ORTHOPTIC EVALUATION

DR. VARSHINI SHANKER DR. PUSHKAR DHIR

PATIENT PRESENTATION

• Diplopia• Pulling sensation• Poor Concentration

• Headache• Over the eyes• Strain

DR / DA

PMT (2-4PM, ALL DAYS EXCEPT SATURDAY)

AIM OF PRESENTATION

Importance of knowing Orthoptics Overview of Sports Vision N new fascinating stuffJinx of AC/A ratio measurementSynaptophore – made easy.

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.

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

WHAT ALL WE CHECK IN ORTHOPTICS?

1. CONVERGENCE2. ACCOMODATION

3. BSV ( SMP/ FUSION/ STEREOPSIS)

TOOLS FOR OBJECTIVE ORTHOPTIC EVALUATION

• a

•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

Discussion

NPA

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

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

SYNAPTOPHORE / MAJOR AMBLYOSCOPE

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

WHICH SLIDES TO PUT

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

SLIDE SIZE ANGLE SUBTENDED

FOVEAL 1 °

MACULAR 1-3°

PARAMACULAR 3-5°

PERIPHERAL >5°

SYNAPTOPHORE DISCUSSED

Orthoptic Tools - Therapeutic

• a

Less Than 20 Pd Exophoria /Tropia

Base Out Prism Exercise+

Dot Card Exercises

+/- Fusional exercises on

Synaptophore or Cat Card

Orthoptic Tools - Therapeutic

• a

• Near Point of Accomodation if > 10cms.

• Accomodative Infacility / Inertia < 10 cps.

Brock stringFlippersJump Convergence

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

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.

• THANK YOU EVERYONE FOR PATIENTLY LISTENING TO THIS SEMINAR &

• REQUEST U FOR NET NEUTRALITY • For feedbacks & brickbats plz mail at• ykush@yahoo.co.in./drdhir2014@gmail.com

TELL ME AND I FORGET, TEACH ME AND I MAY REMEMBER,

INVOLVE ME AND I LEARN