BV 14 - strab tx

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Author:
sookylala
ID:
290606
Filename:
BV 14 - strab tx
Updated:
2014-12-04 07:25:04
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strabismus treatment
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Description:
strabismus treatment
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  1. Features and tx for constant XT?
    • basic exo, uni, rare, AC, early onset
    • poor prognosis for functional cure - tx difficult
    • surgery
  2. Intermittent XT- convergence insuf/basic XT?
    • sx, 25PD
    • good sensory fusion with stereo
    • vt and prism tx good w/o surgery
  3. intermittent XT- diverg excess?
    • exo/stereo near, suppression in dx
    • tx: build on fusion they have
  4. IST tx?
    • since nystagmus- penalisation with atropine
    • surgery as early as possible
    • prog poor for full functional cure even with surgery
  5. Accom acquired ST features?
    • angle varies with accom
    • >2D hyp
  6. accom acquired ST tx?
    • daytime emergency - treat right away otherwise may become partially accom (nonaccom component on top) intermittent->constant
    • tx:
    • 1. full rx + add will usually eliminate strab- eyes straight-image hitting both foveas-eliminate suppression
    • 2. amb therapy is necessary
    • 3. sensory fusion: increase fusion ranges and stereo
    • 4. no fusion: anti suppression tx
  7. Partial accom acquired ST?
    • >2D hyp
    • AC ef-rare, reduced stereo
    • uni- amblyopia
    • 12-18M of VT usually required
  8. Non accom acquired ST?
    • poor prog w/o surgery
    • onset >2YO + fusion, post surgery fusion chance
  9. Post surgery with acquired ST?
    • poor prog with VT, prism, lenses
    • scarring, fibrosis, limitation of gaze
    • no stereo
  10. What are the 6 phases of tx?
    • 1. establish initial optical correction
    • 2. improve MV functioning
    • 3. establish normal peripheral fusion
    • 4. establish normal central fusion
    • 5. obtain bv in free space
    • 6. Maintenance program
  11. steps in establishing an initial optical correction?
    • 1. optimum lenses
    • 2. prism
    • 3. occlusion therapy
  12. Optimum lenses goals?
    • improve retinal clarity
    • improve VA
    • decrease strab
    • obtain sensory fusion
    • improve motor fusion
  13. Prescribing for optimum lenses?
    • full cyclo rx in preschoolers
    • if >5yo -0.5 to -1D symmetrically
  14. ST + myopia rx?
    • least plus + ADD: bifocal
    • may increase angle
    • prism
  15. XT + hyp rx?
    least plus to best VA
  16. Relieving, correcting, training prism?
    • Relieving: partial prism
    • correcting: full prism
    • training: excess prism to train fusion

    if no sensory function with prism: DO NOT PRESCRIBE
  17. Phase 2?
    • improve accomm
    • improve OM and hand eye
    • improve pursuit and saccades
    • reassess sensory function after phase 2 goals achieved
  18. Phase 3?
    • establish normal peripheral fusion
    • eliminate peripheral suppression
    • eliminate AC
    • stabilise normal peripheral sensorimotor skills
  19. How to manage AC?
    • cant train out AC and leave deviation - diplopia
    • difficult
    • treated alongside suppression
    • tx: overprescribe prism, synoptophore flashing, after images on fovea, occlusion if constant strab
  20. Phase 3 tx?
    • dark room, no central contours or small details
    • target at obj angle for ST, ortho for XT
    • occlusion
    • VT
  21. VT steps for phase 3?
    • 1. appropriate enviro: light, dark etc
    • 2. suppression breakers: flashing, moving, prism out of zone
    • 3. mental hold: get them to see it once, then try get them to hold it, hold it counting, see if they can hold it with prism
    • 4. increase sensory and motor fusion demand: BI/BO, flippers, use smaller targets
  22. Phase 4?
    • establish normal central fusion
    • eliminate central suppression
    • improve shallow amblyopia
    • stabilise efficient central sensorimotor skills
  23. Phase 4 tx?
    • 1. if suppression broken in stage 3-> red/green targets-¬†use smaller and smaller targets- more small detail, central contours
    • 2. add/remove prism: increase fusional ranges
    • 3. reassess angle- sensory fusion increases, angle decrease, amb improves
  24. Phase 5 considerations?
    • relieving prism?
    • strab surgery?
    • stabilise accom and vergence efficiency?
  25. Phase 5 prism?
    • still may be small deviation left by this stage- prescribe prism to get eyes to fuse
    • <20PD prescribe
    • >20PD surgery
  26. Surgery in phase 5 amount of deviation?
    • >20PD ST
    • >25PD XT
    • >10PD vert
  27. What are the 3 groups referred for surgery?
    • 1. cosmesis cure
    • 2. poor prog for functional cure: large angle and >6/24
    • 3. good prog: large angle with bcrx, shallow amb, good sensory fusion, motor fusion ranges expanded
  28. How to stabilise accom and vergence efficiency in phase 5?
    • prisms
    • flippers
  29. Phase 6?
    • Home maintenance
    • Home AVT: antisuppression, vergence ranges, 3x10-20min/week
  30. When to re-evaluate after stage 6?
    • 1M, 3M, 6M, 1Y
    • 6M for adults
    • 1Y adults

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