Mr Raj (M/43) came for eye examination, with complaints of tired eyes & headache after prolonged hours looking at computer. He will hold his phone further away to see near more comfortably, and he was being asked.. “why you hold hp so far.. you old already ah?”. He has not worn any glasses before.
Vision without glasses
R: 6/6 [+1.00 blur lens test 6/7.5]
L: 6/6 [+1.00 blur lens test 6/12+]
Examination shows:
R: +0.25/-0.25×20 (6/6) (+1.00 blur lens test 6/12) [R: right dominant eye] L>R (Adding +0.50 RE: R>L but not favoured)
L: PL (6/6) (+1.00 blur lens test 6/12)
Add: +1.25
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
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0 – 2 XP (blue part)
With Add Near: 12 – 14 EP (blue part)
Add +0.75 Near: 8 – 10 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
Modified power
R: +0.50/-0.25×20 (6/6)
L: +0.25 (6/6)
Add: +0.75
Other assessments show: (with modified power)
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+1.25
(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)
MEM (Accommodation lag – to measure accommodation response seeing near target)
R: +0.50
L: +0.50
(normal value: +0.25 to +0.75)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 0.50
– cannot clear -0.50 monocularly & binocularly
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 20/18
Near, Base-In/Divergent, NFV: 8/6
(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]
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
With Add: 8/10, 8/10, 8/10, 8/10, 8/10cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Interpupillary Distance = 6.8cm
Mr Raj has mild longsightedness/hyperopia for far vision.. and he has reading power now. It is absolutely normal to be needing reading power for near vision as we enter 40s into the stage of presbyopia. Eyes requiring reading power is due to the natural lens inside our eye loses elasticity to change its shape to focus upclose. Simply give the power needed by our eyes, we continue to be productive in the things that we do & keep kicking a$$. Mana tua!
Mr Raj seems to have higher exophoria.. when we look at his PFV, it is just being compensated – he has 10 XP and he needs PFV 20^ to pull in & balance his near exophoric posture (Sheard’s criterion).. and he ngam2 has 20^. His convergence, NPC is fine.
When eyes see clearly with reading power, it is like a stimulus to keep our eyes engaged.. possibly contributing to his intact NPC. All’s well.
We prescribe spectacles lenses with added plus at near. Mr Raj wears his glasses & he will be able to see far & near simultaneously clear. With reading glasses, you may need to put on when you need to see near & remove glasses when you need to see far. Or the reading glasses may sit lower on your nose so that it does not disturb your far vision. This possibly could be referred as “being old” too. Or alternatively, he can wear contact lens with added plus at near too if he would like to explore in the future.
Let’s sayang our eyes.. we are not old so do our eyes!
I wear spectacles… I wear contact lenses… I want to have refractive eye surgery… take any option you like – as long as our eyes can see clearly with refractive error/power all corrected appropriately & we are still able to do what we love doing, that’s all matter!