LOW CHUI THONG – 88 Optometry

CThong (F/15) came for eye examination, with complaint of blurry seeing whiteboard at school. Near vision is fine.

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

Existing glasses
R: PL/-0.75×180 (6/6)
L: +0.25/-0.75×180 (6/6)

Subjective Refraction
R: +0.25/-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: 6/12)
Add: +0.50

Other assessments show:

Cover Test
Distance: NMD
Near: NMD

Howell Card
Distance: 1 EP
Near: 0 – 2 XP
+1.00 Near: 6 – 8 XP
-1.00 Near: 4 XP
+2.00 Near: 4 XP
-2.00 Near: 2 XP

NRA
+1.50
(when blur reported, alternate occlusion: RE sees clear, LE sees blurry)

PRA
-0.25
(when blur reported, alternate occlusion: RE sees clear, LE sees blurry)

NPC
8/10cm, 8/10cm, 8/10cm, 8/14cm, 8/14cm, 8/14cm

AA
R: 13.5D, 11.5D, 10D (blur @end of RAF rule, clear @30cm)
L: 11.5D, 10D, 8.5D (blur @end of RAF rule, clear @30cm)

NPC (with Add +0.75)
8/12cm, 8/12cm, 12/16cm, 12/16cm

MEM
R: +1.00
L: +1.00

Fusional Reserves
Near, NFV: 2/12/10
Near, PFV: x/6/2
Distance, NFV: 6/8/6
Distance, PFV: 8/14/10

Vergence Facility
Near: 3 cpm (double BI, double did not get closer with blink)
Distance: 0 cpm (double BO, double did not get closer with blink)

Fusional Reserves (with 1BI OU)
Near, PFV: x/6/2

Interpupillary distance, IPD = 6.0cm

We ask CThong whether or not her near vision will be blurry/lose focus after some time, she said yes.. in which she will blink3 her eyes. Her mother also reported noticing her blinking her eyes often watching TV/phone.

CI + AI?

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″