Wing (F/25) came for eye examination, vision with existing glasses of 2years is fine seeing far & near. No headache is reported. She wears glasses to work & she puts on daily disposable contact lens for outings only. She will feel slightly dry with contact lens in which she needs to put eye drop once or twice to last her until end of day. When she changed to her current spec 2years ago, there was increase in her power.. she was told.
Vision without glasses
R: cannot guess 6/120
L: cannot guess 6/120
Vision with existing glasses
R: -9.50/-0.75×155 (6/6)
L: -8.50/-0.75×15 (6/9)
Power of own contact lens
R: -9.00
L: -8.00
Examination shows: (Monocular Occlusion + Delay Fogging)
R: -9.75/-0.25×155 (6/6) [+1.00 blur lens test: 6/12] (R: right dominant eye) L>R
L: -9.25/-0.25×15 (6/6) [+1.00 blur lens test: 6/9]
Binocular Balancing
R: -9.75/-0.25×155
L: -8.75/-0.25×15 (adding +0.25 in left eye: R>L, but not favoured)
Near: R>L (adding +0.25 in left eye: L>R)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
small XP, fast recovery @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 (XP movement LE > RE)
(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 – 8 XP (blue part)
-1.00 Near: 0
(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
-0.50
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
10/14cm, 10/14cm, 10/15cm, 10/15cm, 10/16cm, 10/16cm
(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: 25 YO, 25 YO, 25 YO (pt reported target is blurry @end of RAF rule, only comes into focus starting @36cm)(astigmatism is omitted as vision is reported to be better without)
L: 25 YO, 25 YO, 25 YO (pt reported target is clear @end of RAF rule)(vision is better with astigmatism)
(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 +/- 1.50
BE: 7 cycle per minit(cpm), cannot clear minus lens(2nd lens)
R: 10 cycle per minit(cpm), difficult with minus lens(2nd lens) (right eye sees better than with both eyes)
L: 11 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with left eye)
– cannot clear -2.00
(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: PL
L: +0.50
(normal value: +0.25 to +0.75)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/20/18
Near, Base-In/Divergent, NFV: x/20/18
Distance, Base-Out/Convergent, PFV: x/18/16
Distance, Base-In/Divergent, NFV: 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: 13 cpm (double Base Out, blink then single swiftly)
Distance: 14 cpm
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD = 6.3cm
Fluorescein
R: -ve staining
L: -ve staining
