Downloaded 16 times
Uploaded byBABLI SHARMA
NSBD.pptx
This document summarizes non-strabismic binocular dysfunction (NSBD), which refers to visual abnormalities that remain undetected in individuals with normal eye health and no strabismus. It describes the components of binocular single vision and covers evaluation procedures like cover testing, phoria measurement, near point of convergence, and tests of fusion, vergence, and stereopsis. Common forms of NSBD like convergence insufficiency, divergence excess, and various types of phoria are explained. Treatment options focus on refractive correction, addition of prisms, and vision therapy.
More Related Content
![Types of pediatric contact lens [autosaved]](https://cdn.slidesharecdn.com/ss_thumbnails/typesofpediatriccontactlensautosaved-200210123904-thumbnail.jpg?width=640&height=640&fit=bounds)
More from BABLI SHARMA
NSBD.pptx
- 1. NON STRABISMIC BINOCULAR DYSFUNCTION PRESENTER- BABLI SHARMA (B.OPTOM , M.OPTOM) DHIR HOSPITAL & POST GRADUATE INSTITUTE OF OPHTHALMOLOGY
- 2. o INTRODUCTION • WHENA 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 MACULARPERCEPTION : 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 )
- 4. o NON-STRABISMIC BINOCULARDYSFUNCTION : • 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. o ROUTINE OPTOMETRYPROTOCOL 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. o 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 o PHORIA MEASUREMENT • MADDOX ROD METHOD • MODIFIED THORINGTON TEST • NORMAL VALUE : DISTANCE : 1 -2 EXO NEAR : 4-6 EXO
- 7. o 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 o 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. o ACCOMMODATIVE FUNCTIONS: o 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 o ACCOMMODATIVE FACILITY • DONE WITH FLIPPERS • MONOCULAR AND BINOCULARLY • NEAR POINT CARD • NORMAL : BAF : 8-10 CPM MAF: 11-12 CPM
- 9. o MEM : •TO OBJECTIVELY DETERMINE THE LEAD AND LAG OF ACCOMMODATION • DONE WITH MEM CARDS • NORMAL : +0.50 - +0.75D o 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. o FUSIONAL VERGENCERANGES : • 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 o VERGENCE FACILTY : • ASSESS THE DYNAMICS OF FUSIONAL VERGENCE SYSTEM AND THE ABILITY TO RESPOND OVER TIME 12 BO /3BI NORMAL : 8-10CPM
- 11. o FUSION ATD&N o 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. o STEREO TESTING •TITMUS FLY TEST / RANDOM DOT STEREOPSIS • EVALUATE THE DEGREE AND PRESENCE OF STEREOPSIS • NORMAL 40 SEC OF ARC
- 13. SYMPTOMS ASSCOCIATED WITH USE OF EYES VAIS NORMAL REFRACTION IS NORMAL BINOCUL AR VISION PROBLEM ? BV PROBLEM ? D&N PHORIA EXOPHORIA IS PRESENT INVESTIGAT E AND ANALYSE PFV DATA
- 14. EVALUATE AC/A RATIO AND COMPARED&N PHORIA PHORIA D>N DIVERGENCE EXCESS PHORIA D <N CI PHORIA D = N BASIC EXOPHORIA
- 15. BV PROBLEM D&N PHORIA ESOPHORIA IS PRESENT INVESTIGATE NFV DATA EVALUATE AC /A RATIO AND COMPARE D&N PHORIA PHORIA D>N DIVERGENCE INSUFFICIENCY PHORIA D <N CONVERGENCE EXCESS PHORIA D = N BASIC ESOPHORIA
- 16. BV PROBLEM ? D &N PHORIA NO SIGNIFICANT PHORIAD&N CONSIDER ACCOMMODATI VE PROBLEM INVESTIGATE AND ANALYZE ACCOMMODATIVE GROUP DATA ALL MINUS LENS TEST ARE LOW AI ALL PLUS LENS TEST ARE LOW AE PLUS AND MINUS TEST ARE LOW ACCOMMODA TIVE INFACILITY
- 17. NO PHORIA AND ACCOMMOADTIV EFINDINGS NORMAL CONSIDER FVD CONSIDER LATENT HYPEROPIA,VERTICLE CYCLOPHORIA ANISEIKONIA NO PHORIA AND ACCOMMOADTIVE FINDINGS NORMAL CONSIDER FVD ANALYZE DATA APPROPRIATE FOR FVD LOW PHORIA,LOW BI,LOW BO, LOW NRA AND PRA, LOW BAF
- 18. TYPES OF NSBDPRIMARY 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
- 19. REFERENCE • AK KHURANA,COMPREHENSIVE OPTHALMOLOGY • CLINICAL MANAGEMENT OF BINOCULAR VISION BY MITCHELL SCHEIMAN • COVD – WWW.COVD.ORG
- 20.