Kak Vmala (F/57) came for eye examination, vision is fine seeing far without glasses.. and her near vision with her reading glasses is fine. She wants to change new glasses as her lenses have scratches already. We observe that her eyes look tired.
Vision without glasses
R: 6/7.5-
L: 6/9-
Vision with existing reading glasses of 3-4years
R: +2.75/-0.25×180
L: +2.75
Examination shows: (Delay Fogging)
R: +0.50 (6/6) [+1.00 blur lens test: 6/9] (R: right dominant eye) R=L
L: +0.50 (6/6) [+1.00 blur lens test: 6/7.5-]
Add: +2.50
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: patient reported NMD)
small XP, fast 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 6^ Base Down on Right eye@Near & 8^ Base Down on Right eye@Distance
Distance: 1 – 3 EP (yellow part)
Near: 10 – 12 XP (blue part)
-1.00 Near: 6 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
Modified
R: +0.75
L: +0.75
Add: +2.25
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye@Near & 8^ Base Down on Right eye@Distance
Distance: 0 – 1 EP (yellow part)
Near: 10 XP (blue part)
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
20/24cm, 20/24cm, 18/24cm, 18/24cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/20/1
Near, Base-In/Divergent, NFV: x/10/8
Distance, Base-In/Divergent, NFV: x/6/4
Distance, Base-Out/Convergent, PFV: x/14/10
(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]
We repeated the tests
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/16/1
Distance, 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: 5 cpm (double Base Out, blink2 single)
Distance: 0 cpm (double with Base Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Amsler Chart (to assess integrity of macula)
R: all lines are straight
L: all lines are straight
(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 = 6.6cm
Modified
R: +0.75/-0.25×10
L: +0.75/-0.25×180
Add: +2.25
We ask whether or not Kak Vmala has blurry near vision sometimes.. she said her near vision is fine if she has her glasses on.