JRong (M/11) came for eye examination, he reported far vision is fine early in the day but blurry as time goes by.. since beginning of this year. He sometimes has headache on right side.
Vision without glasses
R: 6/15- slow
L: 6/15- slow (better)
BE: 6/9-
Examination shows:
R: +0.25 (R: right dominant eye) R>L
L: +0.25
Vision fluctuation noted in both eyes.. BCVA OU 6/7.5+
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes to his left.. when covering right eye, the target goes to his right)
small XP, fast recovery @Near
(alternating CT: patient reported NMD]
(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: 2 – 4 XP (blue part)
Near: 16 – 18 XP (blue part)
+1.00 Near: 14 – 16 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
+1.00
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-1.25
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
32/42cm, 32/44cm, 32/46cm
(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: 40 YO, 20 YO, 10 YO, 15 YO (pt reported target is okay @end of RAF rule)
L: 8 YO, 8 YO, 8 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 +/- 2.00
BE: 10 cycle per minit(cpm), no difficulty
R: 9 cycle per minit(cpm), difficult with minus lens(2nd lens)
L: 10 cycle per minit(cpm), difficult with plus lens(1st lens)
(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: PL
L: PL
(normal value: +0.25 to +0.75)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/6/1
Near, Base-In/Divergent, NFV: x/16/12
Distance, Base-Out/Convergent, PFV: x/6/4
Distance, Base-In/Divergent, NFV: x/8/6
(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: 3 cpm (double with Base Out, blink2 eyes & single.. then double with Base In & cannot regain single, double images go closer with blink before going far apart again)
Distance: 7 cpm (double with Base Out, blink eyes & single.. double Base In, blink3 eyes & single)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
We ask whether or not his near vision is blurry or got double on near print.. he said that he sometimes sees double on near print.. in which he blinks3 his eyes & it’s fine after that.
Modified
R: +0.25 (R>L)
L: +0.25
Add(R/L): +0.50/+0.25 (L>R)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule (with Add +0.50 OU)
28/38cm, 28/42cm, 28/46cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar (with Add +0.50 OU)
Near, Base-Out/Convergent, PFV: x/8/1
Near, Base-In/Divergent, NFV: x/14/6
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar (with Add +0.50 OU + 2BI OU)
Near, Base-Out/Convergent, PFV: x/6/1
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar (with 2BI OU)
Near, Base-Out/Convergent, PFV: x/6/2
Distance, Base-Out/Convergent, PFV: x/4/1
Mother reported that JRong sees tab lying down. We tend to hold our phone/tab very near in this posture.. it may cause unnecessary stress to our eyes. He previously has a pair of glasses but he did not wear them (they did not bring the glasses).
We reinforce proper visual hygiene:
1) taking regular break in between near work (20-20-20 rule)
– after 20minutes of near work, to look at 20feet away(or far, far away) for 20seconds… to relax back our eyes
2) Harmon distance
– to hold book/phone/tab at an elbow distance
3) good illumination
– always have light on to read
Prescribe full-time wear
R: +0.25
L: +0.25
We also prescribe flipper +/-0.50 eye exercise.
We will see JRong 6-8weeks.. KIV NPC & PFV@Near.
