Worksheetsbinocular vision
Total questions: 30
Worksheet time: 30mins
A 22-year-old university student complains of intermittent diplopia after 30 minutes of reading. Cover test: 4Δ XP at distance, 16Δ XP at near. NPC: 12 cm, PFV at near: 6Δ/10Δ/6Δ. Vergence facility with 12 BO/3 BI flippers: 5 cpm. Sheard's criterion is not met.
What is the most likely diagnosis?
Fusional Vergence Dysfunction
Basic Exophoria
Convergence Insufficiency
Divergence Excess
Which of the following clinical findings BEST differentiates Basic Esophoria from Convergence Excess?
AC/A ratio
NPC
Distance BO range
NRA/PRA findings
A 30-year-old reports severe frontal headaches after near tasks. CT: Ortho at distance, 8Δ EP at near. AC/A ratio is 8:1. NRA is +2.75D. Which is the most likely finding?
Decreased BI ranges at near
Low BAF with -2.00 lenses
Decreased PFV at distance
Low NRA
In Fusional Vergence Dysfunction, which of the following is typically NORMAL?
Phoria
Vergence Facility
Positive and Negative Fusional Vergence
NPC
Which of the following conditions is characterized by low NRA, reduced positive fusional vergence, and a tendency toward esophoria at near?
Basic Esophoria
Convergence Excess
Accommodative Excess
Divergence Insufficiency
Which vergence parameter is MOST useful for monitoring improvement in Convergence Insufficiency during therapy?
Near BI recovery
NPC
Vergence Facility
Distance BO range
Which patient presentation best fits Divergence Insufficiency?
8Δ EP at distance, ortho at near, low AC/A
6Δ XP at distance, 16Δ XP at near, normal AC/A
Ortho at distance, 10Δ EP at near, high AC/A
Intermittent exotropia greater at distance than near
A child with reading difficulties has normal phorias but reduced both BO and BI ranges, low vergence facility, and normal accommodation. Diagnosis?
Basic Exophoria
Fusional Vergence Dysfunction
Accommodative Infacility
Latent Hyperopia
A patient fails +2.00 on BAF but passes monocularly, NPC is normal, phoria is ortho, and vergence ranges are full. Which is MOST likely?
Accommodative Excess
Fusional Vergence Dysfunction
Accommodative Infacility
Binocular Infacility
You prescribe a base-in prism for a patient with 12Δ XP at near. After 2 weeks, symptoms reduce, but NPC remains poor. What should be your next step?
Increase prism power
Begin vision therapy for convergence
Add plus lenses for near
Recheck refraction
Which of the following is the MOST sensitive test for detecting mild Convergence Insufficiency?
Near point of convergence
Vergence facility
Stereopsis
AC/A ratio
Case: A 20-year-old complains of blurred vision at near after 10–15 minutes of reading. CT: Ortho at distance, 10Δ XP at near. NPC: 15 cm with break, 12 cpm BAF (+2.00/−2.00). PFV at near: 4/10/4.
Which of the following would MOST LIKELY benefit the patient?
Base-out prism
Pencil pushup therapy
Plus addition lenses
Loose lens accommodative therapy
Case: A 28-year-old presents with symptoms of visual fatigue at near. CT: 8Δ EP at both distance and near. AC/A = 4:1. PFV at near: 14/20/12. NFV at near: x/5/3. Vergence facility (BI/BO) is 4 cpm.
Diagnosis?
Fusional Vergence Dysfunction
Basic Esophoria
Convergence Excess
Accommodative Excess
Case: A teenager has headaches and avoidance of reading. CT: 10Δ XP near, 3Δ XP distance. NPC: 20 cm. BAF: 3 cpm. Monocular Facility: 10 cpm.
What’s the most targeted diagnosis and first therapy step?
Basic Exophoria – Jump convergence
Convergence Insufficiency – Brock string training
Accommodative Infacility – Lens flippers
Divergence Excess – Distance therapy
Case: A 40-year-old has binocular blur at near. CT: Ortho. PFV and NFV at near are normal. BAF: Fails −2.00, passes +2.00. Monocular Facility: Fails −2.00, passes +2.00.
Diagnosis?
Accommodative Infacility
Fusional Vergence Dysfunction
Convergence Excess
Basic Esophoria
Case: Patient has reduced comfort when watching 3D movies. CT: Ortho. Stereopsis: 100 arcsec. Vergence facility: 4 cpm with 12BO/3BI. Normal NPC.
Most likely diagnosis?
Intermittent Exotropia
Fusional Vergence Dysfunction
Latent Hyperopia
Accommodative Excess
Case: A 15-year-old presents with asthenopia, especially after studying. CT: 8Δ XP near, 3Δ XP distance. Normal accommodation. MEM = +0.25.
Which therapy component is LEAST useful initially?
Cat card
Pencil pushup
Lens flipper ±2.00
Brock string
Case: A child exhibits excessive head tilting and squinting during reading. CT: 2Δ EP distance, 14Δ EP near. AC/A = 8:1.
What is the preferred initial management?
Vision therapy for convergence
Plus addition at near
Base-out prism
Monovision correction
In the Bagolini test, a patient with a right esotropia sees one complete oblique line and a partial line missing on the left side. Interpretation?
Normal fusion
Diplopia with suppression scotoma
Suppression of the left eye
ARC in the right eye
Which of the following findings contradicts a diagnosis of harmonious ARC?
Normal stereopsis
No diplopia or confusion despite manifest deviation
Fusion at the angle of anomaly
Misaligned after-images in test
Which clinical technique allows quantification of the angle of anomaly in binocular vision anomalies?
Synoptophore
Worth 4 Dot
Cover test
Bagolini test
A patient with esotropia shows no fusion on the synoptophore and cannot superimpose fusion slides. What is most likely impaired?
Motor fusion
Sensory fusion
Vergence adaptation
Proximal convergence
Which test is least affected by a patient’s conscious responses and most useful in diagnosing central suppression in children?
Random Dot Stereogram
Worth 4 Dot
Bagolini Striated Glasses
4Δ Base-Out Test
Case: A 7-year-old presents with a 15Δ esotropia. On synoptophore, fusion slides are aligned at 0°, but the patient has no stereopsis. After-image test shows misaligned foveal tags.
Diagnosis?
Diplopia
Suppression
ARC
Binocular confusion
Case: A 17-year-old orthotropic patient post XT-surgery has fusion at near but reports diplopia at distance. Bagolini: two separated lines at distance. Worth 4 Dot: 5 lights at distance.
Most appropriate interpretation?
Divergence excess
Diplopia with stable fusion
Decompensating ARC
ARC breakdown at distance
Case: A 20-year-old with decompensating phoria presents with headaches, blurred vision, and reduced reading span. Worth 4 Dot: fusion. Stereo: 60 arcsec. Recovery ranges: poor BO, normal BI.
Diagnosis?
CI with suppression
Basic exophoria with ARC
Convergence insufficiency
Latent deviation with diplopia
Case: A patient with vertical diplopia post-trauma shows fusion on Worth 4 Dot and Bagolini, but tilted images on synoptophore.
What does this indicate?
Cyclotropia
Diplopia with suppression
Normal BSV
Unharmonious ARC
Case: A 10-year-old child presents with complaints of intermittent double vision. On cover test, a 25Δ exophoria is observed. She reports symptoms mainly during near tasks. Her near point of convergence is 15 cm.
Which orthoptic management is most appropriate?
Convergence exercises
Fresnel prisms
Prism adaptation therapy
Vision therapy with divergence exercises
Case: A 40-year-old patient presents with intermittent double vision. On cover test, there is a latent exotropia of 10Δ. The patient reports that the double vision occurs mainly in low light conditions or after prolonged periods of reading.
What is the most likely diagnosis?
Intermittent exotropia
Divergence insufficiency
Divergence excess
Convergence insufficiency
Case: A 23-year-old patient presents with intermittent diplopia, mainly after prolonged near work. Cover test reveals 12Δ esophoria at near, and near point of convergence is 7 cm. The patient’s stereoacuity is reduced to 1200 arcseconds at near.
What is the most likely diagnosis?
Convergence excess
Convergence insufficiency
Divergence insufficiency
Vertical strabismus
