Differential Diagnosis - Pacific University

5/31/2012
TBI Case: Accommodative Findings
• Amplitude:
▫ OD: 5.25/4.75D
▫ OS: 5.00/4.75D
• Accuracy: MEM (+0.50)
• Facility: +/-2.00 flippers
▫ 2.00D too difficult
▫ 1.50D OD: 4.5cpm
▫ 1.50D OS: 11cpm
▫ 1.50D OU: Suppression
• Binocular Cross-Cyl: +0.75 (varied +0.25 to+1.00)
• NRA, PRA
▫ +3.50/+2.75, -1.50/-1.25
Accommodation/Vergence Relationship
• Low PRA
▫ Decreased accommodative amplitude and/or
decreased negative fusional vergence (BI)
• Low NRA
▫ Reduced ability to relax accommodation and/or
decreased positive fusional vergence (BO)
TBI Case: Vergence Findings
• Gross Convergence
▫ 18 inches
• Near Vergence Ranges
▫ Phoropter: smooth, in-instrument
• BO: 34/34/18
• BI: 24/28/15
▫ Prism bar: jump vergence, free-space
• BO: 20/14
• BI: 10/8
TBI Case: Other Testing
• Visual Midline Shift:
Negative
• DEM (Developmental Eye
Movement test) Tests for
Saccadic Dysfunction:
H/V ratio: 7 th percentile
TBI Case: Other Testing
• Motor-Free Visual Perceptual Test, Edition 3
(MVPT-3): Age equivalent: 18 years. Most
difficulty with figure ground and form constancy
TBI Case: Assessment and
Recommendations
• Assessment
▫ Accommodative Insufficiency and Infacility
▫ Gross Convergence Insufficiency (possibly
secondary to accommodative dysfunction)
▫ Decreased Visual Perceptual Skills
• Recommendations
▫ Vision therapy to improve visual efficiency and
reduce symptoms
▫ Re-evaluate vertical deviation
Coursebook Page 21 of 139
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