Vseetha (F/15) came for eye examination, with complaint of blurry vision seeing whiteboard at school since quite some time ago. Near vision is fine with no headache. She has not worn any glasses before.
Vision without glasses
R: 6/12
L: 6/15-
Examination shows: (Delay Fogging)
R: -0.75 (6/6) (+1.00 blur lens test 6/12)
L: -1.00 (6/6) (+1.00 blur lens test 6/9-) [L: left dominant eye] L>R
Near: L>R (adding +0.50 in right eye, still L>R) (Add is not favoured)
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 left.. when covering right eye, the target goes to her right)
small XP, fast recovery @Near
(alternating CT: upon covering left eye, patient reported the target goes to her left.. when covering right eye, the target goes to her right)
(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: 2 XP (blue part)
Near: 2 – 4 XP (blue part)
+1.00 Near: 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
+1.00
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-2.75
(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)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 15 YO, 15 YO, 15 YO
L: 20 YO, 20 YO, 25 YO
(normal value: AA goes according to age; YO=years old)
Accommodation Facility – ability to change focus: far to near or near to far (by Flipper +/-2.00)
BE: 13 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 13 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with right eye]
L: 10 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with left eye]
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, 5/7cm, 5/7cm, 6/8cm, 6/8cm, 8/10cm
(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/18/16
Distance, Base-Out/Convergent, PFV: x/20/18
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: 0 cpm (double with Base Out)
Distance: 0 cpm (double with Base Out)
(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″)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar (with 2BI OU)
Near, Base-Out/Convergent, PFV: x/18/16
Near, Base-In/Divergent, NFV: x/16/14
Interpupillary distance, IPD = 6.0cm
Modified
R: -0.75 2BI
L: -0.75 2BI
After the eye examination, mother reported that she will see her phone in the dark for many hours.