BV 14 - strab tx
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BV 14 - strab tx
Features and tx for constant XT?
basic exo, uni, rare, AC, early onset
poor prognosis for functional cure - tx difficult
Intermittent XT- convergence insuf/basic XT?
good sensory fusion with stereo
vt and prism tx good w/o surgery
intermittent XT- diverg excess?
exo/stereo near, suppression in dx
: build on fusion they have
since nystagmus- penalisation with atropine
surgery as early as possible
prog poor for full functional cure even with surgery
Accom acquired ST features?
angle varies with accom
accom acquired ST tx?
daytime emergency - treat right away otherwise may become partially accom (nonaccom component on top) intermittent->constant
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
Partial accom acquired ST?
AC ef-rare, reduced stereo
12-18M of VT usually required
Non accom acquired ST?
poor prog w/o surgery
onset >2YO + fusion, post surgery fusion chance
Post surgery with acquired ST?
poor prog with VT, prism, lenses
scarring, fibrosis, limitation of gaze
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
steps in establishing an initial optical correction?
1. optimum lenses
3. occlusion therapy
Optimum lenses goals?
improve retinal clarity
obtain sensory fusion
improve motor fusion
Prescribing for optimum lenses?
full cyclo rx in preschoolers
if >5yo -0.5 to -1D symmetrically
ST + myopia rx?
least plus + ADD
may increase angle
XT + hyp rx?
least plus to best VA
Relieving, correcting, training prism?
: partial prism
: full prism
: excess prism to train fusion
if no sensory function with prism: DO NOT PRESCRIBE
improve OM and hand eye
improve pursuit and saccades
reassess sensory function after phase 2 goals achieved
establish normal peripheral fusion
eliminate peripheral suppression
stabilise normal peripheral sensorimotor skills
How to manage AC?
cant train out AC and leave deviation - diplopia
treated alongside suppression
: overprescribe prism, synoptophore flashing, after images on fovea, occlusion if constant strab
Phase 3 tx?
dark room, no central contours or small details
target at obj angle for ST, ortho for XT
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
establish normal central fusion
eliminate central suppression
improve shallow amblyopia
stabilise efficient central sensorimotor skills
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
Phase 5 considerations?
stabilise accom and vergence efficiency?
Phase 5 prism?
still may be small deviation left by this stage- prescribe prism to get eyes to fuse
Surgery in phase 5 amount of deviation?
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
How to stabilise accom and vergence efficiency in phase 5?
: antisuppression, vergence ranges, 3x10-20min/week
When to re-evaluate after stage 6?
1M, 3M, 6M, 1Y
6M for adults