Gvinder (F/45) came for eye examination, vision with existing glasses is fine seeing far.. and she removes glasses to see near. She wears monthly toric contact lenses but she said vision with contact lens is blurry for far & near vision.
Vision without glasses
R: 6/24-
L: 6/15-
Existing glasses of 5years
R: -2.00/-1.75×175
L: -1.00/-2.00×5
Contact lens prescription of 5years
R: -2.75/-1.25×180
L: -1.50/-1.75×180
Subjective Refraction
R: -2.00/-1.50×175 (6/6-) (+1.00 blur test: 6/12)
L: -1.00/-1.75×5 (6/6-) (+1.00 blur test: 6/12)
Add: +1.50
Lowering short-sightedness/astigmatism is not favoured
Near vision is better with glasses
Other assessments show:
Cover Test
Distance: NMD
Near: small XP, fast recovery
Howell Card
Distance: 0
Near: 4 XP
-1.00 Near: 2 XP
NRA
+0.75
PRA
-0.25
Modified
R: -2.00/-1.50×175
L: -1.00/-1.75×5
Add: +1.75
NPC
8/12cm, 8/12cm, 8/12cm, 8/12cm, 8/12cm
MEM
R: +0.25
L: PL
Fusional Reserves
Near, PFV: 14/16/14
Near, NFV: x/10/8
Distance, NFV: x/6/4
Distance, PFV: 16/18/14
Vergence Facility
Near: 12 cpm
Distance: 5 cpm (slow BI)
Interpupillary distance, IPD = 6.5cm
Gvinder wants to wear contact lens every day.
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