1. BINOCULAR DYSFUNCTION REMEDIATION I ACCOMMODATIVE THERAPY

2. Accommodative Dysfunctions Run along the vertical axis of the new fangled, BVA ‘O’ MATIC CHART Less severe: towards center More severe: towards periphery

3. PCE 2ºAE PCE 2ºAI CE AI AE PCI CI LOW HIGH LOW/ NORMAL HIGH/ NORMAL HIGH/ NORMAL LOW/ NORMAL

4. Accommodative Dysfunctions Off vertical axis: increased vergence involvement –Left: PCI or CI –Right: PCE (secondary to accommodative excess or insufficiency)

5. PCE 2ºAE PCE 2ºAI CE AI AE PCI CI LOW HIGH LOW/ NORMAL HIGH/ NORMAL HIGH/ NORMAL LOW/ NORMAL

6. Accommodative Insufficiency (AI) More severe at bottom edge Vergence is a secondary modality to address 5 accommodative activities first 2-3 sessions Incorporate 2 vergence activities after 2rd session

7. Accommodative Excess (AE) More severe at top edge Usually expect smaller “gains” each week of Tx compared with insufficiency Vergence is a secondary modality to address 5 accommodative activities first 3-4 sessions Incorporate 2 vergence activities after 3rd session

8. Accommodative Infacility (AInf) Towards periphery (usually a older, more severe cases) –Top: “Classic” accommodative infacility PLUSDiagnostic criteria for AE PLUS MINUS –Difficulty clearing MINUS (and plus) on monocular +/-2.00 facility Takes longer to remediate than other accommodative Dx

9. Accommodative Infacility Towards periphery (usually a older, more severe cases) insufficiency –Bottom: accommodative infacility with accommodative insufficiency AND...Diagnostic criteria for accomm. insufficiency AND... PLUS –Difficulty clearing PLUS (and minus) on monocular +/-2.00 facility Takes longer to remediate than AE and AI, but shorter than true infacility

10. Therapy Techniques for Accommodation Tx Monocular Hart Chart Rock: Monocular Lens Rock: Monocular window screen rock: Alternate occlusion methods (lens rock or far/near rock): *Red/Red Rock: *Binocular A/S Chart Rock:

11. Vergence Techniques for Accommodation Tx Brock string: –Add ladybug vergence –Add BI/BO flippers –Add BOP/BIM

12. Vergence Techniques for Accommodation Tx Vectogram: –Add spatial localization –Add BI/BO flippers –Add BOP/BIM Eccentric circles: –Add spatial localization –Add BI/BO flippers –Add BOP/BIM

14. Tips For Vision Therapy