May jie (F/45) Yeow’s sis came for eye examination, vision with her existing glasses is fine seeing far. She will remove her glasses to see near comfortably. She is full-time contact lens wearer.. wearing -2.50 in both eyes. Last year, she had an eye infection in right eye and she was advised to lay off contact lens for 3months.
Vision without glasses
R: 6/45-
L: 6/45-
Vision with existing glasses made recently
R: -3.00/-0.50×85(6/6)
L: -2.50/-0.75×95 (6/6)
Examination shows: (Delay Fogging)
R: -3.25 (6/6) [+1.00 blur lens test: 6/7.5-] [R: right dominant eye]
L: -2.75 (6/6-) [+1.00 blur lens test: 6/9] L>R
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 goes to her left .. when covering right eye, the target goes to her right)
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 = 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 – 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
+1.75
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-1.00
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
8/14cm, 8/14cm, 8/14cm, 8/16cm, 8/16cm, 8/16cm
(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 (pt reported target is clear @end of RAF rule)
L: 45 YO, 45 YO, 45 YO (pt reported target is clear @end of RAF rule)
(normal value: AA goes according to age; YO=years old)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.50
L: +0.50
(normal value: +0.25 to +0.75)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/18/16
Near, Base-In/Divergent, NFV: x/14/12
Distance, Base-In/Divergent, NFV: x/8/6
Distance, Base-Out/Convergent, PFV: x/20/18
(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: 9 cpm (double with Base Out, blink3 & single)
Distance: 3 cpm (double with Base Out, blink3 & single then double back again)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Fluorescein R: +0.50
R: mild staining inferiorly
L: mild staining inferiorly
All near tests are done with Add.
Interpupillary distance, IPD: 6.1cm
We advise her to lay off contact lens for a few weeks & use some non-preserved artificial tears to lubricate her eyes.