Joanne (F/37) came for eye examination, with complaint of slight blurry far vision when driving with existing glasses since 1 year ago. Previously, she did not really drive much.. she started driving again 1year ago. She has a history of fall 2years ago, but she did not hurt her head.
Vision without glasses
R: cannot guess 6/60
L: 6/60-
Vision with existing glasses of 3years
R: -6.00/-1.50×175 (6/6-)
L: -5.00/-2.00×160 (6/6-)
Examination shows: (Delay Fogging)
R: -5.50/-1.50×175 (6/6) [+1.00 blur lens test: 6/12] (R: right dominant eye)
L: -4.50/-2.00×160 (6/6) [+1.00 blur lens test: 6/9]
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance (sometimes left eye seems to deviate outwards)
(unilateral cover test:cover uncover right eye: patient reported the target goes to her left)
moderate esophoria, moderate recovery @Near (sometimes LE esotropia)
(unilateral cover test:cover uncover right eye: patient reported the target goes to her left)
(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: 4 – 6 XP (blue part)
Near: 12 – 14 XP (blue part)
-1.00 Near: 14 – 16 XP (blue 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
Examination of Eye Alignment (Maddox Rod)
Distance: 4 Base In
Near: 4 Base Out
(normal value: 0 – 1 EP or 0 – 3 XP @Distance & 0 – 6 XP @Near)
Base Out/EP = Esophoria is misalignment of the eye, eye is deviated inwards
Base In/XP = Exophoria is misalignment of the eye, eye is deviated outwards
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
no doubling reported (left eye is observed to deviate outwards @ about 9cm)
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-In/Divergent, NFV: 10/12/10
Near, Base-Out/Convergent, PFV: 10/12/10
Distance, Base-Out/Convergent, PFV: 10/x/x
Distance, Base-In/Divergent, NFV: x/10/8
(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: no double reported (upon Base In & Base Out, eyes move towards apex)
Distance: no double reported (upon Base In & Base Out, eyes move towards apex)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
3D Vision (Random Dot 3S)
12.5″
(normal value: 12.5″)
Examination of Binocular Perception (Worth 4 Dots)
Distance: 4 dots
Near: 4 dots
(normal value: 4 dots = normal; 3 dots = Right suppression; 2 dots = Left suppression; 5 dots = Double vision)
AHP Head Posture
slight face turn to right
Interpupillary distance, IPD = 6.6cm
When prompted, Joanne said that she sometimes notices shadow on car plate when she drives home after work at night, especially if she is tired. No shadow is seen on computer/near vision reported.
We refer her to see orthoptist & ophthalmologist.