Ms Lim (F/44) mother of XYu & YuTong came for eye examination, with complaint of tired eyes & blurry seeing computer with existing glasses of about 1year. She was told about having power increment of 025 to 050 when she changed into her existing glasses..
Vision without glasses
R: cannot guess 6/120
L: 6/60-
Vision with existing glasses
R: -4.50/-4.00×170 (6/6) [Add: +1.00(on Focimeter)/Add: +1.50(lens marking)]
L: -3.25/-3.50×10 (6/6) Add: +1.50
Examination shows: (Delay Fogging)
R: -4.50/-3.50×170 (6/6) [+1.00 blur lens test: 6/9]
L: -3.25/-3.25×10 (6/6) [+1.00 blur lens test: 6/9] (L: left dominant eye) L>R (adding up to +0.50 in left eye, still L>R)
Add: +1.50 (L>R) (adding up to +0.50 in right eye, still L>R)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
small XP, fast recovery @Distance
(alternating CT: patient reported NMD)
moderate XP, moderate recovery @Near
(alternating CT: pt reported NMD)
(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@Near & 6^ Base Down on Right eye@Distance
Distance: 0
Near: 20 XP (blue part)
-1.00 Near: 14 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
+1.25
(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
Right eye deviates @10cm
(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: 45 YO, 45 YO, 45 YO (pt reported N6 target is blurry @end of RAF rule, become clear @40cm, better in -3.25DC)
L: 45 YO, 45 YO, 45 YO
(normal value: AA goes according to age; YO=years old)
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)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/x/x
Near, Base-In/Divergent, NFV: x/18/14
Distance, Base-In/Divergent, NFV: x/14/12
Distance, Base-Out/Convergent, PFV: x/x/x
(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]
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar (with 2BI OU)
Near, Base-Out/Convergent, PFV: x/x/x
Near vision is better without 2BI OU
Binocular Perception (Worth 4 Dots)
Distance: 4 dots seen
Near: 4 dots seen
(normal value: 4 dots seen = normal, 3 dots seen = Right suppression, 2 dots seen = Left suppression)
All near tests are done with Add.
Interpupillary distance, IPD = 6.8cm