Mreen (F/19) came for 1 year follow up, with complaints of far prints no longer are dark & easy to see like it used to be as well as tired eyes with near work since few months ago. She needs to sit towards the mid front of lecture hall in order to see better.
Vision without glasses
R: 6/60-1
L: 6/60+1
Vision with existing glasses of 1year
R: -2.50/-0.25×180 (6/15-)
L: -3.25/-0.75×180 (6/6)
Examination shows: (Binocular Refraction)
R: -3.25/-0.50×180 (6/6)
L: -3.25/-0.75×180 (6/6) (+1.00 blur lens test 6/9) [L: left dominant eye]
Near: Add is not favoured
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
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)
Near: 2 XP (blue part) – 0 – 1 EP (yellow part) (top arrow paces around 0, slightly on yellow & blue)
-1.00 Near: 3 – 5 EP (yellow 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
+2.25
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-1.00
(normal value: -1.37 to -3.37)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +1.00
L: +1.00
(normal value: +0.25 to +0.75)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: no blur reported
L: no blur reported
(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
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Accommodation Facility – ability to change focus: far to near or near to far (by Flipper +/- 1.50) cannot clear -2.00
BE: 13 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 12 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)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-In/Divergent, NFV: 12/14/8
Near, Base-Out/Convergent, PFV: x/35/30
Distance, Base-In/Divergent, NFV: x/10/6
Distance, Base-Out/Convergent, PFV: 18/16 (above break point 8, target is seen double briefly before becoming single) double is seen as blue red shadow
(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]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 10 cpm
Distance: 12 cpm (difficulty with Base In – target is seen double briefly before becoming single)
(normal value: 1 cycle = 2 times clearing target (target becomes clear & single)
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary Distance = 6.6cm
*Updated
We prescribe daily disposable contact lens
R: -3.50 (6/6)
L: -3.25/-0.75×180 (6/6) R>L
When R: -3.25 (6/6 slight shadowy but no shadow with both eyes) L>R
Since her lecture hall is big, we prescribe R -3.50