ChloeL complains of blurry far vision with existing glasses & headache with near work/online classes sometimes. She will tend to remove glasses to see near with chin down & have her reading material held closer to her. She is premature baby according to her dad. We notice that she likes to have her chin down to see far & near with frowning of brows and she said she sees better this way.
Vision without glasses
R: 6/30-
L: 6/30-
Vision with existing glasses of 2yrs
R: -1.00 (6/18)
L: -1.00 (6/18)
Examination shows:
R: -2.00 (6/6), N5@35cm with chin down (no chin down cannot see N5)
L: -2.00 (6/6), N5@35cm with chin down (no chin down cannot see N5)
She prefers -2.25 both eyes.
Other assessments show:
Examination of 3D Vision (Random Dot 3S)
20″
(normal value: 12.5″)
Examination of Eye Alignment/Vergence (Cover Test)
small XP, fast recovery @Distance
small XP, moderate recovery @Near (she reported the target goes up & down)
(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
Examination of Eye Muscles (EOM)
RE overshoot @dextroelevation/10.30 o’clock, double vision reported the largest, with pain
– double vision(smaller) reported at right gaze dextroversion/9 o’clock too, no pain
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
18cm, 20cm, 22cm
(normal value: less than 7.5cm)
AA (Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 7.5cm, 7.5cm, 7.5cm
L: 9cm, 9cm, 10cm
(normal value: less than 8cm)
NRA (accommodation analysis – ability to relax accommodation)
+2.00
(normal value: +1.50 to +2.50)
PRA (accommodation analysis – ability to stimulate accommodation)
-0.50
(normal value: -1.37 to -3.37)
Examination of Eye Alignment (Howell Card)
Distance: 4 XP
Near: 14->16->18 XP
-1.00 Near: 8 – 10 XP
(normal value: 1 EP-0 or 0-3 XP @Distance & 0-6 XP @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
Examination of Eye Alignment (Maddox Rod)
Distance: 4 XP/BI
Near: RE 2 BD
Chin down Near: Orthophoria
(normal value: 1 EP-0 or 0-3 XP @Distance & 0-6 XP @Near; BI=base in, BD=base down)
Examination of Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 4/2
Near, Base-In/Divergent, NFV: 8/18/10 (8=blur point)
(normal value: Break/Recovery)
Near, PFV: 15-31/10-22
Near, NFV: 7-17/3-11
[Scheiman et al, 1989]
BHTT Head Tilt Test
RE slight higher hyper @left head tilt
We will refer her to see doctor to check on her chin down posture.