Thong (F/17) came for eye examination, with complaint of blurry far vision with existing glasses since some time ago. Near vision is fine & no headache reported.
Vision with existing glasses of 1.5years
R: -4.25/-0.75×180 (6/15-)
L: -4.25/-0.75×175 (6/12-)
Examination shows: (Delay Fogging)
R: -5.00/-0.75×180 (6/6) (+1.00 blur lens test 6/9-) [R: right dominant eye] R>L
L: -4.75/-1.25×175 (6/6) (+1.00 blur lens test 6/9-)
Add: +0.75 R>L (adding +0.25 in left still R>L)
– Add is not favoured though
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @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
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0 – 1 EP (yellow part)
Near: 3 – 5 EP (yellow part)
+1.00 Near: 0 – 1 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
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
-2.50
(normal value: -1.37 to -3.37)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 1.00
BE: 7 cycle per minit(cpm), difficult with plus lens (1st lens)
R: 11 cycle per minit(cpm), difficult with plus lens(1st lens)
L: 5 cycle per minit(cpm), difficult with minus lens(2nd lens)
* cannot clear +2.00 & +1.50 flipper
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
MEM (Accommodation lag – to measure accommodation response seeing near target)
R: +0.50
L: +1.00
(normal value: +0.25 to +0.75)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, TTN
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Jump convergence: slight laggy hesitant on left eye after repeated testing
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 13 YO, 13 YO, 13 YO
L: N5 blurry
+0.75 L: 15 YO, 15 YO, 15 YO
(normal value: AA goes according to age; YO=years old)
Examination of Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-In/Divergent, NFV: 10/12/6
Near, Base-Out/Convergent, PFV: -/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]
Thong has some esophoria at near.. possible due to reduced accommodation/focusing in left eye – we know from findings of reduced accommodation facility, amplitude accommodation & MEM >+0.75 in left eye. With esophoria, according to Percival’s criterion, the fusional reserves at near should be balanced – smaller reserve is at least half the larger reserve.. in which her PFV to break is 20^.. so her NFV to break should be at least 10^.. and she has 12^.. her reserves are still adequate thus her near vision is still okay. However, we know esophoria at near is no good & shortsightedness/myopia progression is noted.. so prescribing added plus for near will relieve her near work & also as a myopia control for her. We will monitor her AA.
We also reinforce proper visual hygiene that must be set to pilot mode in our everyday life? to have regular break time for our eyes, with proper posture (no baring tidur to see phone) & healthy Harmon distance(elbow distance) in holding our near material. Together we can all do something in our effort to combat myopia.
- we’ll update about sis Jia in a separate post