27/2/2022
XRui (M/16), HYu’s bro came together for eye examination, with cycloplegic refraction. He reported that vision with existing glasses is fine seeing far & near.
Vision without glasses/Unaided vision
R: 6/120
L: 6/120 (better)
Vision with existing glasses
R: -4.50/-0.50×180 (6/7.5-)
L: -5.00/-0.75×155 (6/6-)
Cycloplegic Refraction
R: -5.00/-0.50×180 (6/6)
L: -5.25/-1.25×155 (6/6)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance (pt reported target moves temporally upon alternating cover test)
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) slightly over 1 yellow
Near: 2 XP (blue part)
+1.00 Near: 2 – 4 XP (blue part)
-1.00 Near: 0 – 2 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
+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: +1.50
L: +1.00
(normal value: +0.25 to +0.75)
Accommodation Facility – ability to change focus: far to near or near to far (by Flipper +/- 2.00)
BE: 10 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 5 cycle per minit(cpm), difficult with minus lens(2nd lens)
– [both eyes see better than seeing with right eye]
L: 10 cycle per minit(cpm), difficult with minus lens(2nd lens)
– [left eye sees better than seeing with both eyes]
(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: 2/1
Near, Base-In/Divergent, NFV: 2/1
Distance, Base-In/Divergent, NFV: 10/4
Distance, Base-Out/Convergent, PFV: 18/14 (above break point 8, target becomes double before becoming single again)
(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: 33 YO, 33 YO, 33 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
22/32, 26/38, 32/47cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Jump Convergence: right eye deviates out & moves back in (with repeated testings)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
with Add +0.50: 22/35, 26/40, 34/48cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 8 cpm (slow with Base Out)
Distance: 0 cpm (see double with 12 Base Out)
(normal value: 1 cycle = 2 times seeing clear
Distance: 15 cpm
Near: 15 cpm)
3D Vision (Random Dot 3S)
12.5″
(normal value: 12.5″)
Interpupillary Distance = 6.7cm
We prescribe him auto stereogram.
*UpdatedA
XRui came for follow up. He said his near vision is okay now.
Vision with existing glasses
R: -4.50/-0.50×180
L: -5.00/-0.75×155
VA OU 6/7.5+2
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes to his right & up.. when covering right eye, the target goes to his left & up)
NMD @Near
(alternating CT: upon covering left eye, patient reported the target goes to his right .. when covering right eye, the target goes to his left)
(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: 1 EP (yellow part)
Near: 0 – 2 XP (blue part)
+1.00 Near: 2 – 4 XP (blue part)
-1.00 Near: 1 – 3 EP (yellow part)
(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
-3.75
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
12/22cm, 16/26cm, 26/36cm, 30/40cm, 32/42cm
(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: 22 YO, 22 YO (pt reported N5 target is blurry @end of RAF rule, clear @34cm)
L: 20 YO, 20 YO (pt reported N5 target is blurry @end of RAF rule, clear @34cm)
(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: 10 cycle per minit(cpm), difficult with plus lens(1st lens) (both eyes see better than with right eye)
L: 10 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)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/20/18
Near, Base-In/Divergent, NFV: x/12/10
Distance, Base-In/Divergent, NFV: x/6/4
Distance, Base-Out/Convergent, PFV: x/16/14
(normal value: Blur/Break/Recovery)
Near, PFV: x/15-31/10-22
Near, NFV: x/7-17/3-11
[Scheiman et al – Children 7-12yo Data]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 9 cpm (double with Base Out, blink & single)
Distance: 1 cpm (double with Base Out, double get closer before drifting far apart again)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
We repeated
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/20/18
Glad to see improvement in his PFV@ Near.
We prescribe Brock string eye exercise for XRui.
We will see him in 2-3months.
5/3/2023
Prescribe
R: -4.75/-0.75×5
L: -5.00/-1.25×160
Add: +0.50
Continue Brock string.