RTong (F/15) came for eye examination, vision with existing glasses of 1year is fine seeing far & near. We observe that she has alternating exotropia. She knows that her left eye will move outwards since she was little.. and she has some control in bringing back her left eye. No family history of squint eye reported.
Vision without glasses
R: 6/45 (better)
L: 6/45
Vision with existing glasses
R: -3.00/-0.75×180 (6/6)
L: -3.50/-0.25X180 (6/6)
Examination shows: (Delay Fogging)
R: -3.25/-0.50×180 (6/6) [+1.00 blur lens test: 6/12-] [R: right dominant eye] R>L
L: -3.50/-0.25×180 (6/6) [+1.00 blur lens test: 6/15-]
Near: L>R
Other assessments show:
3D Vision (Random Dot 3S)
12.5″
(normal value: 12.5″)
Examination of Eye Alignment/Vergence (Cover Test, CT)
large alternating exotropia @Distance (fixing RE)
moderate alternating exotropia @Near (fixing LE)
– eyes are straight when she is attentive & focused @D&N
(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: 4 XP (blue part)
Near: 4 XP (blue part)
+1.00 Near: 2 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 R: 6/45 (better)
– result is read in split second before the double bar & arrow disappear the next moment when her eye deviates out
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+2.25
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-3.25
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
12/26cm, 12/26cm, 12/26cm, 6/8cm, 8/12cm, 12/26cm
(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: 15 YO, 20 YO, 20 YO (pt reported target is clear @end of RAF rule) (target is better with -0.50DC than -0.25DC/no DC)
L: 25 YO, 25 YO, 30 YO (pt reported target is clear @end of RAF rule) (target is better with -0.25DC than without)
(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: 13 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 12 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with right eye)
L: 10 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: +0.75
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/4/2 (OS deviates @4^)
Near, Base-In/Divergent, NFV: x/35/30 (above break point 18^, double then single)
Distance, Base-Out/Convergent, PFV: x/x/x (OS deviates @1^)
Distance, Base-In/Divergent, NFV: x/30/18
(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: 0 cpm (double with Base Out & Base In) [easier with BO than BI]
Distance: 0 cpm (double with Base Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
– pt is tired already
Interpupillary distance, IPD: 5.8cm
We saw RTong last year but she did not go to see eye doctor.
We prescribe Dot Card eye exercise.
We will see in her 2months.
