Mr Leow (M/82) EDWEENA’S DAD came for eye examination, with complaint of blurry far vision with existing glasses of many2 years ago.. he realises that he can far better removing his glasses.
Vision without glasses
R: 6/12
L: 6/12
Existing Glasses (lenses have been refitted to new frame previously)
R: +2.50/-1.25×70
L: +1.50
Add: +2.50
Subjective Refraction
R: +1.00/-0.50×90 (6/7.5-) PHNI
L: +0.75 (6/7.5-) PHNI
Add: +2.50
Other assessments show:
Cover Test
Distance: NMD
Near: small XP, fast recovery
Worth 4 Dots
Distance: 4 dots
Near: 4 dots
Pupil Reflex
R: -RAPD
L: -RAPD
Colour Vision
R: normal
L: normal
Amsler Grid
R: a few crooked lines
L: some crooked lines
Slit Lamp
R: cataract
L: cataract
Fluorescein
R: -ve staining
L: -ve staining
Elderly parents may tell us that they can see far better & they do not need their glasses for far vision anymore. This is usually a temporary phase due to changes in the lens inside their eyes.
We refer to see eye specialist doctor/ophthalmologist.
_____________________________________
Separately…
Ivin’s mum (F/66) came for eye examination, she also reported seeing far vision better removing her glasses & she does not need glasses for far vision now.
Existing Glasses of 5years
R: +1.25/-0.50×90
L: +1.00
Add: +2.50
Subjective Refraction
R: +0.50 (6/7.5-) PHNI
L: +0.50 (6/7.5-) PHNI
Add: +2.50
Other assessments show:
Cover Test
Distance: NMD
Near: small XP, fast recovery
Worth 4 Dots
Distance: 4 dots
Near: 4 dots
Pupil Reflex
R: -RAPD
L: -RAPD
Colour Vision
R: normal
L: normal
Slit Lamp
R: cataract
L: cataract
Fluorescein
R: -ve staining
L: -ve staining
We refer Ivin’s mum to see eye specialist doctor/ophthalmologist for cataract surgery.
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 Alignment
(Maddox Rod) placed on RE
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/Stereopsis
12.5″
Worth 4 Dots – Binocular Perception 4 dots