WXuan (M/5) came for eye examination, mother noticed that he holds phone pretty close and he always rubs his eyes. He has strong family history of high myopia.
We refer for cyclo Rx.
Dr’s diagnosis: mild atopic conjunctivitis
Prescription: Hydrelo, Myopine
Cyclo Rx
R: -1.00/-2.75×10 (6/18)
L: -1.00/-2.75×160 (6/15)
*UpdatedA
2/3/2021
Examination shows:
R: -2.25/-2.50×10 (6/15) PHNI
L: -2.25/-2.50×160 (6/12) PHNI
Examination of 3D Vision (Titmus Fly)
20″ (incorrect two choices in between)
(normal value: 20″)
*UpdatedB
WXuan (M/6) came for follow up.. he is still on atropine & 2hrs of alternate patching every day.
Vision with existing glasses
R: -2.25/-2.50×10 (6/15-) PH 6/9- (N5@30cm)
L: -2.25/-2.50×160 (6/12+) PH 6/7.5-3, 6/6-3 (N5@30cm)
VA OU: 6/9-
Subjective Refraction
R: -2.75/-2.00×10
L: -2.75/-2.00×160
VA OU: 6/6-
Other assessments show:
Howell Card
Distance: 2 – 4 XP
Near: 12 XP
+1.00 Near: 14 – 18 XP
-1.00 Near: 14 – 16 XP
+2.00 Near: 14 XP
-2.00 Near: 14 XP
Maddox Rod
Distance: 4 BI
Near: 16 BI
MEM
R: PL
L: +0.50
Random Dot 3S
63″
20″ (with Add +0.75)
Worth 4 Dots
Distance: 4 lights
Near: 4 lights (sometimes 5 lights reported)
Interpupillary distance, IPD = 5.4cm
Modified
R: -2.25/-2.00×10
L: -2.50/-2.00×160
NOTES
Vision without glasses
6/6 – smallest testing line
6/7.5 – 2nd smallest line
6/9 – 3rd smallest line
6/12 – 4th smallest line
6/15 – 5th
6/18 – 6th
6/21 – 7th
6/24 – 8th
Examination of Eye Alignment
Cover Test, CT @ Distance & Near
– NMD(No Movement Detected) or
– small XP, fast recovery
EP = Esophoria is misalignment of eye, eye is deviated inwards
XP = Exophoria is misalignment of eye, eye is deviated outwards
ACT: alternating CT
Examination of Eye Alignment
(Maddox Rod) placed on RE
Examination of Eye Posture
(Howell Card) by 6^ BD OD
Distance:
– 0-3 XP (blue part) or
– 0-1 EP (yellow part)
Near:
– 0-6 XP (blue part)
Accommodation/Focusing analysis – ability to relax
NRA
+1.50 to +2.50
Accommodation/Focusing analysis – ability to focus
PRA
-1.37 to -3.37
Convergence, NPC – ability of eye to maintain a single clear near image (RAF rule)
Break/Recovery – within 10cm or TTN(to the nose)
AA(Amplitude Accommodation) – eye stamina (Dioptre, D) (RAF rule)
6yo – 16.5D | 6cm
9yo – 15.5D | 6.5cm
12yo – 14.5D | 7cm
15yo – 13.5D | 7.5cm
18yo – 12.5D | 8cm
21yo – 11.5D | 9cm
24yo – 10.5D | 10cm
27yo – 9.5D | 11cm
30yo – 8.5D | 12cm
MEM(Monocular Estimation Method) – measure accommodation response seeing near target
+0.25 to +0.75 (with movement)
Accommodation Facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
Monocular: 6cpm – 16cpm
Binocular: 4cpm – 14cpm
(1 cycle per minute, cpm = 2 words)
Fusional Reserves –
Convergent/Divergent reserve stamina (Prism Bar)
Blur/Break/Recovery
Children 7-12yo
Near, BO/PFV: x/15-31/10-22
Near, BI/NFV: x/7-17/3-11
Adult
Near, BO/PFV: x/10-28/7-21
Near, BI/NFV: x/7-19/5-15
Distance, BO/PFV: x/4-18/5-9
Distance, BI/NFV: x/4-10/2-6
Vergence Facility – ability to make rapid repetitive vergence changes (Prism Flipper 12BO & 3BI)
Distance: 12-18 cpm
Near: 12-18 cpm)
(1 cycle = 2 times clearing target)
Random Dot 3S – 3D Vision/Stereopsis
12.5″
Worth 4 Dots – Binocular Perception
4 dots/lights