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Diagnostic and Correction of Heterophoria

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Diagnostic and Correction of Heterophoria MASARYK UNIVERSITY FACULTY OF MEDICINE Diagnostic and correction of heterophoria DIPLOMA THESIS Masters thesis facilitator: Name of autor: doc. MUDr. Svatopluk Synek,CSc. Bc. Sonja Drugović Brno, June 2017 MASARYK UNIVERSITY FACULTY OF MEDICINE Department of Optometry and Orthoptics ANNOTATION: NAME: Bc. Sonja Drugović SPECIALIZATION: Optometry THEME OF THE WORK: Diagnostic and correction of heterophoria LEADER OF THE WORK: doc. MUDr. Svatopluk Synek,CSc. YEAR: 2017 The presented master`s thesis describes the methods and principles of diagnostic and correction of heterophoria. In theoretical part I focus on metods examinating and measuring of heterophoria in optometry practice. There are show their possible solutions with prismatic correction. In practical part I meassuaring of heterophoria with using Madox teching and Von Grafee tests. The last chapter is focused on full correction of the measured heterophoria and treatment of heterophoria. Key words: heterophoria, mesurement of heterophoria, orthophoria, prism correction Statutory Declaration I declare that I have developed and written the enclosed Master Thesis completely by myself, and have not used sources or means without declaration in the text. Any thoughts from others or literal quotations are clearly marked. The Master Thesis was not used in the same or in a similar version to achieve an academic grading or is being published elsewhere. I agree with archiving of this thesis in the library of the Medical Faculty in Masaryk University. ………………………. 15.04.2017. Zagreb Bc. Sonja Drugović Acknowledgment: I would like to thank doc. MUDr. Svatopluk Synek, CSc. leader my thesis whose help and encouragement was unwavering throughout the study. Its support and expertise is invaluable. I would like to also thank Mgr.Beneš and Mgr.Veselý for their assistence. Finally, I want to thank all my colleagues at the Department of Optometry on University of Applied Sciences Velika Gorica for general help and encouragement. Content: 1. BINOCULAR SINGLE VISION .......................................................................................................................... 1 1.1. Grades of Binocular Vision....................................................................................................................... 1 1.2. Anatomy and the physiology of ocular movements ................................................................................ 2 1.3. Fusional reserves ..................................................................................................................................... 5 1.4. Accommodative Convergence/Accommodation AC/A ........................................................................... 5 1.4.1. Gradient method .................................................................................................................................. 6 1.4.2. Heterophoria method ........................................................................................................................... 6 2. DISORDES OF BINOCULAR VISION ................................................................................................................ 7 2.1. Heterotropia (manifest strabismus) ........................................................................................................ 7 2.2. Pseudostrabismus .................................................................................................................................... 9 2.3. Eccentric fixation ..................................................................................................................................... 9 2.4. Abnormal retinal corespodence ............................................................................................................ 10 2.5. Heterophoria (latent strabismus) .......................................................................................................... 10 3. THE USE OF PRISMS IN THE DIAGNOSIS OF OPTOMETRY - SUBJECTIVE METODES .................................... 13 3.1. Maddox rod ........................................................................................................................................... 13 3.2. Maddox wing ......................................................................................................................................... 14 3.3. Modified Thorington test ....................................................................................................................... 14 3.4. Von Graefe technique ............................................................................................................................ 15 3.5. Polarized cross test ................................................................................................................................ 16 3.6. Shober test............................................................................................................................................. 16 3.7. Synoptophore ........................................................................................................................................ 17 3.8. Worth test ............................................................................................................................................. 18 3.9. Bagolini test ........................................................................................................................................... 19 4. THE USE OF PRISMS IN THE DIAGNOSIS OF OPTOMETRY - OBJECTIVE METODES ....................................... 20 4.1. The Hirschberg test ................................................................................................................................ 20 4.2. The Krimsky Method .............................................................................................................................. 21 4.3. Angle kappa ........................................................................................................................................... 22 4.4. Cover test ............................................................................................................................................... 23 5. GRAFICAL ANALYSIS OF NORMAL AC/A RATIO .......................................................................................... 25 5.1. Donders diagram ................................................................................................................................... 25 5.2. Sheard's criterion ................................................................................................................................... 25 5.3. Percivals criterion .................................................................................................................................. 26 5.4. MHK ....................................................................................................................................................... 27 6. PRISM ......................................................................................................................................................... 28 7. EXAMINATION ........................................................................................................................................... 32 7.1. Patient History ....................................................................................................................................... 32 7.2. Direct observation ................................................................................................................................. 33 7.3. Measuring Pupillary Distance (PD) ........................................................................................................ 33 7.4. Symptoms of decompensation .............................................................................................................. 34 8. THE TREATMENT OF OCULOMOTOR ANOMALIES ...................................................................................... 36 8.1. Correct the refractive error .................................................................................................................... 36 8.2. Modification of refractive error ............................................................................................................. 36 8.3. Orthoptic exercises ................................................................................................................................ 36 8.4. Therapeutic prisms ................................................................................................................................ 38 8.5. Surgery .................................................................................................................................................. 39 8.6. Botulinum Toxin A ................................................................................................................................. 39 9. EXPERIMENTAL SECTION ............................................................................................................................ 40 9.1. Hypothesis ............................................................................................................................................. 41 9.1.1. Hypothesis 1 ....................................................................................................................................... 41 9.1.2. Hypothesis 2 ......................................................................................................................................
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