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Effect of heterophoria measurement technique on the clinical accommodative convergence to accommodation ratio.

BACKGROUND: Measurement of the stimulus accommodative convergence to accommodation (AC/A) ratio is a standard procedure in clinical optometric practice. Typically, heterophoria is assessed at several accommodative stimulus levels, and the gradient of the vergence to accommodation function computed. A number of procedures are available for the subjective measurement of heterophoria, but it is unclear whether the use of different vergence measurement techniques will alter the obtained AC/A value. Accordingly, the current study compared AC/A ratios measured using 3 clinical subjective heterophoria tests, namely the von Graefe (VG), Maddox Rod (MR), and Modified Thorington (MT) procedures. METHODS: The AC/A ratio was measured in 60 visually normal subjects between 20 and 25 years of age using each of the 3 procedures listed above. The accommodative stimulus was varied by the introduction of +/-1.00 diopter (D) spherical lenses over the distance refractive correction while subjects viewed a target at a viewing distance of 40 cm. To examine the repeatability of each procedure, the AC/A ratio was measured on 2 separate occasions for each measurement technique, with the 2 sessions being separated by at least 24 hours. RESULTS: Mean values of stimulus AC/A ratio measured using the VG, MR, and MT procedures were 3.47, 2.99, and 2.46Delta/D, respectively. These differences were significant (p=0.0001). In addition, the coefficient of repeatability for the 3 techniques was 2.22, 1.99, and 1.20 Delta/D, respectively. CONCLUSIONS: Ratios obtained using the Modified Thorington technique with +/-1.00 D lenses showed the best repeatability, whereas the poorest repeatability was found with the von Graefe technique when only +1.00 D lenses were used to vary the accommodative stimulus. Accordingly, we recommend that that Modified Thorington procedure with +/-1.00 D lenses be used to quantify heterophoria during clinical measurement of the stimulus AC/A ratio.

Accommodation, Ocular↗

Optometrists as key providers in the prevention and early detection of malignancies.

Optometrists have become active in many aspects of primary health care. Opportunities exist for optometrists to join other health care providers in the fight against cancer. The purpose of this article is to review information about cancer epidemiology, describe cancer screening guidelines, and to provide examples of ways for optometrists to become involved in promoting goals for reducing cancer risk and increasing the early detection of cancer. In addition to diagnosing ocular cancers and metastases to the eye and orbital region, optometrists may provide cancer information as part of their case history, provide positive health messages to reduce cancer risk factors, and directly observe signs of skin cancer.

Eye Neoplasms↗

Obviate.

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Humans↗