YMi jie (F/55) came for eye examination, with complaint of slight blurry far vision & glaring especially during night driving.. light is seen dispersed.. since this year. She will remove glasses to see near.
Vision without glasses
R: 6/60-2
L: 6/12-
Vision with existing glasses of 2years
R: -2.25/-1.75×95 (6/6-)
L: -1.50 (6/6)
Examination shows: (Delay Fogging)
R: -2.50/-1.50×95 (6/6) [+1.00 blur lens test: 6/21]
L: -1.00 (6/6) [+1.00 blur lens test: 6/12-] [L: left dominant eye]
Add: +2.25
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target is bigger & closer.. when covering right eye, the target is smaller & further away)
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: 6 – 8 XP (blue part)
-1.00 Near: 4 – 6 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
+0.75
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.50
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
10/18cm, 10/18cm, 10/18cm, 10/20cm, 10/20cm, 10/20cm
(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: pt reported N8 target is blur @end of RAF rule, clear @40cm, better with -1.50DC than -1.25DC)
L: pt reported N8 target is blur @end of RAF rule, clear @40cm)
(normal value: AA goes according to age; YO=years old)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/25/18 (break point 4, 6, 12, 14 – double then single)
Near, Base-In/Divergent, NFV: x/12/10
Distance, Base-In/Divergent, NFV: x/6/4
Distance, Base-Out/Convergent, PFV: x/12/10
(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: 7 cpm (double with Base Out, blink2 & single)
Distance: 7 cpm (double with Base Out, blink2 & single)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Fluorescein
R: -ve
L: -ve
Slit Lamp Microscope Fluorescein
R: mild cataract (R>L)
L: mild cataract