Course Code: Clinical Optometric Practice 1

Module #7

Name: RANON, LYAN ANACLETO Q.

DAY 7 AFTERNOON SESSION :

PM Lesson 8- Part 5 Title: FUNCTIIONAL TESTS BY VON GRAEFE
OR THE OPTOMETRIC EXTENSION PROGRAM TESTS (OEP)
Lesson Objectives:
1. To be able to perform correctly the Functional tests.
2. To be able to determine the cause of the visual problem of the Px whether it be accommodative,
refractive or binocularvision problem.

Activity 1: What I Know Chart, part 1 (3 mins)

What I Know Questions: What I Learned (Activity 4)

a) #4 Static Retinoscopy 1. Give the tests for  #4 Static Retinoscopy
b) # 5 Dynamic Retinoscopy@ 20in accommodation  # 5 Dynamic Retinoscopy@ 20in
c) # 6 Dynamic Retinoscopy @40 in system?  # 6 Dynamic Retinoscopy @ 40in
d) # 7 Distant Subjective Test  # 7 Distant Subjective Test
e) # 14 A Dissociated Cross CylTest  # 14 A Dissociated Cross Cyl
f) # 14 B Binocular/ Fused CrossCyl. Test
Test  # 14 B Binocular/ Fused Cross
g) # 19 A & B Amplitude of Cyl. Test
Accommodation  # 19 A & B Amplitude of
h) # 20 Positive Relative Accommodation
Accommodation  # 20 Positive Relative
i) # 21 Negative Relative Accommodation
Accommodation  i) # 21 Negative Relative
Accommodation

a) # 9 True Adduction @ Far 2. Give the tests for  # 9 True Adduction @ Far
b) # 10 Convergence @ Far vergence system?  # 10 Convergence @ Far
c) # 11 Abduction @ Far  # 11 Abduction @ Far
d) # 16 A Positive Relative  # 16 A Positive Relative
Convergence Convergence
e) # 16 B Positive Fusional  # 16 B Positive Fusional
Reserve Reserve
f) # 17 A Negative Relative  # 17 A Negative Relative
Convergence Convergence
g) # 17 B Negative Fusional  g) # 17 B Negative Fusional
Reserve Reserve
 Course Code: Clinical Optometric Practice 1
Module #7

Name: RANON, LYAN ANACLETO Q.

a) # 3 Habitual Phoria @ Far 3 Give the  # 3 Habitual Phoria @ Far
b) # 13 B Habitual Phoria @ near Lateralphoria  # 13 B Habitual Phoria @ near
c) # 8 Induced Phoria @ Far/ tests?  # 8 Induced Phoria @ Far/
d) # 13 B Induced Phoria @ near  # 13 B Induced Phoria @ near
e) # 13 B + 1.00 Gradient AC/ATest  # 13 B + 1.00 Gradient AC/A
f) # 15 A Induced Phoria Thru Test
Unfused Cross Cyl.  # 15 A Induced Phoria Thru
g) # 15 B Induced Phoria ThruFused Unfused Cross Cyl.
Cross Cyl.  g) # 15 B Induced Phoria Thru
Fused Cross Cyl.

Activity 3: Create your own mnemonics that will help you remember the following:

1.Equipment used test # 15 A

Purify Over Cause Pollution Contaminate

• Phoropter head
• Overhead Lamp
• Cross grid
• Prisms
• Cross cyl

2. Give the expected responses of test #15 B

Up right, Up left, Top, and One

 One upper right and one lower left
 One upper left and one lower right
 One on top of the other
 One target only
 Course Code: Clinical Optometric Practice 1
Module #7

Name: RANON, LYAN ANACLETO Q.

3. Steps on test # 14 A

T-16, P-near, T-cross, L-new, P-Over, IN Mindanao A and

B.
• TD – 16 inches
• PD – near PD
• TT – Cross grid
• LP - New Rx subjective findings # 7, total near for presbyope
• PP – Occlude the Px while you are adjusting the prisms
OD 3 BU
OS 3 BI
Inst. – 1) As you open both eyes, you tell the Px that he will see two cross grid one on top
of the other.2) Ask him to compare the vertical lines & the horizontal lines above & below if they
are equal in intensity3) If equal,

METHOD A FOR EQUALITY OF LINE TARGET AT THE START OF THE TEST

a) place the cross cylinder red dot along 90 degrees , then ask him to report if
the vertical lines will become darker , as you add plus lenses over and above the
lens in place.
b) Once the Px report that the vertical line are darker, instruct the Px to
report if there is equality of line target as you reduce the plus lenses.
c) Record the Lens w/c gives equality of line targets.

METHOD B FOR NO EQUALITY OF LINE TARGET AT THE STAR OF THE TEST

a) Add +0.50 D over & above the LP, then ask if there is already equality of line target. If
yes , perform Method A.
b) If not ask the Px what line is darker, the horizontal or the vertical ?

c) Set the cylinder axis 90 degrees from the darkest line

d) Instruct the Px to report if the lines will be equal
e) Introduce cylinder lens in 0.25 D steps until there is equality of line targets
f) Place the cross cyl red along 90 degrees and perform Method A. This time with the
incorporation with the cylinder lens.
g) Record the lens w/c the Px reports equality of line target with cyl component

Activity 4: What I Know Chart, part 2 (2 mins)

 Course Code: Clinical Optometric Practice 1
Module #7

Name: RANON, LYAN ANACLETO Q.

Activity 5: Check for Understanding (5 mins)

A.What is the test target in test # 14 B? (5pts)

The test target in #14 B in the cross-grid chart

B.Give the equipment’s used in test # 14A? (10pts.)

• Phoroptor head
• Overhead Lamp
• Prisms
• Cross Cylinder
• Cross grid card

C.Give the equipment’s used in test # 14 B? (10 pts)

• Phoroptor head
• Overhead Lamp
• Cross Cylinder
• Cross grid card

D.Give the expected responses of test 15B? (10 pts)

• One upper right and one lower left
• One upper left and one lower right
• One on top of the other
• One target only

E.Case Analysis: Case 1 (3pts.)

In Test # 14A, Px reports vertical lines are sharper in test #14 B at the start of the test, the
examiner turns the JCC red dot along 180 and ask again if w/c line are sharper. The Px’S
response, is that the vertical lines are still sharper. What does that indicate? How do you
record?
Indicates vertical preference and record #14 B VERTICAL PREFERENCE
 Course Code: Clinical Optometric Practice 1
Module #7

Name: RANON, LYAN ANACLETO Q.

F. Case Analysis: Case 3
a In test # 14A, The Px is 45 yrs. Old, # 7 finding is OU – 1.00 D add 3.00 D with a
Far VAcc OU 20/25, and near VAcc 20/20. PD is 64/61. Answer the following to
start with in test #14A
TD – 16 inches
TT – Cross grid
PD – 61 mm
LP - +2.00 D
PP – OD 3 Base up, OS 3 Base down
Auxiliary lens - JCC
Instructions: – 1) As you open both eyes, you tell the Px that he will see two cross grid
one on top of the other. 2) Ask him to compare the vertical lines & the horizontal lines above &
below if they are equal in intensity 3) If equal,
Method : METHOD A FOR EQUALITY OF LINE TARGET AT THE START OF THE
TEST
a) place the cross cylinder red dot along 90 degrees , then ask him to report if
the vertical lines will become darker , as you add plus lenses over and above the
lens in place.
b) Once the Px report that the vertical line are darker, instruct the Px to
report if there is equality of line target as you reduce the plus lenses.
c) Record the Lens w/c gives equality of line targets.
METHOD B FOR NO EQUALITY OF LINE TARGET AT THE STAR OF THE TEST
a) Add +0.50 D over & above the LP, then ask if there is already equality of line target. If
yes , perform Method A.
b) If not ask the Px what line is darker, the horizontal or the vertical ?
c) Set the cylinder axis 90 degrees from the darkest line
d) Instruct the Px to report if the lines will be equal
e) Introduce cylinder lens in 0.25 D steps until there is equality of line targets
f) Place the cross cyl red along 90 degrees and perform Method A. This time with the
incorporation with the cylinder lens.
g) Record the lens w/c the Px reports equality of line target with cyl component

C. LESSON WRAP-UP
1) Activity 6: Thinking about Learning (5 mins)

1) INSTRUCTION: Please mark your work w/c have been accomplished so that you will know how
much workthere is left for you to do.

1.How was your learning experience?

-It was great that this module taught me so many things.

3. What topic you find it easy and what topic you find it hard for yo?
-None so far, but I know I have to practice more the different test on this module.
 Course Code: Clinical Optometric Practice 1
Module #7

Name: RANON, LYAN ANACLETO Q.

DAY 7 MORNING SESSION :
AM Lesson 8- Part 4 Title: FUNCTIIONAL TESTS BY VON GRAEFE
OR THE OPTOMETRIC EXTENSION PROGRAM TESTS (OEP)

Activity 1: What I Know Chart, part 1 (3 mins)

What I Know Questions: What I Learned (Activity 4)
a) #4 Static Retinoscopy 1. Give the tests for  #4 Static Retinoscopy
b) # 5 Dynamic Retinoscopy@ 20 accommodation  # 5 Dynamic Retinoscopy@
in system? 20in
c) # 6 Dynamic Retinoscopy  # 6 Dynamic Retinoscopy @
@40 in 40in
d) # 7 Distant Subjective Test  # 7 Distant Subjective Test
e) # 14 A Dissociated Cross Cyl  # 14 A Dissociated Cross
Test CylTest
f) # 14 B Binocular/ Fused  # 14 B Binocular/ Fused
CrossCyl. Test CrossCyl. Test
g) # 19 A & B Amplitude  # 19 A & B Amplitude
ofAccommodation ofAccommodation
h) # 20 Positive Relative  # 20 Positive
Accommodation Relative
i) # 21 Negative Relative Accommodation
Accommodation  i) # 21 Negative Relative
Accommodation
a) # 9 True Adduction @ Far 2. Give the tests for  # 9 True Adduction @ Far
b) # 10 Convergence @ Far vergence system?  # 10 Convergence @ Far
c) # 11 Abduction @ Far  # 11 Abduction @ Far
d) # 16 A Positive Relative  # 16 A Positive Relative
Convergence Convergence
e) # 16 B Positive Fusional  # 16 B Positive
Reserve FusionalReserve
f) # 17 A Negative Relative  # 17 A Negative Relative
Convergence Convergence
g) # 17 B Negative Fusional  g) # 17 B Negative Fusional
Reserve Reserve
a) # 3 Habitual Phoria @ Far 3 Give the Lateral  # 3 Habitual Phoria @ Far
b) # 13 B Habitual Phoria @ near phoria tests?  # 13 B Habitual Phoria @ near
c) # 8 Induced Phoria @ Far/  # 8 Induced Phoria @ Far/
d) # 13 B Induced Phoria @ near  # 13 B Induced Phoria @ near
e) # 13 B + 1.00 Gradient  # 13 B + 1.00 Gradient
AC/ATest AC/ATest
f) # 15 A Induced Phoria  # 15 A Induced Phoria
ThruUnfused Cross Cyl. ThruUnfused Cross Cyl.
g) # 15 B Induced Phoria Thru  g) # 15 B Induced Phoria
Fused Cross Cyl. ThruFused Cross Cyl.
 Course Code: Clinical Optometric Practice 1
Module #7

Name: RANON, LYAN ANACLETO Q.

Activity 3: Create your own mnemonics that will help you remember the following:

1.Equipment used test #18 A

Put On Nice Purse

• Phoropter head
• Overhead Lamp
• Near acuity Snellen Chart that can isolate letters
• Prisms

2. Give the expected responses of test # 18 B

Bring Rica There

a) Break point- represent the point when the Px has used all his vertical vergence and can no
longer maintain single vision.
b) Recovery point – indicates that the retinal disparity induced by the prism has been decreased
to the point that the Px can access the vertical vergence system and regain single vision
c) There is “NO” blur finding for vertical vergence testing because accommodation does not
change during vertical vergence movement

3. Steps on test # 12 A

T-20, P-far, T-Best, L- New, P-Over, IN Manila

• TD – 20 ft.
• PD – Far PD
• TT – Best VA w/ new Rx from the subjective findings # 7
• LP - New Rx Power from the subjective findings # 7
• PP – Occlude the Px while you are adjusting the prisms
OD 12 Base In ( Dissociating prism)
OS 6 Base up ( measuring prism )
Inst. – 1) As you open the phoroptor, instruct the Px, Now you will see 2 targets one upper
right & one lower left .( Give your Px a time to see the targets). Report if the targets will
become horizontally aligned
• Method : Reduce 6 BU until the Px reports Horizontal alignment.

Activity 4: What I Know Chart, part 2

Activity 5: Check for Understanding (5 mins)

A.Why is there no blurring in test # 12 B? (10 pts)

The accommodation does not change during vertical vergence movement.

B.Give the equipment’s used in test # 18A? (10pts.)

• Phoroptor head
• Overhead Lamp
• Near acuity Snellen Chart that can isolate letters
 Course Code: Clinical Optometric Practice 1
Module #7

Name: RANON, LYAN ANACLETO Q.

• Prisms

C.Discuss the record in test # 12B with negative recovery, what does that indicat? (5 pts)
If there is a negative recovery then the recovery goes beyond zero to the opposite base.

D.Give the expected responses of test 18B? (10 pts)

a) Break point- represent the point when the Px has used all his vertical vergence and can
no longer maintain single vision.
b) Recovery point – indicates that the retinal disparity induced by the prism has been
decreased to the point that the Px can access the vertical vergence system and regain
single vision
c) There is “NO” blur finding for vertical vergence testing because accommodation does not
change during vertical vergence movement

E.Case Analysis: Case 1 (3pts.)

In Test # 12A, Px reports horizontal alignment with prism OD 12 BI ^, OS 1
BU ^, how do you Record and support your answer.
#12A 1 left hypo/ #12A 1 right hyper
F. Case Analysis: Case 3
In test # 18B, The Px is 48 yrs. Old, # 7 finding is OU – 1.00 D add 2-.00 D
with a Far VAcc OU 20/25, and near VAcc 20/20. PD is 65/61. Answer the
following for Px to start with in test #18B
TD – 16 Inches
TT- Reduced Snellen chart
PD- 61 mm
LP - +1.00D
PP -Occlude the Px while you are adjusting the prisms to ready to produce base up &
base down on both eyes, but manipulate one eye only.
Instructions: Please report if there is break/ recovery
Method: Choose what eye to manipulate that is convenient to you. Testing Supraduction: 3)
Introduce BD until break 4) Reduce BD until recovery Testing Infraduction : 3) Introduce BU
until break 4) Reduce BU until recovery • If the recovery goes beyond zero to the opposite
base there will be a negative recovery.

C. LESSON WRAP-UP
1) Activity 6: Thinking about Learning (5 mins)

2) INSTRUCTION: Please mark your work w/c have been accomplished so that you will know how
much workthere is left for you to do.
 Course Code: Clinical Optometric Practice 1
Module #7

Name: RANON, LYAN ANACLETO Q.

1.How was your learning experience?
-It was great that the first module
educated me a lot.

3.What topic you find it easy and what topic you find it hard for you ?
- None so far but I think I need more to practice in laboratory about some this in
this module.