Qing (F/18) came for eye examination, with complaint of blurry far vision with existing glasses, and near vision is fine. She sometimes wears daily contact lenses without astigmatism.
Vision with existing glasses of 2year
R: -4.00/-2.00×180 (6/9-)
L: -4.00/-2.00×180 (6/7.5-3, 6/6-2)
Examination shows: (Delay Fogging)
R: -4.25/-2.50×180 (6/6) (+1.00 blur lens test 6/9-)
L: -3.75/-2.75×180 (6/6) (+1.00 blur lens test 6/9-) [L: left dominant eye] L>R
Near: R>L
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
small XP, 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 – 2 XP (blue part)
Near: 10 – 12 XP (blue part)
-1.00 Near: 4 – 6 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
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+1.75
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-1.50
(normal value: -1.37 to -3.37)
MEM (Accommodation lag – to measure accommodation response seeing near target)
R: +0.25
L: +0.25
(normal value: +0.25 to +0.75)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 1.50
BE: 11 cycle per minit(cpm), difficult with plus lens (1st lens)
R: 13 cycle per minit(cpm), difficult with minus lens(2nd lens)
L: 11 cycle per minit(cpm), difficult with minus lens(2nd lens)
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
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: 15 YO, 15 YO, 15 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-Out/Convergent, PFV: 14/20/16
Near, Base-In/Divergent, NFV: 14/16/12
(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]
Modified power
R: -4.50/-2.25×180
L: -4.00/-2.50×180
Qing has some some significant exophoria at near. So, firstly, we want to know whether or not her convergence, NPC is lousy.. that is causing the exophoric deviation of eyes.. but her convergence is good.. as well as her focusing. With exophoria, we also want to see whether or not her eye motor fusion, PFV is able to pull in & balance the exophoric position. She has 10-12 XP, she needs to have PFV of double the exophoria (Sheard’s criterion).. and she has 20.. just ngam ngam enough.. hence no near complaint & she is asymptomatic as her motor & eyes muscles are still strong. Enjin mata semua masih boleh tahan. Normally, we treat & alleviate symptoms.. by giving vision therapy. Since she has no near complaint, we will monitor her.
Contact lens wear may make exophoria worse. Since she wears contact lens occasionally only, we will assess her exophoria again when she puts on her contact lens.
Nonetheless, proper visual hygiene is reinforced.. siblings Qing, Nen & Zhong can remind each other to have regular break in between hp following 20-20-20 rule.. after 20minutes of hp, must see 20feet/far2 away for 20seconds to relax back eyes (or every 30minutes, see far2 away for 1-2minutes) and cannot switch off light oh.. kai den kan lah hao ma?