Wong Khee Yap – 88 Optometry

Mr Wong (M/48) came for follow up. Vision with existing reading glasses is fine. He has no complaint on his far vision & night driving.

Vision without glasses
R: 6/12-
L: 6/9

Existing reading glasses of 1+year
R: +1.25/-0.25×65
L: +1.00
Add: +1.75

Subjective Refraction
R: +1.00 (6/6) (+1.00 blur test: 6/7.5)
L: +1.00 (6/6) (+1.00 blur test: 6/7.5-) L>R
Add: +1.75 (L>R)

Other assessments show:

Cover Test
Distance: NMD
Near: small XP, fast recovery

Howell Card
Distance: 0 – 2 XP
Near: 12 – 14 XP
-1.00 Near: 8 – 10 XP

NRA
+0.50

PRA
-0.25

NPC
14/20cm, 14/20cm, 16/22cm, 16/22cm, 18/24cm, 18/24cm

NPC (Add +2.25)
14/20cm, 14/20cm, 14/20cm, 16/22cm, 16/22cm, 16/22cm

MEM
R: +0.50
L: +0.50

Fusional Reserves
Near, PFV: 16/25/16
Near, NFV: x/20/18
Distance, PFV: x/14/12
Distance, NFV: x/8/6

Vergence Facility
Near: 0 cpm
(double with Base Out, double did not go closer with blink)
Distance: 5 cpm
(double with Base Out, become single with blink)

Slit Lamp Microscope
R: very mild cataract
L: very mild cataract

Fluorescein
R: -ve
L: -ve

All near tests are done with Add.

Interpupillary distance, IPD = 6.3cm

We ask Mr Wong again whether or not his near vision is fine or losing focus on near work, he said it’s okay & no lose focus.. but sometimes he needs to adjust his near material in between putting furthest at arm length & bringing closer (the way he showed us).. and he finds it weird.

NPCI?

We can try to work on his NPC, if he is willing to do the eye exercise.

Notes

Vision without glasses
6/6 – smallest testing line
6/7.5 – 2nd smallest line
6/9 – 3rd smallest line
6/12 – 4th smallest line
6/15 – 5th
6/18 – 6th
6/21 – 7th
6/24 – 8th

Examination of Eye Alignment
Cover Test, CT @ Distance & Near
– NMD(No Movement Detected) or
– small XP, fast recovery
EP = Esophoria is misalignment of eye, eye is deviated inwards
XP = Exophoria is misalignment of eye, eye is deviated outwards

Examination of Eye Posture
(Howell Card) by 6^ BD OD
Distance:
– 0-3 XP (blue part) or
– 0-1 EP (yellow part)
Near:
– 0-6 XP (blue part)

Accommodation/Focusing analysis – ability to relax
NRA
+1.50 to +2.50

Accommodation/Focusing analysis – ability to focus
PRA
-1.37 to -3.37

Convergence/NPC – ability of eye to maintain a single clear near image (RAF rule)
Break/Recovery – within 10cm or TTN(to the nose)

MEM(Monocular Estimation Method) – measure accommodation response seeing near target
+0.25 to +0.75

Accommodation Facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
Monocular: 6cpm – 16cpm
Binocular: 4cpm – 14cpm
(1 cycle per minute, cpm = 2 words)

Fusional Reserves –
Convergent/Divergent reserve stamina (Prism Bar)
Blur/Break/Recovery
Children 7-12yo
Near, PFV: x/15-31/10-22
Near, NFV: x/7-17/3-11
Adult
Near, PFV: x/10-28/7-21
Near, NFV: x/7-19/5-15
Distance, PFV: x/4-18/5-9
Distance, NFV: x/4-10/2-6

Vergence Facility – ability to make rapid repetitive vergence changes (Prism Flipper 12BO & 3BI)
Distance: 12-18 cpm
Near: 12-18 cpm)
(1 cycle = 2 times clearing target)