Mr Chan (M/55) came for 2year follow up, with complaint of tired eyes with existing multifocal glasses.
Vision with existing glasses of 2years
R: +0.75/-0.75×90 (6/6-)
L: +0.75/-0.75×90 (6/6)
Add: +1.75
Examination shows:
R: +1.00/-0.75×90 (6/6) (+1.00 blur lens test 6/9-) [R: right dominant eye] R=L
L: +1.00/-0.75×90 (6/6) (+1.00 blur lens test 6/9-)
Add: +1.75 (N5@40cm)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
small XP, small to moderate 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)
Add +1.75 Near: 10 – 12 XP (blue part)
Add +0.75 Near: 6 – 8 XP (blue part) – near slightly blurry
(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
+0.50
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.50
(normal value: -1.37 to -3.37)
Examination of Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar (with Add)
Near, Base-Out/Convergent, PFV: 20/x/x
Near, Base-In/Divergent, NFV: 6/16/14
(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 – Adult Data]
When we look at Mr Chan’s 12 exophoric near posture, we prompt whether or not he loses focus seeing near after some time.. in which he agreed. We also observed that he holds his phone very far away, and this is because vision will more stabilised closer to intermediate Add +0.75 with 6-8 exophoria & far distance with 0-2 exophoria. Previously, we did not check so we missed his exophoric eye posture.
We prescribe free-space stereogram & we will see him in 1month.