Jonah Patel
A sensorimotor exam is a comprehensive eye assessment that evaluates the coordination and functionality of both eyes. It delves into visual efficiency, including eye accommodation, vergence, and ocular motility, to ensure seamless binocular vision. This exam is particularly useful for individuals experiencing blurry vision, double vision, or difficulty focusing, as it identifies any underlying issues causing these symptoms. The test involves assessing eye teaming, depth perception, and eye movements, using techniques such as tracking moving targets, viewing 3D images, and focusing on objects at varying distances. By understanding the relative position of the eyes and their response to visual stimuli, optometrists can diagnose and treat conditions like amblyopia, strabismus, and convergence insufficiency.
| Characteristics | Values |
|---|---|
| Purpose | To evaluate how well the eyes work together as a team (binocular vision) and how effectively they respond to visual stimuli |
| Examination methods | Cover testing, evaluation of the light reflex with Hirschberg or Krimsky testing, neurological assessments, use of prisms to measure ocular deviation, stereo rings, stereo fly, Worth 4-dot, Maddox rod |
| Visual efficiency skills | Accommodation (eye focusing), vergence (eye teaming), ocular motility (eye tracking) |
| Visual processing skills | Identification and discrimination, spatial awareness, visual memory, visual motor integration |
| Eye movement | Ductions (uniocular rotations of the eye), versions (simultaneous rotations of both eyes in the same direction) |
| Depth perception | Looking at 3D images to test the ability to perceive distances accurately |
| Manifest misalignment | If the light reflex is displaced nasally, the patient has an exotropia; displaced temporally, esotropic; displaced inferiorly, hypertropic; displaced superiorly, hypotropic |
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What You'll Learn
- Binocular vision: how well eyes work together as a team
- Visual efficiency: accommodation, vergence, and ocular motility
- Visual processing: identification, spatial awareness, memory, and integration
- Neurological assessments: quantify sensory and motor aspects of extraocular muscles
- Cover testing: evaluate relative position of the eyes
Binocular vision: how well eyes work together as a team
Binocular vision, or eye teaming, describes the way the two eyes work together to integrate images seen by each eye into one image. The left and right eyes have their own line of vision, and in functional binocular vision, these two pathways fuse together to create a single, clear image. This process is known as macular perception. Binocular vision also provides a wide field of vision and precise depth perception.
Each eye receives an image of the object being viewed, which is then sent to the brain. The brain then compares and processes the different images into one single image. This single image is projected in front of the viewer through this eye-to-brain communication. The development of binocular vision is an active learning process that takes place in the visual cortex of the brain.
When the eyes are not properly aligned, the images of the object viewed are dissimilar, and double vision occurs. This is known as strabismus, which can be constant or intermittent. Constant strabismus means the patient never has proper eye teaming or binocularity, and they would see double all the time. Intermittent strabismus means a patient can have single vision when the eyes are teaming and double vision when they are not.
Binocular Vision Dysfunction (BVD) occurs when the eyes don't work smoothly together, leading to double vision, dizziness, headaches, and trouble reading. The brain has difficulty creating one clear image from the two out-of-sync images, and it responds by forcing the eye-aligning muscles to fix the problem by realigning the eyes. This misalignment-realignment cycle is the cause of BVD symptoms.
To correct BVD, patients are often prescribed eye-teaming exercises to improve the ability of both eyes to work well together. This treatment is often referred to as orthoptics or vision therapy, which is a doctor-prescribed program that includes a series of office visits. The goal of vision therapy is to improve the strength, flexibility, and efficiency of the visual system, retraining the brain and visual system to improve function.
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Visual efficiency: accommodation, vergence, and ocular motility
A sensorimotor exam for the eyes delves into visual efficiency and visual information processing skills. Visual efficiency includes accommodation (eye focusing), vergence (eye teaming), and ocular motility (eye tracking).
Accommodation
Accommodation refers to the eyes' ability to focus. Symptoms of a focusing problem may include blurred vision while reading, fatigue or headaches while reading (accommodative insufficiency/paresis), and/or inability to clear vision at a distance after reading (accommodative infacility/spasm). These issues can lead to double vision, frequent loss of place when reading, words moving on the page, headaches, eye strain, and an inability to sustain a visual task for a prolonged period.
Vergence
Vergence refers to the ability of the two eyes to work together in a precise and coordinated fashion, also known as eye teaming. If this does not occur, it may result in strabismus, where one eye turns in (esotropia) or out (exotropia) intermittently or all the time. Vergence of the eyes in the dark depends on the vertical direction of gaze, and this can be studied using eye inclinations and head tilts.
Ocular Motility
Ocular motility refers to eye tracking or the rotations of the eye. Ductions are uniocular rotations of the eye, while versions are simultaneous rotations of the two eyes in the same direction. Versions are typically tested first to evaluate subtle imbalances in eye movements. Ocular motility is noted on a scale from 0 to 4, with zero indicating normal ductions. Underaction is indicated with a minus sign and overaction with a plus sign.
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Visual processing: identification, spatial awareness, memory, and integration
A sensorimotor exam for the eyes goes beyond a regular eye exam, which typically focuses on eyesight and ocular health. The sensorimotor exam delves into visual efficiency and visual information processing skills. Visual processing skills include identification, spatial awareness, memory, and integration.
Identification
Identification is a visual processing skill that involves distinguishing objects or patterns from one another. This skill is essential for various tasks, such as recognising faces, reading text, or navigating environments.
Spatial Awareness
Spatial awareness refers to the ability to perceive and understand the space around oneself and objects in relation to oneself. It involves processing visuo-spatial information accurately. For example, a person with poor spatial awareness may struggle with tasks such as navigating their environment or coordinating their movements, such as when driving a car.
Memory
Visual memory is a complex process that involves encoding, storing, and retrieving visual information. It is an essential aspect of cognitive function, and its decline can be a central issue in neuropsychological examinations, especially in conditions such as Alzheimer's disease dementia. Assessing visual memory often involves tasks that require a visuomotor response, such as drawing or construction, which can reveal complex perceptual analysis and constructional abilities.
Integration
Visual motor integration refers to the ability to coordinate visual information with motor output. This skill is crucial for tasks such as writing, where the eyes must guide the hand, or driving, where visual information must be processed and acted upon. Impairments in this ability can lead to conditions like apraxia, where individuals struggle to perform complex movements, such as driving, despite understanding the required sequence of actions.
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Neurological assessments: quantify sensory and motor aspects of extraocular muscles
A sensorimotor exam evaluates how well your eyes work together and how effectively they respond to visual stimuli. It delves into visual efficiency and visual information processing skills. Visual efficiency skills include accommodation (eye focusing), vergence (eye teaming), and ocular motility (eye tracking). Neurological assessments are a part of every basic examination, but an extended test that quantifies the sensory and motor aspects of the extraocular muscles is a valuable diagnostic tool.
During a sensorimotor exam, an optometrist evaluates various aspects of your vision, such as eye teaming (how well both eyes work together), depth perception (the ability to perceive distances accurately), and eye movements (tracking and focusing abilities). Tests may involve following a moving target with your eyes, looking at 3D images to test depth perception, or focusing on objects at different distances. By conducting these tests, eye doctors can identify any issues with your visual system that may be impacting your vision and ability to perform daily tasks.
The relative position of the eyes can be assessed by multiple methods. Cover testing is usually preferred, but it requires that the patient has foveal fixation in both eyes, can move their eyes, and has sufficient attention and cooperation for the test. Evaluation of the light reflex with Hirschberg or Krimsky testing can be used if these criteria cannot be met. The examiner evaluates the symmetry of the corneal light reflex, which can be useful as an initial estimate of alignment. If the light reflex is displaced, it shows a manifest misalignment. The amount of displacement can be used to estimate the degree of misalignment.
Ductions are uniocular rotations of the eye, while versions are simultaneous rotations of both eyes in the same direction. Versions are typically tested first to help evaluate subtle imbalances in eye movements. If versions are not full, ductions may be tested on one eye with the other eye covered. Ocular motility is typically noted on a scale from 0 to 4, with zero indicating normal ductions. Underaction is indicated with a minus sign, and overaction with a plus sign.
When a quantitative sensorimotor examination is needed, prisms are used to measure ocular deviation, along with accompanying sensory function tests such as stereo rings, stereo fly, Worth 4-dot, and Maddox rod.
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Cover testing: evaluate relative position of the eyes
A sensorimotor exam for the eyes involves assessing ocular alignment, movement, sensory adaptation, and binocular function. It delves into visual efficiency and visual information processing skills. Visual efficiency skills include accommodation (eye focusing), vergence (eye teaming), and ocular motility (eye tracking).
Cover testing is a measurement of eye posture or eye alignment and is used to evaluate the relative position of the eyes. It is performed in two steps:
- Cover-uncover test: The clinician covers one of the patient's eyes with a hand or paddle and observes the movement of the uncovered eye. The cover paddle is then removed, and the clinician looks for movement in the previously covered eye. This step is used to identify strabismus (also called squint or tropia) and phoria (the "natural" eye position of a patient when fusion is disrupted). Strabismus is characterised by the movement of the uncovered eye, while phoria is identified by the movement of the previously covered eye.
- Alternating cover test: The clinician covers one eye and then moves the paddle to the other eye, observing both eyes for subtle movements. This step is called the alternating cover test, and it helps determine the magnitude of the phoria or tropia. The magnitude represents "how much" deviation is present and is often graded with prism lenses to estimate the amount of prism required to stop the eye from moving during the test.
Cover testing requires certain conditions to be met, such as the patient having foveal fixation in both eyes, the ability to move their eyes, and sufficient attention and cooperation for the test. If these criteria cannot be met, alternative methods like Hirschberg or Krimsky testing can be used to evaluate the relative position of the eyes.
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Frequently asked questions
A sensorimotor exam for the eyes evaluates how well your eyes work together and how effectively they respond to visual stimuli. It delves deeper into visual efficiency and information processing skills, including accommodation (eye focusing), vergence (eye teaming), and ocular motility (eye tracking).
During a sensorimotor exam, an optometrist will evaluate various aspects of your vision, including eye teaming, depth perception, and eye movements. Tests may involve following a moving target with your eyes, looking at 3D images, or focusing on objects at different distances.
A sensorimotor exam is crucial in assessing how well your eyes work together and with the brain to provide clear vision. It can help identify any underlying issues affecting coordination between the eyes, such as amblyopia (lazy eye), strabismus (crossed eyes), eye tracking issues, or convergence insufficiency. By detecting these issues early, effective treatments such as vision therapy can be recommended to improve visual function and comfort.
