Vicki Leung, O.D.

23161 Ventura Blvd, Suite 201 Woodland Hills, CA(818) 591-8860dr.leung@eyedocs.org

The Optometric Examination

Visual Acuity

Measuring Visual Acuity

Whole Chart – Standard

ES L

T O ZB P L OD F G AD A O SE G N U SF Z B D R

Measuring Visual Acuity

Line T O Z

F Z B D R

DEFOAE

Measuring Visual Acuity

LetterF

G

E

A

The Optometric Examination

Basic Binocular Vision Testing– Cover Test– Near Point of Convergence– Stereopsis

If Strabismus is present, a Strabismus Evaluation is indicated and should be performed by an eye doctor who evaluates and treats strabismus patients.

The Optometric Examination

Refraction– Objective methods: Retinoscopy and auto-

refraction– Subjective methods: Interactive with the patient,

“Which is better, one or two?”

Nystagmus patients may have high amounts of astigmatism that can go uncorrected. It is important to correct it.

The Optometric Examination

Eye Health ExaminationExternal Eye ExaminationInternal Eye Examination

Treatment of Idiopathic, Congenital Nystagmus

The comprehensive management for the nystagmus patient should include treatment of all associated conditions, as well as improve the characteristics of the nystagmus wave form.

Considerations for treatment:

1. Proper refraction and full correction GlassesPrisms Contact Lenses

Treatment of Idiopathic, Congenital Nystagmus

2. Addressing binocular vision concernsGlassesPrismsContact lensesVision therapy

Treatment of Idiopathic, Congenital Nystagmus

3. SurgeryStrabismus SurgeryNystagmus dampening surgery

Treatment of Idiopathic, Congenital Nystagmus

4. Vision Therapy - The Goal of Vision Therapy is not to dampen the nystagmus, but rather to improve visual acuity.

DEFINITIONS

ASTIGMATISM A refractive condition in which light rays do not focus at a single point, rather focus at 2 lines. Therefore, it requires 2 separate powers to bring both lines in focus to a single point.

AMBLYOPIA Any eye that doesn’t see 20/20, or for certain cases, a difference between eyes that is greater than 2 lines of acuity.

LAZY EYELaypersons term for amblyopia but many mistakenly use it to describe an eye turn.

DEFINITIONS

STRABISMUSAny eye turn, in or out, up or down, intermittent or constant. Can have a combination of directions (i.e. in and up)

– ESOTROPIA - Right or left eye turning inward (or alternating between eyes), can be a constant or intermittent turn.

– EXOTROPIA - Right or left eye turning outward (or alternating between eyes), can be a constant or intermittent turn.

– HYPERTROPIA – Right or left eye turning upward.

DEFINITIONS

DEPTH PERCEPTIONPerception of relative or absolute difference in distance of objects from the observer. Can occur with or without binocular vision. Perception of a third dimension.

STEREOPSISBinocular visual perception of three dimensional space, based on retinal disparity.

BINOCULAR VISIONPertaining to using both eyes simultaneously, so that each eye contributes to the image seen.

VISION THERAPY / ORTHOPTICSThe teaching and training process to improve visual perception and coordination of the 2 eyes. Goals include improving visual acuity, elimination of strabismus, comfortable binocular vision.

Vision Therapy

Traditional Vision Therapy (can be done both at home and at the doctor’s office)– Fusional Vergence Training– Anti-suppression Training

Brock String Tranaglyph R/G trainers

– Accommodation (focusing) Training

Vision Therapy

Foveation Tasks– Vertical line counting (may start at oblique angles)

Vision Therapy

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Vision Therapy

Foveation Tasks– Letter Counting Tasks

Vision Therapy

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Conclusions

Home Vision Therapy can be used to supplement or replace office-based therapy.

Home VT is designed to address binocular vision deficiencies as well as increase foveation, which generally leads to increased visual acuity.

A decrease in amplitude , frequency or intensity of the nystagmus does not necessarily lead to increased visual acuity.

Conclusions

Patients report successful treatment based on improved quality and comfort of vision.

Subjective improvement seems to be greater than the measured visual acuity.