YCheng (M/20) came for eye examination, vision with existing glasses is fine. He complains of dryness during contact lens wear. He has history of sinus.
Vision without glasses
R: 6/45-
L: 6/45-
Vision with own glasses
R: -3.00 (6/6-)
L: -3.25/-0.25×175 (6/6-)
Examination shows:
R: -3.00/-0.50×15 (6/6) [R: dominant right eye]
L: -3.00/-0.75×175 (6/6)
Relax Add: +0.50
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
7cm, 7cm, 7cm
(normal value: less than 7.5cm)
AA (Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 8.5cm, 8.5cm, 9cm
L: 8.5cm, 8.5cm, 9cm
(normal value: less than 9cm for a 20yo)
NRA (accommodation analysis – ability to relax accommodation)
+1.50
(normal value: +1.50 to +2.50)
PRA (accommodation analysis – ability to stimulate accommodation)
-0.75
(normal value: -1.37 to -3.37)
Examination of Eye Alignment (Howell Card)
Distance: 0-1 EP
Near: 2 XP
+0.50 Near: 2-4 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
YCheng will be going to college to further his studies soon. He has come for an eye examination, to make a new pair of glasses as well as to get some contact lens supplies.
YCheng wears contact lens & on top of that also complains of dryness, so we did a slit lamp microscope examination to look at the integrity of the superficial front part of the eye. He has some punctate epithelial erosion(PEE) in both eyes, probably due to contaminated contact lens wear. We advise him to discard/throw away existing contact lenses & to stop wearing contact lens for a period of time while lubricating his eyes with non-preserved artificial tears daily.
We also reinforce proper contact lens care:
- to wash hands with soap & water before handling contact lens
- cautious of hand sanitiser as it will burn our eyes
- to clean by rubbing your contact lens after removal
- must rub to clean your contact lens after each use
- to remove contact lens before sleep every night
- sleep with contact lens is very dangerous – unless prescribed by your eye care practitioner
- to soak contact lens with multi-purpose solution(MPS) for disinfection
- no soaking using tap water or normal saline
- to keep your nails short
- to prevent scratching the front part of eye/cornea accidentally or damage your contact lens
- if contact lens wear is uncomfortable, remove & rinse your lens with saline/MPS
- to check if the lens is “terbalik”/inserted the other way round (the shape of lens should be bowl-like shape with edges not flattened outwards
- if lens is still uncomfortable after rinsing, your lens may have torn.. try a fresh piece of contact lens
- should your eye is reddish (with no pain), stop wearing contact lens & use non-preserved artificial tears generously for a few days until redness subsides
- should your eye has redness with pain, immediately go see a nearby ophthalmologist/eye specialist doctor
YCheng plans to wear contact lens to attend lectures every day, so we prescribe monthly high oxygen lenses to him. Sometimes lectures can go from 9am to 6pm, so having high oxygen lens that caters to long wearing hours up to 12hours or above will ensure healthy eyes all day long. Once he is back at dorm, he can use his glasses.
All the eye examination findings are fine, only the ability of his eye to stimulate accommodation, PRA value is slightly lower. Normally, this is due to a lot of near work & high demand of usage of digital devices. Hence, we have prescribed Relax glasses to relax & support his near vision if he were to work on his assignments or on near work excessively. His Relax glasses are also made in colour changing lenses – to automatically turn into dark colour outdoors when exposed to sunlight & to fade back to clear lenses once indoors as well as cut glaring Night Vision coating in pinkish purple reflection on the lens.
We will check his dry eyes again before he departs to college.
*Updated
After 1st visit
We also gave him a pair of trial contact lens for him to try.
At 2nd visit
The condition of dry eye got worse. We asked & he told us that he has been using non-preserved artificial tears. He only tried the trial contact lens once for 4hours in which he put on the contact lens straight from blister pack of contact lens. With dry spots covering all over the eye, probably his eyes are sensitive to the solution in the blister pack of contact lens. We advise him to rub contact lens before & after use with normal saline.. and also to thoroughly rinse the contact lens with normal saline before putting on the contact lens.
We prescribe gel-type artificial tears to be applied before sleep daily.
At 3rd visit
The condition of dry eye got better, especially in lower portion of right eye. We advise him to continue using the gel eye drop daily & not to wear contact lens first.
He is scheduled to leave for college & we will see if he can drop by to check for his dry eyes before he departs soon.
*Updated
He managed to come back for a follow up, we are happy to see the condition of dry eyes is further improved. We advise to continue using gel artificial tears for a week before starting to wear contact lens back again.
YCheng, remember to rinse your contact lens with saline each time before putting into your eyes ya.. if you have any doubt/queries regarding your eyes, you can contact aunty? take care & jia you!
