LOKE SHYN EE – 88 Optometry

SEe (F/16) came for eye examination with complaint of blurry far vision.. and blurry near vision looking at hp after 30mins.. in which she blinks her eyes to see clearly on phone again before becoming blurry again in 20mins. She has a pair of glasses (she did not bring) that she uses for far vision only, and she does not think that she needs glasses for near.

Vision without glasses
R: 6/21-
L: 6/18-

Subjective Refraction (Delay Fogging +2.00 OU)
R: -1.25/-1.00×170 (6/6) (+1.00 blur lens test: 6/12-) R>L
L: -1.00/-1.00×180 (6/6) (+1.00 blur lens test: 6/12-)
Add: +0.75 (L>R) Add is favoured

Other assessments show:

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

Howell Card
Distance: 1 EP
Near: 2 XP
+1.00 Near: 2 XP
-1.00 Near: 1 EP
+2.00 Near: 6 XP
-2.00 Near: 3 EP

NRA
+1.50

PRA
-1.00

NPC
6/8cm, 6/8cm, 8/10cm, 8/10cm, 10/12cm, 12/14cm

AA (N8 target on RAF Rule)
R: 12D, 10.5D, 9.5D (blur @end of RAF rule, clear @36cm)
L: 16D, 13.5D, 12D (blur @end of RAF rule, clear @34cm)

MEM
R: +0.25
L: +0.25

Accommodation Facility (+/- 2.00)
BE: 10cpm, difficult minus lens
R: 12cpm, difficult minus lens
L: 12cpm, difficult minus lens
– BE/LE sees better than with BE

Fusional Reserves
Near, PFV: x/4/2
Near, NFV: x/12/10
Distance, NFV: x/10/8
Distance, PFV: x/30/25

Vergence Facility
Near: 12 cpm
Distance: 9 cpm (double BI @end of testing)?

We repeated
Fusional Reserves
Near, PFV: x/8/6

Interpupillary distance, IPD = 6.3cm

+gradient AC/A : 2:1
-gradient AC/A : 2.5:1

Receded NPC, low PFV @Near, low AA, low PRA
CI + AI?

We prescribe SEe with added plus at near for full-time wear.

We will see her in 2months.

KIV
PFV @Near
VT for AI, 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)

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)

Random Dot 3S – 3D Vision
12.5″