Ray (M/10) EDWEENA’S NEPHEF came for eye examination, mother reported noticing him blinking his eyes often since few days ago. He has not worn any glasses & no blurry vision is reported.
Vision without glasses
R: 6/6
L: 6/6
Subjective Refraction
R: PL (6/6) (+1.00 blur lens test: 6/18-)
L: PL (6/6) (+1.00 blur lens test: 6/15-)
Other assessments show:
Random Dot 3S
12.5″
Cover Test
Distance: NMD
Near: NMD
Howell Card
Distance: 1 EP
Near: 2 XP
+1.00 Near: 4 XP
-1.00 Near: 2 XP
+2.00 Near: 6 XP
-2.00 Near: 2 XP
NRA
+2.00
PRA
-0.75
NPC
TTN, TTN, TTN, TTN, TTN, TTN
AA
R: 15D, 15D, 15D
L: 15D, 15D, 15D
Accommodation Facility (+/- 2.00)
BE: 7 cpm, difficult plus lens
R: 8 cpm, difficult plus lens
L: 10 cpm, difficult plus lens
MEM
R: +0.50
L: +0.50
Fusional Reserves
Near, NFV: x/10/8
Near, PFV: 25/30/25
Distance, NFV: x/8/6
Distance, PFV: 25/30/25
Vergence Facility
Near: 8 cpm (slow BI)
Distance: 7 cpm (slow BI & BO)
Fluorescein
R: -ve staining
L: very light staining
Slit Lamp
R: mild conjunctival redness
L: mild conjunctival redness, heavy-looking upper eyelid
Interpupillary distance, IPD = 5.8cm
We emphasise visual hygiene, the importance of taking regular break in between seeing near.. and we prescribe non-preserved artificial tears.
Alternatively, we can prescribe +0.25/+0.50 in both eyes for him to be used while he is on screen.
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)
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, 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
12.5″