Esther (F/42) came for eye examination, with complaint of lens coating that has peeled off. She is contact lens wearer most of the days.
Vision without glasses
R: cannot guess 6/120
L: cannot guess 6/120
Vision with existing glasses of about 3years
R: -6.75 (6/6-)
L: -6.50/-1.00×5 (6/6)
Examination shows: (Delay Fogging)
R: -6.75/-0.25×180 (6/6) [+1.00 blur lens test: 6/15-, 6/12-] (R: right dominant eye) R>L
L: -6.75/-0.75×5 (6/6) [+1.00 blur lens test: 6/12]
Add: +1.25 (L>R)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target looks bigger.. when covering right eye, the target looks smaller)
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
Distance: 1 – 3 EP (yellow part)
Modified
R: -6.50/-0.25×180
L: -6.50/-0.75×5
Add: +1.25
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0
Near: 0 – 2 XP (blue part)
-1.00 Near: 0 – 1 EP (yellow 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
-0.25
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
LE deviates @6cm
(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: 43 YO, 44 YO, 44 YO (target is clear @end of RAF rule) (target is clearer with -0.25DC than without astigmatism)
L: 45 YO, 45 YO, 45 YO (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 +/- 0.50
BE: 9 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 3 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with right eye)
L: 8 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with left eye)
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.25
L: +0.25
(normal value: +0.25 to +0.75)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/16/14
Near, Base-In/Divergent, NFV: x/4/2
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]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 7 cpm (double with Base In, blink3 eyes & single)
Distance: 5 cpm (double with Base In, blink3 eyes & single)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
All near tests are done with Add.
Interpupillary distance, IPD = 6.2cm
Fluorescein (assess integrity of front surface of eye, cornea)
R: +ve mild staining inferiorly
L: +ve mild staining inferiorly (L>R)
We ask whether or not Esther feels her eyes are dry.. more on her left eye.. and she said her left eye feels the irritation more. We advise to lay off contact lens temporarily & use non-preservative gel artificial tears.
Trial framing
R: -6.50/-0.25×180
L: -6.50/-0.75×5
Add: +1.25
Esther reported that she feels dizzy with this lowered power. She feels more comfortable in -6.75DS.
Modified
R: -6.75/-0.25×180
L: -6.50/-0.75×5
Add: +1.25