Alia (F/19) datang untuk pemeriksaan mata, mengadu tengok jauh kabur… tengok dekat okay. Speknya yang dibuat dengan kita tahun lepas sudah hilang. Beliau ada sakit kepala sekali sekala, biasanya sakit kepala pada belah petang.. dan akan urut kepala tapi tak legakan jugak. Beliau selalu pakai spek, adakalanya tak pakai bila kat rumah saja.
Vision without glasses
R: 6/7.5-
L: 6/12+
BE: 6/6-
Our record
R: -0.75
L: -0.75
Subjective Refraction
R: -0.50 (6/6) (+1.00 blur lens test: 6/7.5)
L: -0.75 (6/6) (+1.00 blur lens test: 6/12)
When seeing testing chart, she prefers -0.25 OU.
When seeing far2 away, she prefers -0.75 OU (she likes it like the power of her existing glasses)
Retinoscopy
R: PL
L: PL
Other assessments (done Unaided) show:
Cover Test
Distance: NMD
Near: NMD
Howell Card
Distance: 0 – 1 EP
Near: 2 – 4 XP
+1.00 Near: 4 XP
-1.00 Near: 0
+2.00 Near: 6 XP
-2.00 Near: 3 – 5 EP
NRA
+1.50
(blurry mono & bino)
PRA
-2.00
NPC
8/14cm, 8/10cm, 12/16cm, 6/10cm, 6/10cm, 8/12cm, 8/12cm
AA
R: 8.5D, 8.5D, 8.5D (blur @end of RAF rule, clear @ 30cm)
L: 8.5D, 12.5D, 12.5D (blur @end of RAF rule, clear @ 32cm)
NPC (with Add +0.50)
14/20cm, 6/10cm, 10/14cm, 16/22cm, 6/10cm
MEM
R: +0.50
L: +0.25/PL
Accommodation Facility (+/- 2.00)
BE: 10cpm, difficult minus lens
R: 9cpm, difficult minus lens
L: 9cpm, difficult minus lens
Fusional Reserves
Near, PFV: x/4/2
Near, NFV: 6/14/8
Distance, NFV: x/12/8
Distance, PFV: x/10/4
Vergence Facility
Near: 0 cpm (double BO)
Distance: 7 cpm (slow BO)
We repeated
Fusional Reserves
Near, PFV: x/4/2
Interpupillary distance, IPD = 6.4cm
Worth 4 Dots
Distance: 4 lights
Near: 4 lights
Random Dot 3S
12.5″
Kita tanya Alia sama ada penglihatan dekatnya okay & ada kabur tak, beliau kata kadang-kala akan nampak dekat kabur. Alia akan kelip2 mata & boleh nampak jelas. Bila kabur lagi, beliau berhenti tengok dekat & buat kerja lain pulak.
We prescribe
R: -0.50
L: -0.50
with Dot Card eye exercise
Alia akan balik Dengkil keesokan hari.. kita jumpa dalam 2bulan bila dia pulang nanti.
Kita share tentang proper visual hygiene:
1) ambil rehat antara kerja dekat, ikutkan peraturan 20-20-20 (selepas 20minit tengok dekat, alihkan pandangan tengok jauh2 atau sejauh 20kaki, selama 20saat)
2) kena buka lampu dalam bilik bila tengok komputer/phone
3) ambik phone dlm jarak satu siku, tak nak pegang hp terlalu dekat dengan mata
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