Ms Ng (F/48) came for eye examination, with complaint of difficulty seeing near as her glasses keep sliding down.
Vision without glasses
R: 6/60-
L: 6/45-
Vision with existing glasses of 2-3years
R: -3.25/-0.50×135 (6/6)
L: -2.75/-1.00×180 (6/6)
Add: +1.75
Examination shows: (Delay Fogging)
R: -3.25/-0.50×135 (6/6) [+1.00 blur lens test: 6/15] (R: right dominant eye) (scissoring reflex)
L: -2.50/-1.00×180 (6/6) [+1.00 blur lens test: 6/12]
Add: +1.75
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
Distance: 1 EP (yellow part)
Near: 2 – 4 XP (blue part)
-1.00 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
+1.50?
(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
20/30cm, 20/32cm, 22/32cm, 22/34cm, 23/36cm
(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 (target is clear @end of RAF rule) (target is clearer with -0.50DC than -0.25DC)
L: 46 YO, 46 YO, 46 YO (target is clear @end of RAF rule) (target is clearer with -1.00DC than -0.75DC)
(normal value: AA goes according to age; YO=years old)
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)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule (with Add: +2.25 OU)
20/30cm, 20/30cm, 20/30cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
All near tests are done with Add.
Interpupillary distance, IPD = 5.8cm
Mg Ng is in a rush, we will do the remaining tests when she comes back. Due to her receded NPC, we ask whether or not she loses focus on near work or near print moves, she said her near vision is fine.
