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How to tailor your exam to diagnose CVS

Posted by Talin Amadian on February 9, 2022 at 9:00 AM
Talin Amadian
Dr. Talin Amadian is a practicing optometrist, writer and content contributor for Optoprep. She graduated from Western University of Health Sciences College of Optometry and continues to practice in Southern California. Her clinical training includes Neuro-Ophthalmology, Cornea and Refractive Surgery, Glaucoma and Ocular Disease. Dr. Amadian takes pride in educating patients and providing specialized care and education based on each patient’s needs. She is passionate about dry eye treatment and management. During her spare time, she enjoys mentoring and helping prospective optometry students succeed.

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eyeicon-1Each day you will encounter at least one patient, but likely more, with symptoms of computer vision syndrome.

Previously, we discussed symptoms to watch out for while performing your case history that will lead to computer vision syndrome or digital eye strain diagnosis. 

Your case history will give you a lot of information about CVS symptoms. These symptoms will be validated by your standard comprehensive exam.

However, to delve deeper, here are some examination components that will help you solidify your diagnosis. Depending on your practice setting, you may or may not already perform these tests in your standard protocol.

Understanding how to tailor these tests to your patient compared to how you were taught to perform them in school is also critical in determining where your patient’s eye strain is coming from. 

  • Accommodation testing
    • Amplitude of accommodation: Modify your working distance depending on device placement. You can also have your patient use their smartphone rather than your standard target. 
    • Accommodative facility: Similar to above, you can have your patient use their smartphone or other device at their preferred working distance.
    • Negative and positive relative accommodation: Perform at your standard working distance as well as at the patient’s appropriate preferred working distance. 
  • Vergence testing
    • Near point of convergence (NPC): Observe where the patient naturally holds devices and perform the testing in that direction as well. This can be straight ahead or slightly to the side. Always remember that eye alignment can change depending on gaze.
    • Distance and near heterophoria: Similar to NPC, pay close attention to the patient’s gaze direction and perform your testing in all necessary gazes. The patient can have normal results in primary gaze, but reduced results in the direction where they tend to place their devices. 
    • Base-in and Base-out vergence ranges: Perform your base-in and base-out vergence ranges for both distance and near. You can also modify your near working distance to the patient’s preferred computer-distance since that’s where they hold their gaze for the majority of the day. 
    • Stereopsis: Reduced stereopsis can be due to a variety of reasons, including uncorrected Rx. If you perform stereopsis without correction and it is reduced, try again with correction, even if it is the slightest bit of astigmatism. 

Use these exam modifications to see if they lead you closer to solving your patients’ problems. Remember, a thorough case history is always the first step!

~ Dr. Amadian

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Topics: CVS, computer vision syndrome

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