NSBD.pptx

INTRODUCTION

WHEN A NORMAL INDIVIDUAL FIXES HIS VISUAL ATTENTION ON AN OBJECT OF REGARD ,THE IMAGE IS FORMED ON THE FOVEA OF THE BOTH EYES SEPARATELY ,BUT THE INDIVIDUAL PERCEIVES A SINGLE IMAGE .

BINOCULAR SINGLE VISION CONSIST OF 3 GRADES :
SIMULTANEOUS MACULAR PERCEPTION
FUSION
STEREOPSIS

SIMULTANEOUS MACULAR PERCEPTION :

POWER TO SEE TWO DISSIMILAR OBJECTS SIMULATANEOUSLY

FUSION :

POWER TO SUPERIMPOSE TWO INCOMPLETE BUT SIMILAR IMAGES TO FORM ONE COMPLETE IMAGE

STEREOPSIS :

ABILITY TO PERCEIVE THE 3RD DIMENSION (DEPTH PERCEPTION )

1. NON STRABISMIC BINOCULAR DYSFUNCTION PRESENTER - BABLI SHARMA (B.OPTOM , M.OPTOM) DHIR HOSPITAL & POST GRADUATE INSTITUTE OF OPHTHALMOLOGY

2. INTRODUCTION WHEN A NORMAL INDIVIDUAL FIXES HIS VISUAL ATTENTION ON AN OBJECT OF REGARD ,THE IMAGE IS FORMED ON THE FOVEA OF THE BOTH EYES SEPARATELY ,BUT THE INDIVIDUAL PERCEIVES A SINGLE IMAGE . BINOCULAR SINGLE VISION CONSIST OF 3 GRADES : SIMULTANEOUS MACULAR PERCEPTION FUSION STEREOPSIS REFERENCE:-

3. SIMULTANEOUS MACULAR PERCEPTION : POWER TO SEE TWO DISSIMILAR OBJECTS SIMULATANEOUSLY FUSION : POWER TO SUPERIMPOSE TWO INCOMPLETE BUT SIMILAR IMAGES TO FORM ONE COMPLETE IMAGE STEREOPSIS : ABILITY TO PERCEIVE THE 3 RD DIMENSION (DEPTH PERCEPTION )

4. NON-STRABISMIC BINOCULAR DYSFUNCTION : COMMON FORMS OF VISUAL ABNORMALITIES USUALLY REMAIN UNDECETED SYMPTOMATIC EMMETROPE /NEAR EMMETROPE NO DEMONSTRABLE STRABISMUS NORMAL EYE HEALTH IMPACTS LEARNING ABILITY OF A CHILD PATIENT USUALLY C/O ABOUT : EYESTRAIN ,DIPLOPIA ,HEADACHES ,SLEEPINESS ,BLUR, WATERING ETC.

5. ROUTINE OPTOMETRY PROTOCOL FOR EYE EXAMINATION : COMPLAINT AND HISTORY VA (AIDED,UNAIDED,PIN HOLE) RETINOSCOPY OR AR SUBJECTIVE BCVA GROSS EVALUATION OF EYE HEALTH(ANTERIOR AND POSTERIOR ) BASIC MOTILITY CT NPC QUANTIFICATION FOR HETEROPHORIA AT D & N AC /A RATIO ACCOMMODATION FUNCTIONS FUSIONAL VERGENCE RANGES AT D& N SENSORY FUSION AT D & N STEREOPSIS

6. COVER TEST : UNILATERAL CT USED TO DETECT STRABISMUS COVER– UNCOVER TEST USED TO DETECT PHORIA ALTERNATE CT USED TO ASSESS AMOUNT OF PHORIA AND STRABISMUS PHORIA MEASUREMENT MADDOX ROD METHOD MODIFIED THORINGTON TEST NORMAL VALUE : DISTANCE : 1 -2 EXO NEAR : 4-6 EXO

7. NPC : ASSESS CONVERGENCE AMPLITUDES BOTH BREAK AND RECOVERY WILL BE NOTED TARGET USED SHOULD BE ACCOMMODATIVE DONE BY RAF RULER DONE BY PENLIGHT WITH RED LENS NORMAL : BREAK 5-6 CM RECOVER 7-10 CM AC/A RATIO : DETERMINE THE CHANGE ON ACCOMMODATIVE VERGENCE THAT OCCURS WHEN THE PT RELAXES OR STIMULATES ACCOMMODATION BY THE GIVEN AMMOUNT CALCULATED BY GRADIENT METHOD NORMAL : 4 : 1

8. ACCOMMODATIVE FUNCTIONS : NPA PUSH UP AND PULL AWAY METHOD : NEAR POINT CARD AND FIXATION TARGET RAF RULLER CAN BE DONE MONOCULARLY AND BINOCULARLY NORMAL : 6-10 CM ACCOMMODATIVE FACILITY DONE WITH FLIPPERS MONOCULAR AND BINOCULARLY NEAR POINT CARD NORMAL : BAF : 8-10 CPM MAF: 11-12 CPM

9. MEM : TO OBJECTIVELY DETERMINE THE LEAD AND LAG OF ACCOMMODATION DONE WITH MEM CARDS NORMAL : +0.50 - +0.75D NRA – PRA BINOCULAR PROCEDURE SHOULD BE DONE WITH PT HABITUAL CORRECTION READING OR DISTANCE PT IS INSTRUCTED TO REPORT FIRST SUSTAINED BLUR NORMAL : PRA : -2.25D NRA : +2.50

10. FUSIONAL VERGENCE RANGES : ASSESS THE AMPLITUDE OF FUSIONAL VERGENCE RESPONSE FOR BOTH POSTIVE AND NEGATIVE FUSIONAL VERGENCE BLUR/ BREAK / RECOVERY NORMAL PFV NEAR : 17/21/11 DISTANCE : 9/19/10 NFV NEAR : 13/21/13 DISTANCE : X/7/4 VERGENCE FACILTY : ASSESS THE DYNAMICS OF FUSIONAL VERGENCE SYSTEM AND THE ABILITY TO RESPOND OVER TIME 12 BO /3BI NORMAL : 8-10CPM

11. FUSION AT D&N WORTH 4 DOT TEST TO TEST THE FUSION STATUS AND SUPPRESSION RECORDING : DISTANCE : FUSION/SUPPRESSION/DIPLOPIA INTERMEDIATE: FUSION/SUPPRESSION/DIPLOPIA NEAR : FUSION/SUPPRESSION/DIPLOPIA

12. STEREO TESTING TITMUS FLY TEST / RANDOM DOT STEREOPSIS EVALUATE THE DEGREE AND PRESENCE OF STEREOPSIS NORMAL 40 SEC OF ARC

13. TYPES OF NSBD PRIMARY RX OPTIONS CONVERGENCE INSUFFICIENCY LOW PLUS AT NEAR, BI PRISM, VT CONVERGENCE EXCESS ADDED PLUS AT NEAR ,VT DIVERGENCE INSUFFICIENCY RELIEVING PRISMS WITH REFRACTIVE RX , VT DIVERGENCE EXCESS REFRACTIVE RX , VT BASIC EXOPHORIA RELIEVING PRISM,VT BASIC ESOPHORIA ADDED PLUS , VT AI ADDED PLUS ON REFRACTIVE RX, VT AE ADDED PLUS, REFRACTIVE RX, VT ACCOMMODATIVE INFACILITY REFRACTIVE RX , ADDED PLUS, VT FVD REFRACTIVE MODIFICATION , VT SUMMARY OF TX OPTIONS FOR NSBD

14. REFERENCE AK KHURANA ,COMPREHENSIVE OPTHALMOLOGY CLINICAL MANAGEMENT OF BINOCULAR VISION BY MITCHELL SCHEIMAN COVD – WWW.COVD.ORG

15. THANK YOU