Muhamad Harith Abd Rani

Harith (M/31) came for eye examination, with complaint of seeing double vision looking at laptop and phone or when he changes fixation since 3-4days ago.. no double is seen after taking a break.. but the double comes back after a while again. He likes to read and he uses his laptop about 9 hours every day. No double is seen when he closes either eye. No eye pain is reported but he feels that his eyes are warm. No recent trauma is reported.

Vision without glasses
R: 6/30-
L: 6/45+ (better)

Existing Glasses
R: -3.00/-1.00×140 (6/6)
L: -2.25/-1.50×160 (6/6)

Subjective Refraction
R: -2.50/-1.00×160 (6/6) (+1.00 blur test: 6/9+)
L: -2.25/-1.25×175 (6/6) (+1.00 blur test: 6/9-)

Other assessments show:

Cover Test
Distance: NMD
(upon cover-uncover, he reported his right eye seeing alphabets surrounding the target to jiggle up & down, but target did not move)
Near: small EP, fast recovery

Maddox Rod
Distance: 2 Base In, R 2 Base Down
Near: R 1 Base Down

Howell Card
Distance: 0 – 2 XP
Near: 0 – 2 XP

Worth 4 Dots
Distance: 4 dots
Distance: 6 dots (initial moment: he saw extra 2 red dots below the original red dot before normalised the next moment)
Near: 4 dots

Motility
double reported @Right gaze
(biggest diplopia @dextrodepression)

Random Dots 3S
12.5″

Slit Lamp
R: conjunctival/limbal congestion
L: conjunctival/limbal congestion

Fluorescein
R: -ve staining
L: -ve staining

Pupil Reflex
R: -RAPD
L: -RAPD

Colour Vision
R: normal
L: normal

Amsler Grid
R: normal
L: normal

We refer Harith to see eye doctor/ophthalmologist and orthoptist.

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
ACT: alternating CT

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, BO/PFV: x/15-31/10-22
Near, BI/NFV: x/7-17/3-11
Adult
Near, BO/PFV: x/10-28/7-21
Near, BI/NFV: x/7-19/5-15
Distance, BO/PFV: x/4-18/5-9
Distance, BI/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/Stereopsis
12.5″

Worth 4 Dots – Binocular Perception 4 dots