Agnes jie (F/46) came for eye examination, with complaint of blurry near vision & losing focus on computer since 1 year ago.
Vision without glasses
R: 6/60-
L: 6/60
Vision with existing glasses of 3years
R: -3.00/-1.00×100 (6/7.5-)
L: -3.00/-1.25×80 (6/9-)
Add: +1.25
Examination shows: (Delay Fogging)
R: -3.25/-0.75×100 (6/6) [+1.00 blur lens test: 6/9-]
L: -3.75/-1.00×80 (6/6) [+1.00 blur lens test: 6/9-] (L: left dominant eye) L>R
Add: +1.75
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 her right.. when covering right eye, the target goes to her left
NMD @Near
(alternating CT: patient reported the target goes up & down alternatingly)
(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: 3 – 5 EP (yellow part)
Near: 6 – 8 XP (blue part)
-1.00 Near: 0
(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/Posture (Maddox Rod)
Distance: 3 BO
Near: 3 BI (vertical line is seen at centre, red dot is seem on her right)
(normal value: 0-1 EP or 0-3 XP @Distance and 0-6 XP @Near)
BO/EP = Base Out/Esophoria is misalignment of the eye, eye is deviated inwards
BI/XP = Base In/Exophoria is misalignment of the eye, eye is deviated outwards
BD/Hypertropia = is misalignment of the eye, eye is deviated upwards
BU/Hypotropia = is misalignment of the eye, eye is deviated downwards
Modified
R: -3.00/-0.50×100
L: -3.50/-0.75×80
Add: +1.75
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 5 – 7 EP (yellow part)
Modified
R: -2.75/-0.75×100
L: -3.25/-1.00×80
Add: +1.75
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 3 EP (yellow part)
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
-0.50
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
7/9cm, 7/9cm, 7/9cm, 7/9cm, 7/9cm, 7/9cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/8/6
Near, Base-In/Divergent, NFV: x/4/2
Distance, Base-In/Divergent, NFV: x/8/6
Distance, Base-Out/Convergent, PFV: x/14/12
(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]
Modified
R: -2.75/-0.75×100
L: -3.25/-1.00×80
Add: +2.00
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/6/4
Near, Base-In/Divergent, NFV: x/8/6
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 0 cpm (double with Base Out)
Distance: 0 cpm (double with Base Out.. eventually double with Base In too)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar (with 2 Base In OU)
Near, Base-Out/Convergent, PFV: x/14/12
Near, Base-In/Divergent, NFV: x/10/8
Interpupillary distance, IPD = 6.5cm
Prescribe for desktop vision (Atoric lens with 2 BI OU)
R: -2.75/-0.75×100
L: -3.25/-1.00×80
Add: +1.50
Agnes jie said her near vision is more comfortable with 2 BI.
We will prescribe her a pair of computer glasses & we will see her in 2months.