HXuan (F/20) came for eye examination, vision with existing glasses of <1year is fine seeing far.. but her vision takes time to be clear when she looks back at far after seeing near.
Vision without glasses
R: cannot guess 6/60 (when squint eye, can guess 6/30-)
L: cannot guess 6/60 (when squint eye, can guess 6/30-)
Vision with existing glasses of <1year
R: -7.75/-1.25×180 (6/6-)
L: -8.75/-1.25×160 (6/6-)
Examination shows: (Delay Fogging)
R: -8.00 [+1.00 blur lens test: 6/9]
L: -8.50 [+1.00 blur lens test: 6/9] [L: left dominant eye] L>R
Near: Add is not favoured (R>L)
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
(alternating CT: upon covering left eye, patient reported the target goes down.. when covering right eye, the target goes up)
(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 10^ Base Down on Right eye
Distance: 0
Near: 2 XP (blue part)
+1.00 Near: 2 XP (blue part)
-1.00 Near: 1 EP (yellow 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
-0.75
(normal value: -1.37 to -3.37)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.50 (reflex at 110°)
L: +0.25 (reflex at 70°)
(normal value: +0.25 to +0.75)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
6/8cm, 9/11cm, 7/9cm, 8/11cm, 6/11cm, 6/10cm, 6/11cm
(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: 8 YO, 8 YO, 8 YO (target is blurry @end of RAF rule, only comes into focus starting @25cm)
L: 8 YO, 8 YO, <8 YO (target is blurry @end of RAF rule, only comes into focus starting @25cm)
(normal value: AA goes according to age; YO=years old)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
BE: 11 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 12 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with right eye)
L: 13 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)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/30/25
Near, Base-In/Divergent, NFV: 16/20/18
Distance, Base-In/Divergent, NFV: x/12/10
Distance, Base-Out/Convergent, PFV: x/20/18
(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: 10 cpm (double Base In.. blink eyes then single swiftly)
Distance: 13 cpm
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD = 7.0cm
Modified
R: -8.00/-0.50×180
L: -8.50/-0.50×160
Near: Add is not favoured