Ms Tang (F/48)
Vision without glasses
R: 6/7.5- (better)
L: 6/7.5- slow
Vision with existing reading glasses of 3-4years
R: +2.00/-0.25×180
L: +2.25
Examination shows: (Delay Fogging)
R: +0.50/-0.50×80 (6/6) [+1.00 blur lens test: 6/9-]
L: +1.00/-0.50×80 (6/6) [+1.00 blur lens test: 6/7.5] (L: left dominant eye) R>L
Add: +2.00 (R>L)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes up.. when covering right eye, the target goes down)
small XP, fast recovery @Near
(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@Near & 8^ Base Down on Right eye@Distance
Distance: 0 – 2 XP (blue part)
Near: 10 – 12 XP (blue part)
-1.00 Near: 8 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
-0.25
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
12/14cm, 12/18cm, 12/18cm, 14/20cm, 14/20cm, 14/20cm
(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: 47 YO, 47 YO, 47 YO (target is clear @end of RAF rule, target is better is -0.50DC than -0.25DC)
L: 45 YO, 45 YO, 45 YO (target is blurry @end of RAF rule, only comes into focus @47cm.. target is better is -0.50DC than -0.25DC)
(normal value: AA goes according to age; YO=years old)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 18/30/14
Near, Base-In/Divergent, NFV: x/12/10 (above break point 6, double then single)
Distance, Base-Out/Convergent, PFV: 10/12/10
Distance, Base-In/Divergent, NFV: x/6/4
(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: 3 cpm (double Base Out initially, blink eyes single.. then double Base In.. blink3 eyes single)
Distance: 1 cpm (double Base Out initially, blink eyes single.. then double with Base In)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
We tried with 1BI OU/2BI OU.. but she did not like it.
All near tests are done with Add.
Interpupillary distance, IPD = 6.0cm