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1. 2. 3. 4. Vertical Prism Dissociation Successive alternate occlusion Blurring technique ( Humphriss Immediate Contrast Binocular refraction
Purpose
Purpose 1. To Equalize the Accommodation stimulus of two eyes. 2. To relax the accommodation of the two eyes.
Indication
Use only when both eyes have equal MSR VA. If MSR VA and accommodation are different between R and L eye use Prism dissociated Duochrome.
Procedure
1. 2. 3. 4. Fogging both eyes +1.00 Isolate a line of letters (~20/40) Put 3BU over OD and 3BD over OS Make sure PT can see 2 lines of letters, If not, Add more Prism equally for both eyes 5. Instruct Pt to compare 2 lines
Vertical Prism-Dissociation
Copy from ICEE note
Right eye: 3 BU Left eye: 3 BD Note: Equal amount of Prism in each eye
prism
Image
1 cm
1m
Base down
Objective
Procedure( cont.)
6. Give +0.25 to clearer eye( to blur the eye), until both eyes looks equal (Endpoint)
If the clearer eye still looks better after reduce the VA twice (give +0.50) should give -0.25 to the worse eye (to make the worse eye looks better)
Example 1. Balanced at RE +3.00 LE +3.50, indicating that the sphere difference should be 0.50 D, not 0.25 D as suggested by the monocular results Do the Binocular MPMVA.
Record
Binocular Balance + Binocular MPMVA OD +2.00-1.00x165 VA20/15 OS +2.00-1.00x010 VA20/15
T
N B
A
H G
M X
T
B
O
P
N
A
G
Images seen simultaneously with 3 BU right eye 3 BD left eye Right eye sees the lower image, left eye the upper image.
Z
D
H T
D A
O
F
H
Red
Green
Blurred
F
B
H X M
P
Z
D
T
T
N B
A
H G
M X
T
B
O
P
N
A
G
K H N Z D B
D Z N H K
Z
D
H T
D A
O
F
H
A D
F
B
H X M
K H N Z D B
D Z N H K
Each eye sees one chart. The red and green sides within each image are compared for clarity.
Binocular Balance
1. 2. 3. 4. Vertical Prism Dissociation Successive alternate occlusion Blurring technique ( Humphriss Immediate Contrast Binocular refraction
Requires occluder
Procedure
Initial target:20/50 Fog +1.00D OU Compare OD to OS Ask pt Which is clearer? Give +0.25D to the clearer eye Endpoint= both eyes most equally clear Slowly add minus OU -> MPMVA
Binocular Balance
1. 2. 3. 4. Vertical Prism Dissociation Successive alternate occlusion Blurring technique ( Humphriss Immediate Contrast Binocular refraction
Blurring technique
Can be used when VA is slightly unequal Have peripheral fusion lock Requires duochrome target Disadvantages:
Not for hyperopes Not everyone is good responder to Duochrome target
Procedure
Initial target: R/G target Minimal light Fog OS by +1.00D Red-side clear-> add-0.25D Green-side clear-> add+0.25D Endpoint= both sides equal or minimum minus lens-> green-side clearer or red-side clear Fog OD by +1.00D Unfog OS and perform test (Same endpoint criteria as OD) Fog OS by +1.00D Slowly add minus OU -> MPMVA
Binocular Balance
1. 2. 3. 4. Vertical Prism Dissociation Successive alternate occlusion Blurring technique ( Humphriss Immediate Contrast Binocular refraction
Binocular refraction
Have peripheral fusion lock More accurately determine cylinder axis Good for hyperopes, anisometropes, pt with nystagmus, binocular vision problem. OD and OS VAs must be 20/25 Performed after retinoscopy
Procedure
Initial Target: appropriate subjective refraction target. Fog OS until VA=20/50 Perform subjective refraction (initial sphere, JCC, refine sphere) on OD while OS is fogged Fog OD by +1.00D Perform refraction on OS Fog OS by +1.00D Slowly and minus OU -> MPMVA