Mrs Yee (F/48) came for eye examination, complaining of blurry seeing computer with tired, dry eyes since few months ago. No headache is reported.
Vision without glasses
R: cannot guess 6/120
L: 6/120
Vision with existing glasses of 2years
R: -5.00/-1.00×30 (6/6)
L: -5.00/-1.25×165 (6/6)
Add: +1.00
Examination shows: (Delay Fogging)
R: -5.00/-0.75×30 (6/6) [+1.00 blur lens test: 6/9-]
L: -5.25/-1.00×165 (6/6) [+1.00 blur lens test: 6/9-] (L: left dominant eye) L>R
Add: +1.50 (R>L) R: cannot guess 6/120
Lowering astigmatism further binocularly is not favoured
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes to her left & upon covering right eye, the target goes to her right)
NMD @Near
(alternating CT: upon covering left eye, patient reported the target goes to her left & upon 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: 1 EP (yellow part)
Near: 0 – 1 EP (yellow part)
(Add +1.75) Near: 2 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
-0.75
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
18/24cm, 18/24cm, 18/24cm
(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 +1.75)
16/24cm, 16/24cm, 16/24cm
(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 target is clear @end of RAF rule, better in -0.75DC than -0.50DC)
L: 46 YO, 46 YO, 46 YO (pt reported target is blurry @end of RAF rule, clear @34cm, better in -1.00DC than -0.75DC)
(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/25/20
Near, Base-In/Divergent, NFV: x/14/12
Distance, Base-In/Divergent, NFV: x/10/8
Distance, Base-Out/Convergent, PFV: x/25/20
(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 Add +1.75 OU)
Near, Base-Out/Convergent, PFV: x/30/25
Near, Base-In/Divergent, NFV: x/2/1
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 4 cpm (double Base In, blink3 eyes then single)
Distance: 3 cpm (double with Base Out, blink3 eyes then only single + double with Base In, blink then single swiftly)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD = 6.0cm
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)
Fluorescein (to assess integrity of cornea)
R: light staining inferiorly
L: -ve staining
Amsler Chart (to assess integrity of macula)
R: all lines are straight
L: slight double line seen (normal with -0.75DC)
(normal value: lines are straight with equal gaps in between lines & no brown/black patch/spot)
All near tests are done with Add.
Interpupillary distance, IPD = 6.4cm
We prescribe pencil push up eye exercise.