Vnesh (M/13) came for eye examination, he lost his existing glasses made with us. He wears his glasses to school only and he removes glasses when he is at home.
Vision without glasses
R: 6/30-
L: 6/24-
Own glasses of 2years
R: -2.00/-0.50X95
L: -2.00/-0.50X90
Examination shows:
R: -1.75 (6/6-) (R: right dominant eye) L>R
L: -1.75 (6/6-) [adding +0.50 in left eye: R>L but not favoured]
Near vision is better wearing glasses
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
alternating exotropia @Distance (fixing RE) (XP movement L>R) (sometimes eyes are seen straight)
alternating exotropia @Near (sometimes eyes are seen straight)
(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
Other assessments show:
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+0.50 (1st round)
+1.50 (2nd round)
(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)
MEM (Accommodation lag – to measure accommodation response seeing near target)
R: +0.25
L: +0.75
(normal value: +0.25 to +0.75)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
LE deviates @7cm
(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: 8YO, 8 YO, 8 YO (pt reported target is blurry @end of RAF rule, only comes into focus starting @30cm)
L: 12 YO, 12 YO, 12 YO (pt reported target is clear @end of RAF rule)
(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: 9 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 11 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with right eye)
L: 13 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)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/12/10 (above break point 6, double then single) (observed: LE deviate out @6^)
Near, Base-In/Divergent, NFV: x/20/8
Distance, Base-Out/Convergent, PFV: x/10/8
Distance, Base-In/Divergent, NFV: x/20/18 (above break point 10, double then single)
(normal value: Break/Recovery)
Near, PFV: 10-28/7-21
Near, NFV: 7-19/5-15
[Scheiman]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: no double is reported (LE is deviated out)
Distance: no double is reported (with 12BO, BE moves to his left & pt reported TV screen moves to his left) (with 3BI, RE stays & LE moves to his right)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD = 6.0cm
3D Vision (Random Dot 3S)
12.5″
(normal value: 12.5″)
AHP Head Posture
He likes to chin up
We told Vnesh that he has alternating squint eye.. and we ask if he notices that his eyes will move outwards. He said he realises that his left eye will move out (but not with right eye) since few years ago.. and he is able to pull it back in.
We prescribe Dot card eye exercise.