULAR VISION CONDITIONS ASSOCIATED WITH NORMAL AC/A RATIOS
SUMMARY OF KEY POINTS IN TREATING PHORIA PATIENTS ASSOCIATED WITH NORMAL AC/A
Fusional Vergence Dysfunction
BACKGROUND INFORMATION
CHARACTERISTICS
ANALYSIS OF BINOCULAR AND ACCOMMODATIVE DATA
DIFFERENTIAL DIAGNOSIS
TREATMENT
CASE STUDY
Basic Esophoria
BACKGROUND INFORMATION
CHARACTERISTICS
ANALYSIS OF BINOCULAR AND ACCOMMODATIVE DATA
DIFFERENTIAL DIAGNOSIS
TREATMENT
CASE STUDY
Basic Exophoria
BACKGROUND INFORMATION
CHARACTERISTICS
ANALYSIS OF BINOCULAR AND ACCOMMODATIVE DATA
DIFFERENTIAL DIAGNOSIS
TREATMENT

12. Accommodative Dysfunction
Classification of Accommodative Anomalies
General Treatment Strategies for Accommodative Dysfunction
SEQUENTIAL MANAGEMENT CONSIDERATIONS
PROGNOSIS FOR TREATING ACCOMMODATIVE DISORDERS
Accommodative Insufficiency (Ill-Sustained Accommodation, Paralysis of Accommodation, and Unequal
Accommodation)
BACKGROUND INFORMATION
CHARACTERISTICS
ANALYSIS OF BINOCULAR AND ACCOMMODATIVE DATA
DIFFERENTIAL DIAGNOSIS
TREATMENT
CASE STUDIES
Accommodative Excess
BACKGROUND INFORMATION
CHARACTERISTICS
ANALYSIS OF BINOCULAR AND ACCOMMODATIVE DATA
DIFFERENTIAL DIAGNOSIS
TREATMENT
CASE STUDIES
Accommodative Infacility
BACKGROUND INFORMATION
CHARACTERISTICS
ANALYSIS OF BINOCULAR AND ACCOMMODATIVE DATA
DIFFERENTIAL DIAGNOSIS
TREATMENT
CASE STUDY
Summary and Conclusions

13. Eye Movement Disorders
Prognosis with Treatment
Overview of General Management Principles for Ocular Motor Dysfunction
Ocular Motor Dysfunction
BACKGROUND INFORMATION
CHARACTERISTICS
DIFFERENTIAL DIAGNOSIS
TREATMENT
CASE STUDIES
Summary

14. Cyclovertical Heterophoria
Background
DEFINITIONS AND TERMINOLOGY
HISTORICAL PERSPECTIVE
INCIDENCE
Characteristics
CAUSE
MOTOR AND SENSORY FUSION
SYMPTOMS
SYMPTOMS OF CYCLOVERTICAL HETEROPHORIAS
SIGNS
Diagnostic Testing
DISSOCIATED TESTING
FIXATION DISPARITY TESTING
OUT OF PHOROPTER TESTING
DIAGNOSTIC OCCLUSION
Differential Diagnosis
DETERMINING THE MUSCLE INVOLVED IN NONCOMITANCE—THE THREE-STEP TEST
A GRAPHICAL METHOD OF REPRESENTING THE THREE-STEP TEST
Treatment
REFRACTIVE CORRECTION
PRISM
THERAPEUTIC OCCLUSION
VISION THERAPY
SURGERY
Summary
STUDY QUESTIONS

15. Fixation Disparity
Fixation Disparity or Fixation Misalignment
Analysis Approach for Fixation Disparity
FUSIONAL VERGENCE
Forced Vergence Curve Parameters
CURVE SHAPE
CENTER OF SYMMETRY
ASSOCIATED PHORIA: X-INTERCEPT
FIXATION DISPARITY: Y-INTERCEPT
SLOPE
Generation of the Forced Vergence Fixation Disparity Curve
AVAILABLE INSTRUMENTATION
PHOROPTER SETUP
VERTICAL ASSOCIATED PHORIA
HORIZONTAL FIXATION DISPARITY CURVE
LENS-GENERATED FIXATION DISPARITY CURVES
Graphing Findings
Interpretation
Clinical Usefulness for Prescribing
PRISM CORRECTION DESIGN
Sphere Modification
NEAR ADDITION DETERMINATION
DISTANCE SPHERE MODIFICATION
PLANNING AND MONITORING VISION THERAPY PROGRAMS
Conclusion
STUDY QUESTIONS

SECTION IV Advanced Diagnostic and Management Issues

16. Interactions between Accommodation and Vergence
Analysis Approaches
TRADITIONAL ANALYSIS TECHNIQUES
Key Concepts
DISSOCIATED VERSUS ASSOCIATED TESTING
THEORETICAL INTERACTIONS
Tonic Vergence
DEPTH OF FOCUS AND LAG OF ACCOMMODATION
Proximal Vergence
Binocular Vergence Interactions
CONVERGENCE ACCOMMODATION
AC/A RATIO
RELATIONSHIP BETWEEN CONVERGENCE ACCOMMODATION AND AC/A
Clinical Testing
NEAR POINT OF CONVERGENCE
RELATIVE FUSIONAL VERGENCE
ACCOMMODATIVE VERGENCE AND CONVERGENCE ACCOMMODATION
ACCOMMODATIVE PARAMETERS: LAG AND DEPTH OF FOCUS
BINOCULAR AMPLITUDE OF ACCOMMODATION
RELATIVE ACCOMMODATION
ZONE OF SINGLE BINOCULAR VISION
VERGENCE ADAPTATION
FIXATION DISPARITY
Lens or Prism Therapy
Conclusion
STUDY QUESTIONS

17. Refractive Amblyopia
Etiology and Prevalence of Refractive Amblyopia
DEFINITION
CLASSIFICATION
ETIOLOGY
PREVALENCE
Characteristics of Amblyopia
SIGNS
SYMPTOMS
CLINICAL CHARACTERISTICS
Course and Prognosis
Sequential Management Protocol
DETERMINING COMPLIANCE
REFRACTIVE CORRECTION
ADDED LENSES AND PRISMS
PASSIVE THERAPY
ACTIVE AMBLYOPIA AND SUPPRESSION THERAPY
SURGERY
Duration of Results of Sequential Management
Summary and Conclusion
STUDY QUESTIONS

18. Nystagmus
Etiology and Prevalence
DEFINITION AND ETIOLOGY
PREVALENCE
Characteristics
Clinical Evaluation
PATIENT HISTORY
REFRACTIVE ERROR
VISUAL ACUITY
BINOCULAR VISION AND OCULAR MOTILITY
OCULAR HEALTH AND SYSTEMIC HEALTH
Differential Diagnosis
INFANTILE NYSTAGMUS
LATENT NYSTAGMUS
NYSTAGMUS BLOCKAGE SYNDROME
PHYSIOLOGIC NYSTAGMUS
SPASMUS NUTANS
VESTIBULAR NYSTAGMUS
VOLUNTARY NYSTAGMUS
OTHER FORMS OF NYSTAGMUS
Genetic Counseling
Treatment
REFRACTIVE CORRECTION
ADDED LENSES
PRISM CORRECTION
OCCLUSION
VISION THERAPY
PLEOPTICS
PHARMACOLOGIC THERAPY
SURGERY
Summary
STUDY QUESTIONS

19. Aniseikonia
Definitions of Aniseikonia
STATIC VERSUS DYNAMIC ANISEIKONIA
Historical Perspective
KNAPP’S LAW
Diagnosis
HISTORY
REFRACTIVE CONDITION
CORNEAL CURVATURE
RETINAL CONDITIONS (FIELD-DEPENDENT ANISEIKONIA)
OCCLUSION
CLIP-ON ANISEIKONIC CORRECTION—VERIFICATION OF THE RESULTS WITH “SIZE LENSES”
MINIMUM AMOUNT OF ANISEIKONIA CORRECTION
Determination of the Presence of Aniseikonia
SIZE COMPARISON OF DIPLOPIC IMAGES
ALTERNATE COVER TEST
TURVILLE TEST
MADDOX ROD AND TWO-POINT LIGHT SOURCES
THE NEW ANISEIKONIA TEST
The Aniseikonia Inspector
THE SPACE EIKONOMETER
Management
PRACTICAL CONSIDERATIONS
LENS PRESCRIPTION
PRESCRIPTION DECISIONS REGARDING PATIENTS WITH ANISEIKONIA
Iseikonic Lens Design
ANISEIKONIA INSPECTOR
TRANSLATION
MAGNIFICATION BY CHANGING EYEWIRE DISTANCE AND BEVEL
MAGNIFICATION BY CHANGING BASE CURVE
MAGNIFICATION BY CHANGING LENS THICKNESS
CONSIDERATIONS FOR ISEIKONIC PRESCRIPTIONS
ANTIREFLECTIVE COATING AND LENS EDGE COATING
EXAMPLES OF LENS DESIGN
INADVERTENT ISEIKONIC CORRECTIONS
Summary and Conclusion
ANISEIKONIA INSPECTOR
STUDY QUESTIONS

20. Binocular and Accommodative Problems Associated with Computer Use
Incidence of Computer Use
Computer Vision Syndrome versus Computer Use Complex
Characteristics
SYMPTOMS AND THEIR PREVALENCE
SIGNS
ANALYSIS OF BINOCULAR AND ACCOMMODATIVE DATA
Differential Diagnosis
General Treatment Strategies for Visually Related Symptoms of Computer Use Complex
SEQUENTIAL MANAGEMENT CONSIDERATIONS
CORRECTION OF AMETROPIA
LENS COATINGS—BLUE LIGHT PROTECTION
ADDED LENSES
PRISM
VISION THERAPY
SURGERY
OCULAR HEALTH
ERGONOMIC ISSUES
LIGHTING CONDITIONS AND GLARE
OTHER WORKING DISTANCES AND POSITIONS
SEATING POSITION
COMPUTER MONITORS
CHANGING THE REFRESH RATE
REST BREAKS
COURSE AND PROGNOSIS
SUMMARY OF KEY POINTS IN TREATING PATIENTS WITH SYMPTOMS OF COMPUTER USE COMPLEX
Clinical Evaluation
HISTORY AND SYMPTOMS
WORKSTATION
EVALUATION
Sequential Management Protocol
BEST REFRACTIVE CORRECTION
ISSUES OF LENS DESIGN, COATINGS, AND MATERIALS
PRISM
VISION THERAPY
MEDICAL TREATMENT
ERGONOMIC ISSUES
Summary and Conclusion
STUDY QUESTIONS

21. Binocular and Accommodative Problems Associated with Acquired Brain Injury
Overview of ABI
TRAUMATIC BRAIN INJURY
STROKE (CEREBROVASCULAR ACCIDENT)
Optometrist’s Role
ACTIVE REHABILITATION STAGE
POSTREHABILITATION STAGE
Common Binocular Vision, Accommodative, and Eye Movement Disorders Associated with ABI
BINOCULAR VISION DISORDERS
ACCOMMODATIVE DISORDERS
EYE MOVEMENT DISORDERS
Symptoms of the Vision Problems Associated with ABI
Evaluation
Symptom Survey
OTHER SPECIAL TESTING CONSIDERATIONS
Sequential Management Considerations in the Treatment of Disorders Associated with ABI
VARIABILITY OF FINDINGS AND POTENTIAL RECOVERY
COGNITIVE FUNCTION
OPTICAL CORRECTION OF AMETROPIA
ADDED LENSES
PRISM
OCCLUSION
VISION THERAPY
FACTORS AFFECTING PROGNOSIS FOR VISION THERAPY AFTER ABI
ADDITIONAL ISSUES RELATED TO THE VISION THERAPY PROGRAM
CASE STUDIES
Summary

22. Binocular and Accommodative Problems Associated with Learning Problems
Role of the Optometrist in the Management of Learning- and Reading-Related Vision Disorders
Learning and Reading Disabilities: Definition and Epidemiology
Reading Dysfunction
Relationship between Vision Problems and Reading Dysfunction
Research Supporting the Relationship between Visual Efficiency Problems and Reading
Colored Filters or Glasses and Reading
Psychoeducational Testing Used in the Diagnosis of Reading Dysfunction
BASIC COMPONENTS OF PSYCHOEDUCATIONAL TESTING
HISTORY
COGNITIVE TESTING
ACHIEVEMENT TESTING
EMOTIONAL OR PERSONALITY TESTING
Diagnostic Testing and Case History
DEFINING THE NATURE OF THE READING OR LEARNING PROBLEM
PREVIOUS TESTING
MEDICAL OR DEVELOPMENTAL PROBLEMS AND FAMILY HISTORY
Treatment
OBJECTIVES OF OPTOMETRIC INTERVENTION
SEQUENTIAL TREATMENT APPROACH FOR READING-RELATED VISUAL EFFICIENCY PROBLEMS
ROLE WITH EDUCATORS
ROLE WITH OTHER PROFESSIONALS
Summary
STUDY QUESTIONS

23. Development and Management of Refractive Error: Binocular Vision–Based Treatment
Binocular Vision–Based Refractive Development
ACCOMMODATION AND THE SOURCE OF BLURRED IMAGES
A Conceptual Model
THE REFRACTIVE STATE: DISTRIBUTION OF REFRACTIVE ERROR AND ITS COMPONENTS
GROWTH OF OCULAR COMPONENTS
GENETICALLY PROGRAMMED OCULAR GROWTH
VISUALLY DRIVEN OCULAR GROWTH
THE RELATIVE STRENGTHS OF THE GENETICALLY PROGRAMMED AND VISUALLY DRIVEN OCULAR GROWTH MECHANISMS
RATE OF REFRACTIVE CHANGE
CLINICAL ASPECTS OF THE MODEL
Atropine
ATROPINE 1%
LOW-DOSE ATROPINE
SAFETY AND SIDE EFFECTS OF ATROPINE
SIDE EFFECTS OF LOWER DOSES OF ATROPINE
DOSAGE
REBOUND EFFECT
Methylxanthines
THEOBROMINE
7-METHYLXANTHINE
SAFETY AND SIDE EFFECTS OF METHYLXANTHINE
Diet and Supplements
HIGH PROTEIN/LOW CARBOHYDRATE
CARBOHYDRATES VERSUS PROTEIN
TREATMENT STRATEGIES BASED ON ALTERING VISUALLY DIRECTED GROWTH
Myopia—Factors Related to Treatment
AMOUNT AND DIRECTION OF PERIPHERAL RETINAL DEFOCUS IN EACH EYE
AMOUNT OF ACCOMMODATIVE LAG AND INFLUENCE OF INTERACTIONS BETWEEN ACCOMMODATION AND VERGENCE
NORMAL VISUAL ACUITY AND THE RANGE OF SENSITIVITY TO BLUR
AMOUNT OF NEAR WORK PERFORMED AND THE RESULTING TIME-AVERAGE BLUR EXPERIENCED
TIME OUTDOORS/LIGHT EXPOSURE
EFFECT OF VISION THERAPY ON MYOPIA AND CONDITIONS ASSOCIATED WITH MYOPIA PROGRESSION
THE RATIONALE FOR PRESCRIBING VISION THERAPY
Clinical Treatment
MANAGEMENT PROTOCOL
TREATMENT OF MYOPIA OR OF PATIENTS WITH RISK FACTORS INDICATING THE POSSIBILITY OF DEVELOPING MYOPIA
INITIATING TREATMENT
Anisometropia
MYOPIC ANISOMETROPIA
Hyperopia
TREATMENT OF HYPEROPIA
HYPEROPIC ANISOMETROPIA
ANISOMETROPIC AMBLYOPIA
TREATMENT OF ANISOMETROPIA
Astigmatism
AGAINST-THE-RULE ASTIGMATISM IN INFANCY, IN SCHOOLCHILDREN, AND IN PRESBYOPIA
TREATMENT OF ASTIGMATISM
ASTIGMATISM TREATMENT RECOMMENDATION
Summary and Conclusions
PREVENTIVE CARE
The Future
STUDY QUESTIONS

24. Binocular Vision Problems Associated with Refractive Surgery
Review of Refractive Surgery
LASER IN SITU KERATOMILEUSIS
SURFACE ABLATION TECHNIQUES
PHAKIC INTRAOCULAR LENSES
Binocular Vision Complications of Refractive Surgery for Myopia, Hyperopia, and Astigmatism
COMPLICATIONS ASSOCIATED WITH THE REFRACTIVE SURGERY
PREVIOUS PRISM WEAR
ANISOMETROPIA AND ANISEIKONIA
MONOVISION
ACCOMMODATIVE AND CONVERGENCE ISSUES
Optometric Role
Identifying Patients at Risk for Binocular Vision Complications Associated with Refractive Surgery
DIAGNOSTIC EVALUATION OF BINOCULAR VISION COMPLICATIONS AFTER REFRACTIVE SURGERY
Sequential Management Considerations in the Treatment of Binocular Vision Complications after Refractive
Surgery
RESISTANCE TO OPTICAL CORRECTION OF AMETROPIA, ADDED LENSES, AND PRISM
OPTICAL CORRECTION OF AMETROPIA
ADDED LENSES
PRISM
OCCLUSION
VISION THERAPY
Summary

SECTION V Vision Therapy and Optometric Practice

25. Patient and Practice Management Issues in Vision Therapy
Case Presentation
SAMPLE CASE PRESENTATION FOR A CHILD REQUIRING VISION THERAPY
SAMPLE CASE PRESENTATION FOR CONDITIONS NOT REQUIRING VISION THERAPY
Communicating Your Findings to Other Professionals
COMMUNICATING THROUGH WRITTEN CORRESPONDENCE
Practice Management Aspects of Vision Therapy
MODEL FOR THE ESTABLISHMENT OF VISION THERAPY IN A PRIMARY CARE PRACTICE
SHOULD VISION THERAPY BE PERFORMED ON AN INDIVIDUAL BASIS OR WITH MULTIPLE PATIENTS PER SESSION?
Equipment
BASIC EQUIPMENT
COMPUTER SOFTWARE
Appendices
I. Samples of Correspondence and Forms
Insurance Letters
Information to Be Included with Report to Parents about Financial Aspects of Vision Therapy
Vision Therapy Office Policy
II. Home Vision Therapy Procedures; Patient Instructions
Red Lens and Penlight Technique to Eliminate Suppression
Television Trainer
Eccentric Circles: Divergence
Eccentric Circles: Convergence
Eccentric Circles at 10 to 15 Feet
Tranaglyph Slides
Beads and String
Colored Circle Cards for Convergence
First- or Second-Degree Targets at 10 to 15 Feet
Hart Chart: Saccadic Therapy
Ann Arbor Letter Tracking
Visual Tracing
Loose Lens Rock (Monocular)
Index