JCheng (M16) came for eye examination, with complaint of slight blurry far vision with existing glasses since this year. Mother reported that he always rubs his eyes especially after using digital devices these days.
Vision without glasses
R: 6/12
L: 6/21+2
Vision with existing glasses of 3years
R: +1.00/-2.50×180 (6/12-)
L: +1.75/-3.00×180 (6/9-)
Examination shows:
R: +0.25/-2.50×180 (6/6) (+1.00 blur lens test 6/12) [R: right dominant eye]
L: +1.00/-3.00×180 (6/6) (+1.00 blur lens test 6/12)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
small XP fast recovery @ Distance
small XP, fast recovery @ Near (Near>Distance)
(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 Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0 – 2 XP (blue part)
Near: 10 – 12 XP (blue part)
-1.00 Near: 6 – 8 XP (blue part)
+1.00 Near: 14 – 16 XP (blue part)
(normal value: 0-1 EP or 0-3 XP @Distance and 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
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, TTN, 6/10cm, 6/10cm, 6/10cm
(normal value: Break/Recovery in 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: 25 YO, 25 YO, 25 YO
L: 25 YO, 25 YO, 25 YO
(normal value: AA goes according to age)
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+1.00
(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)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 1.50
R: 13 cycle per minit(cpm), difficult with plus lens(1st lens) – [can’t clear +2.00, can clear -2.00]
L: 13 cycle per minit(cpm), difficult with minus lens(2nd lens) – [can’t clear -2.00, can clear +2.00]
BE: 10 cycle per minit(cpm), difficult with plus lens (1st lens)
* cannot clear +2.00 flipper
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Examination of Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 10/8
Near, Base-In/Divergent, NFV: 12/10
Distance, Base-Out/Convergent, PFV: 8/4
Distance, Base-In/Divergent, NFV: 6/4
(normal value: 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]
Modified power
R: PL/-2.50×180
L: +0.50/-3.00×180
Vision is better than own glasses
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 2 – 4 XP (blue part)
Near: 8 – 10 XP (blue part)
(normal value: 0-1 EP or 0-3 XP @Distance and 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
[Interpupillary distance, PD: 6.4cm]
JCheng has some exophoria 10-12 XP at near.. he should have at least twice the vergence reserve, PFV at near to pull in & balance this near posture (Sheard criterion).. but he only has 10^.. giving decompensated exophoria at near.. hence his eye rubbing after near work.
We update his eye prescription and prescribe vision therapy, VT to improve his PFV. We prescribe this free-space stereogram as he gave feedback that he can see the two circles going closer to each other.. and that’s great! It means that we can prescribe this VT to him.
As we continue to keep learning, we read Prof Evans’ book & we tried it ourselves.. and this is intriguing as we can see the words “stereopsis” like in 3D. Some alphabets seem to pop up or “down” differently.. this gives us the encouragement to do the exercise so that we can see the wonders of alphabets popping up&down again. You can try it.. hope you find this intriguing as we found them to be!
We will see JCheng in 1month.