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Lavanyaa Balamurugan

Lvnyaa (F/14) came for eye examination, with complaint of headache for 1month.. headache does not go away after rest/sleep. Vision is fine seeing far & near.

Vision without glasses
R: 6/6 N5
L: 6/6 N5

Unaided/without correction
R: +1.00 test: 6/21-, 6/18-
L: +1.00 test: 6/9

Subjective Refraction (Delay Fogging +2.00 OU we did twice)
R: PL/-0.25×180 (6/6) (+1.00 blur lens test: 6/12-)
L: +0.25/-0.25×180 (6/6) (+1.00 blur lens test: 6/9+)

Other assessments show:

Cover Test
Distance: NMD (ACT: pt reported RE sees target going down, LE sees target going up)
Near: small XP, fast recovery (ACT: LE shows XP movement, RE shows little to no XP movement)

Howell Card (8^ BD)
Distance: 0 – 1 EP
Near: 2 – 4 XP
+1.00 Near: 4 XP
-1.00 Near: 1 EP
+2.00 Near: 8 – 10 XP
-2.00 Near: 5 EP
(6^BD OD or 6^BU OS: double arrow/bar slowly disappear)

NRA
+1.00

PRA
-1.00

NPC
TTN, TTN, TTN, TTN, TTN

AA
R: 15.5D, 15.5D, 15.5D
L: 15.5D, 15.5D, 15.5D

MEM
R: +1.00
L: +1.00

Accommodation Facility (+/- 2.00)
BE: 11cpm, difficult minus lens
R: 14cpm, difficult minus lens
L: 13cpm, difficult minus lens
– BE see better than with RE
– LE sees better than with BE

Fusional Reserves (Unaided)
Near, PFV: 14/x/x
Near, NFV: x/10/8
Distance, NFV: x/8/6
Distance, PFV: 8/10/6

Vergence Facility (Unaided)
Near: 5 cpm
(double BO, blink3 & single)
Distance: 9 cpm

Fusional Reserves (+0.50 OU only)
Near, PFV: x/8/6
Near, NFV: x/6/4

Maddox Rod
Distance: LE 1 BU
Near: 2 BI, LE 1 BU

Worth 4 Dot, W4D
Distance:4 dots (but there is a shadow on top of the bottom circle)
Near: 4 dots

The bottom circle & the shadow on top (drawn by pt)

Worth 4 Dot (+0.25 in OS)
Distance: 4 dots (no shadow at top of the bottom circle seen)

3D Vision (Random Dot 3S)
12.5″ (slow)

Interpupillary distance, IPD = 5.9cm

Trial framing
R: PL/-0.25×180
L: PL/-0.25×180
Distance correction is not favoured to see far, far away.. pt prefers no correction
Add +0.25 OU/+0.50 OU is not favoured

4^BO Test
(placed on OS: movement is seen)
(placed on OD: no movement seen)

+ve 4BO test in OD but no amblyopia -> MFS? LttHyperopia? V deviation?

KIV
– Amsler
– V FV
– 2/3 Vprism?

We prescribe +0.25 OU for near work & reinforce proper visual hygiene.

Mother reported that her headache may be caused by sinus, according to Dr.