Michelle jie (F/48) came for eye examination, with complaint of blurry far vision with existing glasses with no pain/headache, vision on computer is fine & she will remove glasses to see near by holding her phone very upclose. She made a multifocal glasses about 3+ years ago but did not find it comfortable to wear (she did not bring this spec). She reported wearing glasses only after she started working, and ever since her power never stop increasing until now.
Vision with existing single vision lenses >7years
R: -5.25 (6/9-) a lot of shadow
L: -5.00/-0.75×180 (6/9+) a lot of shadow
Examination shows:
R: -5.75/-0.25×130 (6/6) (+1.00 blur lens test 6/18-) [R: right dominant eye] R>L
L: -5.50/-1.00×180 (6/6) (+1.00 blur lens test 6/15-)
Add: +2.50 (N5@40cm) L>R
She even prefers -0.25 shortsightedness higher binocularly.
Other assessments show:
Examination of Eye Alignment/Vergence (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
On alternating Cover Test:
Distance: she reported right eye seeing further & left eye seeing closer
Near: she reported right eye going higher & left eye going lower
Examination of Eye Alignment/Posture (Maddox Rod) AHP face turn to left noted
Distance
– Horizontal: two vertical white lines(one thicker on most right & one thinner) on her right; red spotlight on her left = no prism can quantify as after aligned, white lines & red spotlight will drift apart (face turn to right will align single white line & red spotlight)
– Vertical: R 2 BU
Near
– Horizontal: 18 BO, with each subsequent addition of prism, after aligned, white lines & red spotlight will drift apart too
– Vertical: R 2 BU
(normal value: 0-1 EP or 0-3 XP @Distance and 0-6 XP @Near)
BO/EP = Base Out/Esophoria is misalignment of the eye, eye is deviated inwards
BI/XP = Base In/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: 7 – 9 EP & beyond (yellow part)
Near: 5 – 7 EP (yellow part)
+1.00 Near: 4 – 6 XP (blue part) –> 3 – 5 EP –> 5 – 7 EP (yellow 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
Examination of 3D Vision/Stereopsis (Random Dot 3S)
40″
(normal value: 12.5″)
We asked Michelle if she notices having a face turn to left side (and left eyebrow is higher than right) or whether her old photograph shows that. She recalled that her friends mentioned about her not looking at camera & instead facing to left side.
We refer Michelle for cycloplegic refraction & also to see an eye doctor/ophthalmologist.