Fee (F/19) came for eye examination, with concern of squint eye. She sometimes notices that her left eye seems to drift inwards.. as if she has squint eye. Without glasses, her far vision is fine but she sometimes experiences blurry near vision & headache upon prolonged near work.
Vision without glasses
R: 6/6
L: 6/7.5
Examination shows:
R: PL/-0.50×10 (6/6) [+1.00 blur lens test: 6/12] (R: dominant right eye)
L: +1.50/-1.00×20 (6/7.5+) [+1.75 blur lens test: 6/7.5]
Relax Add: +0.50/+0.75 (N5@40cm)
(she prefers -0.25 in right eye to see better binocularly/with both eyes)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
small EP, fast-moderate recovery @Distance
small EP, 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
NRA (accommodation analysis – ability to relax accommodation)
+1.50
(normal value: +1.50 to +2.50)
PRA (accommodation analysis – ability to stimulate accommodation)
-2.25
(normal value: -1.37 to -3.37)
MEM (to measure accommodation response seeing near target)
R: +0.25
L: +1.75
(normal value: +0.25 to +0.75)
Examination of Eye Alignment (Howell Card)
Distance: 1-3 EP
Near: 0-1 EP
+1.00 Near: 1EP – 0 – 2XP
Distance No glasses: 5 EP
(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
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
R: 14 cycle per minit(cpm)
L: 10 cycle per minit(cpm)
BE: 12 cycle per minit(cpm)
(normal value:
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Fee has uncorrected longsighted power/hyperopia (indicated with power of + sign) in left eye. Without glasses, she can still see pretty well.. as our eyes can auto correct hyperopia that can mask astigmatism in the process too. Therefore, patients with uncorrected hyperopia will complain.. normally after doing a lot of near work & also getting headache if they keep seeing near. She sometimes notices her left eye drifting inwards, and this is because her left eye is doing all the auto focusing work in order to maintain clear vision. All we need to do is to wear glasses of the optimum longsighted power.. eyes are relaxed, the eye alignment will be straight.
For hyperopic patients that present with inwards deviation of eye, we will need to refer for cycloplegic refraction at eye specialist clinic – to put eye drop to temporarily paralyse your eye muscles in order to get the true eye power. We explain on how we go about her condition & Fee reported that she has had an eye prescription about a year back from eye specialist clinic:
R: -0.50 (6/6)
L: +1.25/-0.50×20 (6/7.5)
Since the prescription is not so much different with current one, she did not wish to go for another round. In circumstance like this, we will give her the most hyperopic power we can while maintaining a satisfactory & comfortable vision. We advise her to have a pair of Relax lens, to further support her eyes especially during her studies knowing that the demand on near work is very high. And of course this pair of glasses is packaged with the proper-visual-hygiene nagging LOL
- to have regular break in between near work (20-20-20 rule)
- to hold phone at healthy Harmon distance (an elbow distance to eyes)
- with good posture
- in a well-lit environment.. as well as
- to blink adequately especially when you are concentrating
- or use artificial tears (if prescribed)
We will see her in 3 months.
(PD: 60mm)