WErn (F/9) complains of slightly blurry far vision looking at whiteboard at school & sometimes blurry near vision looking at phone after some time . She has not worn any glasses before.
Unaided VA (Vision without glasses)
R: 6/7.5
L: 6/6
Examination shows:
R: -0.25/-0.25×165 (6/6)
L: PL (6/6)
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
6cm, 14cm, 7cm, 18cm, 6cm, 20cm (repeated 6times)
(normal value: TTN-to the nose or less than 7.5cm)
AA (Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: TTN, TTN, TTN (repeated 3times)
L: TTN, TTN, TTN
(normal value: TTN-to the nose or 7cm for a 9year old)
NRA (accommodation analysis – ability to relax accommodation)
+0.75 (normal value: +1.50 to +2.50)
PRA (accommodation analysis – ability to stimulate accommodation)
-0.75 (normal value: -1.37 to -3.37)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
R: 12 cycle per minit(cpm) difficult with minus lens
L: 13 cycle per minit(cpm) difficult with minus lens
BE: 8 cycle per minit(cpm) difficult with plus lens
(normal value:
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
From the result, we know that WErn has Convergence Insufficiency:
- NPC is reduced & receded, at other times her NPC seem to be fine probably helped & tied by her strong TTN accommodation/focusing that can be focused up to the nose
- NRA is low – as her convergence is reduced, relaxing accommodation further will reveal her poor convergence, hence seeing near blurry
- PRA is low – maybe due to overstimulating focusing/accommodation in order to retain her clear near vision
We have prescribed Pencil Push Up test for home therapy and we will see again in 1month.