13/2/2022
HYu (F/13) came for eye examination, with complaint of blurry far vision with existing glasses of 1 year made with us (this is her 2nd pair of spectacles). She first started wearing glasses at the age of 10 with shortsightedness of -3.75. We heard from HYu that her brother is also having very high shortsightedness.
Vision without glasses
R: 6/45- (better eye)
L: 6/45-
Vision with glasses
R: -5.00/-0.50×135 (6/15-)
L: -5.00 (6/21)
Examination shows: (Retinoscopy & Binocular Refraction)
R: -6.50/-0.50×160 (6/6) (+1.00 blur lens test 6/9-) [R: right dominant eye] R>L
L: -6.25 (6/6) (+1.00 blur lens test 6/9-)
Near: Add is not favoured
She even wanted 025 higher shortsightedness/myopia in both eyes
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
Near: 4 – 6 XP -> 2 – 4 XP (blue part)
+1.00 Near: 2 – 4 XP -> 0 – 2 XP (blue part) -> 0 (stops at 0)
(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
-1.75
(normal value: -1.37 to -3.37)
MEM (Accommodation lag – to measure accommodation response seeing near target)
R: +0.25 <-> PL
L: variable reflex (with movement <-> PL <-> against movement)
(normal value: +0.25 to +0.75)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
BE: 11 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 12 cycle per minit(cpm), difficult with plus lens(1st lens)
L: 12 cycle per minit(cpm), difficult with plus lens(1st lens)
(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: 25/18
Near, Base-In/Divergent, NFV: 14/10
Distance, Base-In/Divergent, NFV: 18/14
Distance, Base-Out/Convergent, PFV: 20/16
(normal value: Blur/Break/Recovery)
Near, PFV: x/10-28/7-21
Near, NFV: x/7-19/5-15
Distance, PFV: x/4-18/5-9
Distance, NFV: x/4-10/2-6
[Scheiman – Adult Data]
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 20 YO, 20 YO, 20 YO
L: 20 YO, 20 YO, 20 YO
(normal value: AA goes according to age; YO=years old)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, TTN, TTN, TTN
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
3D Vision (Random Dot 3S)
12.5″
(normal value: 12.5″)
Interpupillary Distance = 6.3cm
We refer for cycloplegic refraction and we see how it goes.
*UpdatedA
27/2/2022
Cycloplegic Refraction
R: -7.00/-0.50×150 (6/6) (+1.00 blur lens test 6/12)
L: -7.00/-0.50×180 (6/6) (+1.00 blur lens test 6/9-)
Other assessments show:
Lowest (stated as remark)
R: -6.50/-0.50×150 (6/7.5)
L: -6.50/-0.50×180 (6/7.5)
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0
Near: 2 XP (blue part)
+1.00 Near: 2 – 4 XP (blue part) more on 2
-1.00 Near: 0 – 2 XP (blue part) more on 0
(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
+2.25
(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)
MEM (Accommodation lag – to measure accommodation response seeing near target)
R: PL
L: PL
(normal value: +0.25 to +0.75)
Even after cycloplegia, HYu’s eye findings are still about the same. Her vision without glasses/unaided vision does not seem to tally with her power. We double check on her accommodation/focusing response.. and there is still an excess of focusing – we know from findings: accommodation lead on MEM (less than +0.25) & difficulty with plus lenses on monocular facility.. despite having normal NRA (NRA is normal probably due to her strong & smooth vergence?).
She is on atropine treatment now. We see whether or not atropine helps to regulate her accommodation on top of acting as myopia control.
Prescribed
R: -7.00/-0.50×150
L: -7.00/-0.50×180
Add: +0.50
We see her in 2-3months after fulltime wear of new glasses.
*UpdatedAB
HYu came for follow up. Vision with existing glasses is fine seeing far & near.
Vision with existing glasses
R: -7.00/-0.50×150 (6/6)
L: -7.00/-0.50×180 (6/6)
Add: +0.50
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: patient reported NMD)
small XP, fast recovery @Near
(alternating CT: upon covering left eye, patient reported the target goes to her left .. when covering right eye, the target goes to her right)
(normal value: orthophoria/NMD-No Movement Detected or small XP, fast recovery)
EP = Esotropia/Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exotropia/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: 2 – 4 XP (blue part) – seen through bottom part of lens
Near: 6 – 8 XP (blue part) – seen through top part of lens
(normal value: 0-1 EP (yellow part) or 0-3 XP (blue part) @Distance; and 0-6 XP (blue part) @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
-3.50
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, 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: 16 YO, 16 YO, 16 YO (pt reported N5 target is blur @end of RAF rule, clear @32cm)
L: 8 YO, 15 YO, 15 YO (pt reported N5 target is blur @end of RAF rule, clear @32cm)
(normal value: AA goes according to age; YO=years old)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
BE: 12 cycle per minit(cpm), difficult with plus lens(1st lens)
R: 11 cycle per minit(cpm), difficult with plus lens(1st lens) (both eyes see better than with right eye)
L: 12 cycle per minit(cpm), difficult with plus lens(1st lens) (both eyes see better than with left eye)
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: PL
L: PL
(normal value: +0.25 to +0.75)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/16/12
Near, Base-In/Divergent, NFV: x/16/14
Distance, Base-Out/Convergent, PFV: x/18/14
Distance, Base-In/Divergent, NFV: x/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 et al – Adult Data]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 6 cpm (double with Base Out, blink2 & single)
Distance: 7 cpm (double with Base Out, blink2 & single)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Glad that all’s well with HYu.
We reinforce proper visual hygiene.
We will see her in 3-4months.