Madam Teh (F/66) came for eye examination, she had cataract surgery in right eye 3months ago.. and about a year+ in left eye. She was high myope before cataract surgery.. as we recalled checking the power of her last spec.
Vision without glasses
R: 6/12-
L: 6/45+2
Prescription
R: -0.50/-0.75×45 (6/6)
L: -2.75 (6/6)
Add: +3.00 (N5)
Subjective Refraction
R: -0.50/-0.75×45 (6/6) (+1.00 blur test: 6/9-)
L: -2.25 (6/6) (+1.00 blur test: 6/15-) L>R
Add: +2.25 (L>R)
Other assessments show:
Cover Test
Distance: NMD
Near: NMD
Howell Card
Distance: 1 EP
Near: 0 – 2 XP
-1.00 Near: 0 – 2 XP
NRA
+0.50
PRA
-1.50
Modified for comfort
R: -0.50/-0.75×45
L: -2.00
Add: +2.00
NPC
14/22cm, 14/22cm, 14/24cm, 14/24cm, 16/26cm, 16/26cm
MEM
R: with movement
L: with movement
Fusional Reserves
Near, PFV: x/20/18
Near, NFV: x/14/12
Distance, NFV: x/6/4
Distance, PFV: x/12/10
Vergence Facility
Near: 3 cpm
(initially double with Base Out.. with repeated flips, double with Base In & double did not go closer with blink)
Distance: 8 cpm
Fluorescein
R: -ve
L: -ve
All near tests are done with Add.
Interpupillary distance, IPD = 6.0cm
Madam Teh brought in her old glasses.
Own glasses (before cataract surgery)
R: -4.50/-0.50×10
L: -7.00
Add: +2.75
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)
AA(Amplitude Accommodation) – eye stamina (Dioptre, D)
6yo – 16.5D | 6cm
9yo – 15.5D | 6.5cm
12yo – 14.5D | 7cm
15yo – 13.5D | 7.5cm
18yo – 12.5D | 8cm
21yo – 11.5D | 9cm
24yo – 10.5D | 10cm
27yo – 9.5D | 11cm
30yo – 8.5D | 12cm
MEM(Monocular Estimation Method) – measure accommodation response seeing near target
+0.25 to +0.75 (with movement)
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)