Mr John (M/40) came for eye examination, vision is fine seeing far & near. He has tired eyes after seeing computer for long. He has a pair of glasses (made 2years ago) that he wore fulltime daily until his frame was broken last month (he did not bring). He reported having high astigmatism & he first started wearing glasses at the age of 4. No headache is reported.
Vision without glasses
R: 6/6
L: 6/6 (better)
Examination shows:
R: +0.25 (6/6) [+1.00 blur lens test: 6/9-]
L: +0.50/-0.25×180 (6/6) [+1.00 blur lens test: 6/9] [L: left dominant eye] L>R
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 up.. when covering right eye, the target goes down)
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 (slight on blue)
Near: 6 – 8 XP (blue part)
+1.00 Near: 8 – 10 XP (blue part)
-1.00 Near: 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
+0.75
(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
12/18cm, 12/18cm, 12/18cm, 12/18cm, 12/18cm, 12/18cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule (with Add: +0.50 OU)
16/22cm, 16/22cm, 16/22cm
(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: 41 YO, 41 YO, 41 YO
L: 44 YO, 44 YO, 44 YO
(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 +/- 0.50
BE: 10 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 14 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with right eye)
L: 11 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)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: with movement (pupil very small)
L: with movement (pupil very small)
(normal value: +0.25 to +0.75)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/14/12
Near, Base-In/Divergent, NFV: 12/14/12
Distance, Base-In/Divergent, NFV: x/10/8
Distance, Base-Out/Convergent, PFV: x/16/10
(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: 12 cpm (double with Base Out initially, blink2 then single)
Distance: 16 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″ (slow)
(normal value: 12.5″)
Interpupillary distance, IPD = 7.2cm
Mr John seems to have little power only.
We ask him to bring his old glasses and we see how it goes.
