Yoyo (F/24) came for eye examination, with complaint of blurry far vision with existing glasses of 1year. Near vision is fine seeing upclose but vision at computer distance is blurry. She reported having long history of headache since small after a fall at 4yo, and headache does not specifically occur after near work.
Vision with existing glasses of 1year (previous spec was -3.25 in both eyes)
R: -3.75 (6/12-)
L: -3.75 (6/9-)
When own glasses were worn further away & lower on nose, she can see 6/6
Lens coating peeled off a lot
Examination shows: (Delay Fogging)
R: -4.00/-0.50×180 (6/6) (+1.00 blur lens test 6/15-) [R: right dominant eye] R>L
L: -3.75 (6/6) (+1.00 blur lens test 6/15-)
Near: L>R (Add is not favoured)
Vision fluctuation noted & eyes wanted higher shortsightedness/myopia
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: 1 – 3 EP (yellow part)
+1.00 Near: 1 – 3 EP (yellow part)
+2.00 Near: 1 – 3 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
+2.00
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.25
(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: 10 cycle per minit(cpm), difficult with plus lens (1st lens)
R: 2 cycle per minit(cpm), difficult with minus lens(2nd lens)
L: 11 cycle per minit(cpm), difficult with plus lens(1st 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: +0.25
(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)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 10 YO, 10 YO, 10 YO
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: 10/20/18
Near, Base-Out/Convergent, PFV: 10/20/18
(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]
Yoyo has some esophoria at near, in which we tried to relieve with added plus lens at near.. but her esophoria still maintained. Her esophoria means that both eyes like to move in (towards nose) & do not want to move outwards back. This may be caused by excessive near work or holding your phone very upclose, driving eyes to go inwards & difficult to be relaxed back. When this happens, you will find that your far vision becomes blurry over time.
We prescribe glasses with low added plus at near. We will try with prism vision therapy to force the eyes to relax/move outwards & see how it goes.
*Updated
When wearing daily disposable contact lens:
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0 – 1 EP (yellow part)
Near: 1 – 3 EP (yellow part) [at first was at 2 XP (blue part) & slowly drift to 1 – 3 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
We will let her try contact lens with added plus at near & see whether or not her eye posture will be regulated & if her headache gets better.
*Updated 29/1/2022
YoYo said that she will feel dry eyes when wearing contact lenses. She said her eyes no good.. aiyo.. when we look at her eye findings, her ability to stimulate focusing, PRA is very low, so we know that she may see near blurry especially on long hours of phone. This may sometimes be experienced as dry eye-like sensation.. we prescribe daily disposable added plus for near & see if this dry eye sensation gets better.
When wearing daily disposable added plus for near: (Low Add)
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Near: 2 – 4 XP (blue part) top arrow stops at 2 blue
(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
YoYo said her vision is slightly different, it looks like blur abit.. but she can see smallest 6/6 line for far vision. Her near eye posture is normalised to 2-4 Exophoria, thats great! Esophoric near posture is no good, sometimes it may cause headache especially upon prolonged near work/hp.
We will see how she is adapting to the lens.
* We also plan to let her try added plus for near of centre D lens, but she is not on monthly disposable lenses. We will let her try & see how it goes at next visit.