Silan (M/18) came for eye examination, complaining of tired, painful eyes & headache upon doing his computer technician work since recently. His job requires him to look at tiny electrical parts & he sees it very up close.
Unaided VA (Vision without glasses)
R: 6/6-
L: 6/6-
Examination shows:
R: +0.50/-0.25×10 (6/6)
L: +0.50 (6/6)
Reading Add: +0.75 (N5@40cm)
– Without Add, can only see second smallest line, N6@35cm on testing reading chart
– Reading Add: +1.00 (with eye pain)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance & small XP fast recovery @Near
(normal value: orthophoria/NMD-No Movement Detected or small XP fast recovery)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
around 20cm with painful convergence
(normal value: less than 7.5cm)
AA (Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 20cm, 22cm
L: 20cm, 22cm
(normal value: 9cm for a 18years old)
NRA (accommodation analysis – ability to relax accommodation)
+1.25 (normal value: +1.50 to +2.50)
PRA (accommodation analysis – ability to stimulate accommodation)
-0.75 (normal value: -1.37 to -3.37)
NFV @near (divergence stamina: how much eye can diverge) – with Base In Prism Bar
Blur/Break/Recovery: -/6/4
(normal value Break: 7 to 17; normal value Recovery: 3 to 11)
PFV @near (convergence stamina: how much eye can converge) with Base Out Prism Bar
Blur/Break/Recovery: -/10/6
(normal value Break: 15 to 31; normal value Recovery: 10 to 22)
Examination of Eye Alignment (Howell Card)
Distance: 1 – 3 EP
Near: 2 XP
+0.75 Near: 2 -> 4 XP
(normal value Distance: 1 EP-0 or 0-3 XP and Near: 0-6 XP)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
R: 0 cycle per minit(cpm) difficult with + & –
L: 0 cycle per minit(cpm) difficult with + & –
BE: 7 cycle per minit(cpm)
(normal value:
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Retinoscopy (to check eye power by looking into eye reflex that does not require response from patient)
bright reflex & dim reflex are alternately seen
Retinoscopy shows unstable accommodation/focusing with bright & dim reflex alternately seen. This may be due to excessive upclose of near work continuously that has exhausted his eyes.
Proper visual hygiene is advised, to take regular break of 20-20-20 rule in between his technician work & to work in a suitable working distance in which we call the Harmon distance.
We will see Silan again in 4-6weeks after fulltime wear of the new glasses. This period is so that we let the eyes gain optimum vision first, then we recheck & ascertain the eye systems again – the Accommodation & Vergence.