Ms Cnary (F/55), Mr Chan’s wife came for eye examination, vision with existing multifocal glasses is fine seeing far & she will remove glasses to see near lately. She wears contact lenses occasionally power -350 & -400 & she feels dry after 4hours of wearing. She also tends to have headache.. previously she had headache & tired eyes with near work.. now that she has retired, although headache is lesser but she will have headache when she goes out, especially in the sun.
Vision without glasses
R: 6/45-1
L: 6/60+1
Existing glasses >4years (FH is worn slightly higher)
R: -3.50/-0.75×35 (6/6)
L: -4.50/-0.50×175 (6/6)
Add: +2.25
Subjective Refraction
R: -3.50/-0.25×35 (6/6) (+1.00 blur lens test: 6/7.5)
L: -4.50/-0.25×175 (6/6) (+1.00 blur lens test: 6/7.5)
Add: +2.25
Other assessments show:
Cover Test
Distance: NMD
Near: small XP, fast recovery
Howell Card
Distance: 2 XP
Near: 4 XP
-1.00 Near: 4 – 6 XP
NRA
+0.75
PRA
-0.50
NPC
12/22cm, 12/22cm, 14/24cm, 14/24cm, 16/26cm, 16/26cm
Fusional Reserves
Near, PFV: x/8/6
Near, NFV: 8/14/10
Distance, PFV: x/14/12
Distance, NFV: x/8/6
Vergence Facility
Near: 12 cpm
Distance: 14 cpm
We repeated
Fusional Reserves
Near, PFV: x/25/20
Interpupillary distance, IPD = 6.6cm
Fluorescein
R: mild staning
L: mild staining
Slit Lamp
R: mild cataract
L: mild cataract
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)