1 / 30

Strabismus: Ugh!

Strabismus: Ugh!. If it is Strabismus, It Can be Diagnosed with a Cover Test. The Obvious and the Not So Obvious. Two Big Areas Esotropia Exotropia I Wonder if it should not be Intermittent Constant What is the Advantage of Strabismus?. Press and Efficacy: Esotropia.

mary
Download Presentation

Strabismus: Ugh!

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Strabismus: Ugh! If it is Strabismus, It Can be Diagnosed with a Cover Test

  2. The Obvious and the Not So Obvious Two Big Areas Esotropia Exotropia I Wonder if it should not be Intermittent Constant What is the Advantage of Strabismus?

  3. Press and Efficacy: Esotropia Plus (T)NC .6 (T)AC .5 NC .3 AC .1 Good Fusion .1 .1 .1 .1 Family Hx .1 .1 .1 .1 No Ambly .1 .1 .1 .1 < 20 ^ .1 .1 .1 .1 Minus Dense Supp .1 .1 .1 .1 Non Concom .1 .1 .1 .1 Dense Ambly .1 .1 .1 .1

  4. Press and Efficacy: Exotropia • Plus (T)NC .8 (T)AC .7 TNC .5 TAC .4 Good Fusion Family Hx No Ambly .1 .1 .1 .1 < 20 ^ Minus Dense Supp Non Concom .1 .1 .1 .1 Dense Ambly .1 .1 .1 .1

  5. Ugly Factors • No Desire To Change • Anomalous Correspondence • Amblyopia • Intractable Diplopia • Constancy • Non-Concomitant • Restrictions • Prior Surgery?

  6. Do They Want To Change?Strabismic From Head to Toe • The Child That Did Not Want a Brother • The College Student That Wanted A Husband • Esotropes want Detail and are Willing to Give up Binocularity to Get it (Developmental) • Exotropes want the “Big Picture” Panoramic Viewing (Genetic, ABI or Functional)

  7. Anomalous Correspondence • A Type of Binocularity • Develops Early---???????????? • Reaction of Organism to Diplopia • Sees Double • Suspends/Suppresses • Goes into an Anomalous Fusion Cortically

  8. Anomalous Correspondence • Depth • Shallow-Ignore • Deep-Ugh! • Treatment • Embed the Binocularity • Move to Harmonious Anomalous • Change to Normal Correspondence

  9. AmblyopiaMaples WC, Bither M. Treating the trinity of infantile vision development: infantile esotropia, amblyopia, anisometropia. J Optom Vis Dev 2006;37: 123-130. • Eccentric Fixation • Develops Early • Secret to Amblyopia (Anisometropic and Eccentric Fixation)----Fixation • 0 Retino Motor Locus • Treatment-Develop Central Fixation

  10. Constancy • INTERMITTENT IS EASIER • The reason that Exos are easier than Esos may be that there are more Intermittent Exos • If Intermittent: • Do not Patch • Work on Binocularity where you can find binocularity and expand it. WORK BACKWARDS TO BIOUCLAR AND MONOCULAR SKILLS

  11. Intractable Diplopia • Late Onset • Trauma • Stroke • Horror Fusionis • The OMD Who Saw Nothing But ID’s • Patch (Contact Lens), Blur, Suppress---

  12. Non-Concomitant • Pathology • Prior Surgery Worse if Complications • Restrictions almost always will not have full use • Duane’s Congenital and Train other Visual Skills • Brown Can be from infection of the tendon sheath and if so, when infection controlled can decrease

  13. Seven Levels of Dx and Tx • Bilateral Integration • Central Fixation • Monocular Equality • Biocular Skills • Basic Binocular Skills • Advanced Binocular Skills • Special (Perceptual/Cognitive/Executive)

  14. Working the System: Testing/Demonstrate • Bilateral Skills: Anatomical Interaction • VO Star • Harmon Bimanual Circles • Standing and Seated Posture • Dry Land Swimming • Angels in the Snow • Line Roll

  15. Working the System: Testing/Demonstrate • Central Fixation • Ophthalmoscopic (Visuscope) • MIT • Cover Test and Angle Lambda (Kappa) Very Gross • Past Pointing

  16. Working the System: Testing/Demonstration • Monocular Equality • Fixation: Wolff Wands, VO 12* Star; Fixation Worksheet; Parquetry Blocks; Chalkboard Saccades • Saccade (Real World): See Above; Wayne Saccades; Hart Chart Challenge; Battle Ship Hart Chart • Pursuit: Wolff Wands; Marsden Ball; Head Rotations; Chalkboard Pursuits; Mechanical Rotator • Near Far-Far Near: Hart Chart, Wayne Saccade • Accommodation: Kraskin Bifocal; Monocular Rock

  17. Working the System: Testing • Biocular Skills: In My Opinion-The Key to Effective Amblyopic and Strabismus Therapy • Suppression • Anomalous Correspondence • Double but MORE THAN Double-Equally Real • “The one I am attending”

  18. Biocular • Tests (Anomalous Correspondence-Press) • Bagolini Lenses • Polarized Vectogram • Amblyscope • Worth Four Dot • Maddox Rod with Red Lens • Hering-Bielschowsky After Image

  19. Working the System: Testing • Tests (Suppression) • Bagolini Lenses • Keystone • Brock String • Quoits (Cross) • Binocular Refractions • Physiological Diplopia • Retinal Rivalry • Others

  20. Working the System: Testing • Basic Binocular • Tons of Tests • Retinoscopy • Phorias • Vergences • Telebinocular • Stereo

  21. The Intermittent Trope Can you get Stereo? • If Stereo • Demonstrated with Peripheral Targets Brock Stereo Motivator or Quoits on a Window • Build Ranges • Ramp • Step • Ability as measured by Accuracy as measured by the Speed and Stamina of the Patient A Ass • Speed means both Fast AND Slow • Minimal Differences (Quoits and 1 ^ difference)

  22. Rules of Engagement”Where the Eye looks and were the Brain thinks it looks is different” • Start Were They Are and Go Where They Ain’t • Start Slow and Start Low • Synapses that Fire Together Continue to Fire Together • Analyze the Procedure: All VT is Bio-Feedback • Patient & Therapist MUST BE involved • Know What you are Attempting to Accomplish • Be Enthustatic • Accomplishment is the Best Reward

  23. Working the System: Therapy • Central Fixation • Pleoptics • Ophthalmoscopic Bleaching • Fixation/Saccade/Pursuit • Smaller and Smaller • MIT • Eye Hand Activities

  24. Working the System: Therapy • Bilateral Skills • Yoked Prisms with Motor Activities • Line Roll • Line Walk • Harmon (Lowman) Board • Harmon Circles • Van Orden Circles

  25. Working the System: Therapy • Monocular Equality (Biocular & Binocular) • Monocular Disassociated Binocular (MDB) Marsden Ball • MDB Pointers • AN 12 pointed Star MDB • Kraskin Bifocal Rock MDB • Modified Modified UpDegrave MDB

  26. Working the System: Therapy • Biocular • Squinchel • Marsden Ball • Physio Diplopia • Quoits • Brock String • 12 Pointed Star

  27. Working the System: Therapy • Binocular Esotrope • Luster • Gross/Peripheral/Moving Targets • Give Me 5 on the Balance Board • Touch my Fingers • Top Clear/Bottom Clear/Both Clear (= Blur) • Quoits-Suppression and Fusion • Keystone without Detail • Encourage Periphery • Motor Activities

  28. Working the System: Therapy • Extotropes • Rx (+) and tend to be poorer academic achievers • “Take This Job and Shove It” “ I Quit” • High Sx: See COVD-QOL Checklist • Functional or Nerve/Muscle Damage • Needs “Orthoptics”: Fixations, Pursuits, Vergence, ACCOMMODATION • Get Stereo; Let Stereo Go; Regain Stereo • See 1/See 2

  29. Skeffington’s Model • Exotropia • Divergence Excess Needs + at Near (Cooper, NO!) • Sympathetic and Parasympathetic-Exos Peripheral Dominant • Social and Biological Clash • Myopia/Esotropia • Hyperopia (Normal Refraction)/Exotropia

  30. Working the System: Therapy • Esotropes • Minimal +; Monocular (-) Followed by Low + • Tend to be High Achievers (Bull Dogs) Low Sx • Want their own Way (Spoiled?-Indulgent Parents) • Will tell you what they think you want to hear • Developmental or SERIOUS PATHOLOGY • Ah, Ha is Needed. That is how you do it

More Related