SLong (M/15) came for eye examination, with complaint of far vision is fine early in the day but blurry starting from second half of the day since 1+ year ago. He also sometimes sees shadow/moving near print.. with headache after near work. He also complains about itchy eye in right eye.
Vision without glasses
R: 6/6- slow
L: 6/6- slow (better)
Examination shows:
R: +0.50/-0.25×10 (6/6) [+1.00 blur lens test: 6/9+] (R: right dominant eye) R>L
L: PL (6/6) [+1.00 blur lens test: 6/9-]
Near: L>R
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
moderate XP, moderate recovery @Near
(alternating CT: upon covering left eye, patient reported the target goes to his left.. when covering right eye, the target goes to his right) [XP movement LE more than RE]
(normal value: orthophoria/NMD-No Movement Detected or small XP, fast recovery)
EP = Esotropia/Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exotropia/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: 0 – 2 XP (blue part)
Near: 14 – 16 XP (blue part)
+1.00 Near: 16 – 18 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
+0.25
(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
TTN, 6/8cm, 8/10cm, 8/10cm, 10/12cm, 10/12cm
(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: 18 YO, 18 YO, 18 YO (pt reported target is okay @end of RAF rule) (target is better with -0.25DC than without)
L: 15 YO, 15 YO, 15 YO (pt reported target is blurry @end of RAF rule, comes into focus @30cm)
(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: 11 cycle per minit(cpm), difficult with plus lens(1st lens)
R: 13 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with right eye) [Flipper +/- 1.00]
L: 13 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with left eye)
– RE cannot clear -1.50
We tried
BE: 8 cycle per minit(cpm), difficult with plus lens(1st lens) [with Flipper +/-2.00]
(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: +1.50
L: +0.75
(normal value: +0.25 to +0.75)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/10/6
Near, Base-In/Divergent, NFV: x/12/6
Distance, Base-Out/Convergent, PFV: 12/18/16
Distance, Base-In/Divergent, NFV: x/12/6
(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: 5 cpm (initially no double.. then double with Base Out, blink2 eyes & single.. then remain double with Base Out)
Distance: 7 cpm (double with Base Out.. blink3 eyes & single)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Modified
R: +0.50/-0.25×10
L: PL
Add: +0.50
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target) (with Add +0.50 OU)
R: +1.00
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar (with Add +0.50 OU)
Near, Base-Out/Convergent, PFV: 12/20/16
Near, Base-In/Divergent, NFV: x/20/14
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar (with Add +0.50 OU + 1BI OU)
Near, Base-Out/Convergent, PFV: 12/20/18
Near, Base-In/Divergent, NFV: 14/18/14
Pt reported that vision with 1BI OU is comfortable for far & near vision.
Prescribe
R: +0.50/-0.25×10 1BI
L: PL 1BI
Add: +0.50