Orthoptic evaluation 1
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ORTHOPTIC EVALUATION
DR. VARSHINI SHANKER DR. PUSHKAR DHIR
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PATIENT PRESENTATION
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• Diplopia• Pulling sensation• Poor Concentration
• Headache• Over the eyes• Strain
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DR / DA
PMT (2-4PM, ALL DAYS EXCEPT SATURDAY)
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AIM OF PRESENTATION
Importance of knowing Orthoptics Overview of Sports Vision N new fascinating stuffJinx of AC/A ratio measurementSynaptophore – made easy.
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WHAT ARE WE EVALUATING??
Ortho
=
Straight
Opticas
=
Vision
Orthoptics
Orthoptics = literally means "straightening of the eyes", dates back to the 1850s limited in scope to eye-muscle training and the cosmetic straightening of eyes.
Vision therapy = includes Orthoptics + include training and rehabilitation of the eye-brain connections involved in vision.
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ORTHOPTIST :-
They specialize in study of ocular motility & visual development &
master themselves in non –surgical treatment.
ORTHOPTIST + OPHTHALMOLOGIST :-
Diagnose visual system dysfunction
(Vision (lazy eye) , Eye Movement (Versions & Vergences ,
Eye Alignment (Squints) , Binocularity (BSV)
ORTHOPTICS :-
Focuses on NON- SURGICAL treatment of
Amblyopia ,Strabismus , Diplopia
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WHAT ALL WE CHECK IN ORTHOPTICS?
1. CONVERGENCE2. ACCOMODATION
3. BSV ( SMP/ FUSION/ STEREOPSIS)
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TOOLS FOR OBJECTIVE ORTHOPTIC EVALUATION
• a
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•Convergence is ability to move eyes inside B/L•Driven by 3 things – Accommodation , Fusion , Proximity.•* Whenever there is pathology in either 3, NPC will be reduced.•C/F:- Blurred Vision , Diplopia , Brow Pain
CONVERGENCE
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Discussion
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NPA
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CLINICAL FEATURES & TYPES
Convergence DysfunctionAccomodative Insufficiency
Ill sustained accomodation
Accomodative infacility / inertia
Spasm of Accommodation
Accomodation Paralysis
Accommodative Dysfunction
C/F:-Headache, Poor ConcentrationBlurred Vision after near work
C/F:-DiplopiaEye Brow PainSwimming of lettersHeavy LidBlurred Vision
Convergence Insufficiency
Divergence Excess(>10 pd difference b/w near & distance)
Divergence Insufficiency
Convergence Excess
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FUSION
Ability to Maintain Fusion B/L with Accomodation Kept ConstantIt comes from Retinal CorrespondenceConcept of Break Point & Recovery Point.
Checked with Prism Bars & Not with synaptophore fusion slides
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SYNAPTOPHORE / MAJOR AMBLYOSCOPE
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IPD MEASUREMENT
SUBJ. & OBJECTIVE ANGLE OF DEVIATION
PRIMARY & SECONDARY DEVIAITON
ANGLE OF DEVIATION IN 9 GAZES
STATUS OF BINOCULAR VISION (S.Perception / Fusion / Stereopsis )
MEASUREMENT OF VERTICAL & CYCLO-DEVIAITION
AFTER IMAGE TEST FOR NRC & ARC
MACULAR FUNCTION WITH H.B
ANGLE ALPHA MEASUREMENT
ANTI SUPPRESSION EXERCISES
IN ARC
CONVERGENCE DEFICIENCY EXERCISES
RELAXATION EXERCISES
FUSIONAL EXERCISES
PLEOPTIC TREATMENT
DIAGNOSTICTHEAPEUTIC
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WHICH SLIDES TO PUT
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WHITE BINDING• Original Maddox Series /
Torsions• Labelled with prefix A
YELLOW BINDING • Stereoscopic • Labelled with D
RED BINDING • Simultaneous Perception• Labelled with G or H
GREEN BINDING • Fusion Series • (Sensory & motor fusion)
• Labelled with F
BLUE BINDING• Special Purpose Slide (after
image, HB slides)• Labelled with S
• Mayou Series of 8 slides
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SLIDE SIZE ANGLE SUBTENDED
FOVEAL 1 °
MACULAR 1-3°
PARAMACULAR 3-5°
PERIPHERAL >5°
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SYNAPTOPHORE DISCUSSED
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Orthoptic Tools - Therapeutic
• a
Less Than 20 Pd Exophoria /Tropia
Base Out Prism Exercise+
Dot Card Exercises
+/- Fusional exercises on
Synaptophore or Cat Card
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Orthoptic Tools - Therapeutic
• a
• Near Point of Accomodation if > 10cms.
• Accomodative Infacility / Inertia < 10 cps.
Brock stringFlippersJump Convergence
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VISION THERAPYOrthoptic Therapy
Accomodation Therapy
Visual-Attention Therapy (Vapor Strobes)
Eye Hand Coordination Therapy
Peripheral Area Therapy
Visual-Perception Therapy
Visual-Vestibular Therapy
Visual Auditory Integration Therapy
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REFERENCES
• American Optometry Association CPG-18• Dos Slides on Orthoptics by Dr.Wangchuk Doma.• Practical Orthoptics inTreatment of squint –
T.Kenneth Lyle.• Discussion with Dr. Varshini Shankar & one on one
discussion with Mr.Krishna(Opto Venu) & Ms.Nikita.• Haag Streit Manual of Major Amblyoscope.• Synaptophore Guide by Haag Streit.• For Videos and Pics ,mail me.
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• THANK YOU EVERYONE FOR PATIENTLY LISTENING TO THIS SEMINAR &
• REQUEST U FOR NET NEUTRALITY • For feedbacks & brickbats plz mail at• [email protected]./[email protected]
TELL ME AND I FORGET, TEACH ME AND I MAY REMEMBER,
INVOLVE ME AND I LEARN