18/9/2021
Max (M/16) came for eye examination, existing glasses were broken. With existing glasses, he is fine seeing far.. and he has tired eyes looking at near.
Power of existing glasses
R: -7.25/-1.75×180
L: -5.75/-3.00×180
Examination shows:
R: -7.25/-1.75×180 (6/6)
L: -6.00/-2.50×180 (6/6) (L: dominant left eye)
Add: +0.75
Other assessments show:
Examination of Eye Alignment/Posture (Cover Test)
NMD @Distance
NMD @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, 6cm, 6cm
(normal value: less than 10cm or to the nose, TTN)
AA (Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 8.5cm, 8.5cm, 8.5cm
L: 8.5cm, 8.5cm, 8.5cm
(normal value: 8.5cm for 16yo)
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0
Near: 1 EP <-> 0
+1.00 Near: 2-4 XP -> 0-2 XP
(normal value: 1 EP-0 or 0-3 XP @Distance and 0-6 XP @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards (yellow part)
XP = Exophoria is misalignment of the eye, eye is deviated outwards (blue part)
NRA (accommodation analysis – ability to relax accommodation/focusing)
+2.00
(normal value: +1.50 to +2.50)
PRA (accommodation analysis – ability to stimulate accommodation/focusing)
-0.50
(normal value: -1.37 to -3.37)
MEM (to measure accommodation response seeing near target)
R: +1.25
L: +1.25
(normal value: +0.25 to +0.75)
Facility (Accommodation facility – ability to change focus: far to near or near to far in 1 minute) by Flipper +/- 2.00
R: 10 cycle per minit(cpm) – difficult with + lens
L: 10 cycle per minit(cpm) difficult with + lens
BE: 5 cycle per minit(cpm) difficult with -ve lens
(normal value:
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
…………………………………………………………………………………………..
*UpdatedA
Max (M/17) came for follow up, vision with existing glasses of 10months is fine seeing far & near.
Vision without glasses
R: cannot guess 6/120
L: cannot guess 6/120
Vision with existing glasses
R: -7.25/-1.75×180 (6/6)
L: -6.00/-2.50×180 (6/6)
Add: +0.75
Examination shows: (Delay Fogging)
R: -7.25/-1.50×180 (6/6) [+1.00 blur lens test: 6/9]
L: -6.00/-2.25×180 (6/6) [+1.00 blur lens test: 6/7.5-] [L: left dominant eye]
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes to his left .. when covering right eye, the target goes to his right)
NMD @Near
(alternating CT: upon covering left eye, patient reported the target goes to his right .. when covering right eye, the target goes to his left)
(normal value: orthophoria/NMD-No Movement Detected or small XP, fast recovery)
EP = Esotropia/Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exotropia/Exophoria is misalignment of the eye, eye is deviated outwards
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0 – 1 EP (yellow part)
Near: 0 – 2 XP (blue part)
+1.00 Near: 2 – 4 XP (blue part)
-1.00 Near: 0
(normal value: 0-1 EP (yellow part) or 0-3 XP (blue part) @Distance; and 0-6 XP (blue part) @Near)
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) by plus lens
+1.50
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-1.00
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
6/8cm, 6/8cm, 8/10cm, 8/10cm, 10/12cm, 10/12cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 16 YO, 16 YO, 16 YO (pt reported target is clear @end of RAF rule) (target is better with -1.50DC than lower ones)
L: 16 YO, 16 YO, 16 YO (pt reported target is clear @end of RAF rule) (target is better with -2.25DC than lower ones)
(normal value: AA goes according to age; YO=years old)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
BE: 9 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 9 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with right eye)
L: 10 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with left eye)
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.50
L: +0.50
(normal value: +0.25 to +0.75)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/20/16
Near, Base-In/Divergent, NFV: x/14/12
Distance, Base-In/Divergent, NFV: x/6/4
Distance, Base-Out/Convergent, PFV: x/16/14
(normal value: Blur/Break/Recovery)
Near, PFV: 10-28/7-21
Near, NFV: 7-19/5-15
Distance, PFV: 4-18/5-9
Distance, NFV: 4-10/2-6
[Scheiman et al – Adult Data]
Own glasses
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/18/12
Near, Base-In/Divergent, NFV: x/10/8
Distance, Base-In/Divergent, NFV: x/8/6
Distance, Base-Out/Convergent, PFV: x/20/18
(normal value: Blur/Break/Recovery)
Near, PFV: 10-28/7-21
Near, NFV: 7-19/5-15
Distance, PFV: 4-18/5-9
Distance, NFV: 4-10/2-6
[Scheiman et al – Adult Data]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 9 cpm (double with Base Out, blink & single)
Distance: 11 cpm
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD: 6.2cm