Winnie (F/42) came for eye examination, with complaint of sometimes blurry near vision looking at her kids’ books towards end of day.. in which she uses phone light to shine on books to help her to see. Far vision is fine & no headache is reported. She is usually out & about and she does not use her phone much.
Vision without glasses
R: 6/6
L: 6/6-
Examination shows: (Delay Fogging)
R: PL/-0.25×180 (6/6) [+1.00 blur lens test: 6/6-, +1.25 blur lens test 6/12] (R: right dominant eye) R>L
L: PL/-0.25×180 (6/6) [+1.00 blur lens test: 6/6-, +1.25 blur lens test 6/12]
Add: +1.25 (N5@40cm) [good ROCV]
No longsightedness/hyperopia is accepted monocularly/binocularly
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
NMD @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: 4 – 6 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
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+1.00
(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)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.50
L: +0.50
(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: 45 YO, 45 YO, 45 YO
L: 43 YO, 43 YO, 43 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
no doubling is reported
(patient reported that vertical line moves to her right side at end of RAF rule; at other times, vertical line moves to her right side & another vertical line is seen to move to her left at end of RAF rule)
(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 +/-1.00)
BE: 13 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 0 cycle per minit(cpm), difficult with minus lens(2nd lens)
L: 0 cycle per minit(cpm), difficult with minus lens(2nd lens)
– cannot clear -0.50 monocularly
(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/x
Near, Base-In/Divergent, NFV: 6/4
Distance, Base-In/Divergent, NFV: 4/2
Distance, Base-Out/Convergent, PFV: 20/18
(normal value: 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: 9 cpm (double with Base In, blink eye then can see single)
Distance: 16 cpm
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
All near tests are done with Add.
Interpupillary distance, IPD = 6.4cm