Mr Chan (F/60) came for eye examination, vision with existing multifocal glasses is fine seeing far & near. He reported needing to tilt up to see computer better.
Vision without glasses
R: 6/45
L: 6/60-2
Existing glasses >5years (FH is worn higher)
R: -1.50/-1.50×50 (6/6-)
L: -4.00/-0.75×70 (6/6-) L>R
Add: +2.25
Subjective Refraction
R: -1.50/-1.25×50 (6/6) (+1.00 blur lens test: 6/7.5)
L: -4.00/-0.50×70 (6/6) (+1.00 blur lens test: 6/18)
Add: +2.25
We tried reducing shortsightedness but he did not like it
Other assessments show:
Cover Test
Distance: NMD
Near: small XP, fast recovery
Howell Card
Distance: 1 EP
Near: 12 XP
-1.00 Near: 10 XP
NRA
+0.25
PRA
-0.25
NPC
10/12cm -> 38/44cm, 12/14cm -> 32/38cm, 14/16cm -> 30/36cm
(twice of break/recovery reported in a single testing)
Fusional Reserves
Near, PFV: x/4/-1
Near, NFV: x/18/16
Distance, NFV: x/6/4
Distance, PFV: x/8/6
Vergence Facility
Near: 0 cpm
(double BO, double did not go closer with blink)
Distance: 0 cpm
(double BO, double did not go closer with blink)
We repeated
Fusional Reserves
Near, PFV: x/25/20
Interpupillary distance, IPD = 6.6cm
Fluorescein
R: -ve
L: -ve
Slit Lamp
R: mild cataract
L: mild cataract
Trial framing
R: -1.50/-1.50×50
L: -4.00/-0.75×70
Pt prefers own higher astigmatism power seeing far, far away
Mr Chan has anisometropia (big power difference between both eyes) all these years.
FH worn higher causing XP? CI?
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) (RAF rule)
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)