Carmen (F/46) came for eye examination, with complaint of difficulty seeing small print (on medication packages) with existing glasses of 2+ years. Vision is fine seeing laptop & paperwork.
Vision without glasses
R: 6/6
L: 6/6- slow
Existing glasses
R: PL/-0.25×160
L: PL
Add: +1.50
Examination shows: (Delay Fogging)
R: +0.25 (6/6) [+1.00 blur lens test: 6/7.5-]
L: +0.50 (6/6) [+1.00 blur lens test: 6/7.5+] (L: left dominant eye) L>R
Add: +1.75 (L>R)
Adding -0.25/up to +0.50 in right eye with/without -0.25DC, still L>R @far & near vision
Astigmatism (right eye) is not preferred for far vision but astigmatism (right eye) is preferred @near vision.
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes down.. when covering right eye, the target goes up)
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: 1 EP (yellow part)
Near: 4 – 6 XP (blue part)
-1.00 Near: 0 – 2 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
+0.75
(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: +0.75
L: +0.50
(normal value: +0.25 to +0.75)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
6/8cm, 6/8cm, 6/8cm, 6/8cm, 6/8cm
(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: 44 YO, 44 YO, 44 YO
L: 45 YO, 45 YO, 45 YO
(normal value: AA goes according to age; YO=years old)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 12/14/12
Near, Base-In/Divergent, NFV: x/10/8
Distance, Base-In/Divergent, NFV: x/6/4
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]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 1 cpm (double Base In)
Distance: 3 cpm (double Base Out, many3 blink then only single)
(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 Add +2.00 OU)
Near, Base-Out/Convergent, PFV: x/10/6
Near, Base-In/Divergent, NFV: x/6/4
All near tests are done with Add.
Amsler Chart (assess integrity of macula)
R: a few gaps seem bigger
L: all lines are straight
(normal value: lines are straight with equal gaps in between lines & no brown/black patch/spot)
Interpupillary distance, IPD = 6.0cm