Charlotte (F/45) came for eye examination, with complaint of difficulty writing notes from laptop.. vision on laptop is still fine. Driving in the day is fine but red light can be seen as two when driving at night. She has a pair of glasses of 6years that she wears for night driving only.. to see better at red lights.. daytime driving is better without her glasses. She had lasik 18 years ago.
Vision without glasses
R: 6/6
L: 6/9-
Existing glasses
R: -0.50
L: -0.50/-0.50×25
Add: +0.75
Examination shows: (Delay Fogging)
R: PL (6/6) [+1.00 blur lens test: 6/7.5-] (R: right dominant eye) R>L
L: -0.25 (6/6) [+1.00 blur lens test: 6/12-]
Add: +1.25 R>L
No hyperopia/longsightedness is accepted monocularly/binocularly
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
NMD @Near
(alternating CT: upon covering left eye, patient reported the target goes to her left & seems closer.. when covering right eye, the target goes to her right & seem further away)
(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: 6 – 8 XP (blue part)
-1.00 Near: 2 – 4 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
+2.00
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.25
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
18/26cm, 18/26cm, 18/26cm, 18/26cm, 18/26cm, 18/26cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Modified
R: PL
L: -0.25
Add: +1.75
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
14/22cm, 14/22cm, 14/22cm, 14/22cm, 14/22cm, 14/22cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
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: 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: x/18/14
Near, Base-In/Divergent, NFV: 14/16/14
Distance, Base-In/Divergent, NFV: x/6/4
Distance, Base-Out/Convergent, PFV: x/18/16
(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: 3 cpm (double Base Out.. blink3 then single)
Distance: 1 cpm (double Base Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
All near tests are done with Add.
Amsler Chart (assess integrity of macula)
R: all lines are straight
L: all lines are straight
(normal value: lines are straight with equal gaps in between lines & no brown/black patch/spot)
Interpupillary distance, IPD = 6.1cm