Lee Wee Meng – 88 Optometry

Ms Lee WM (F/58)Mr.Kevin’s Wife came for eye examination, with complaint of discomfort wearing new glasses in which she also complains about the overall weight.. once uncomfortable, she will wear her old pair of glasses that is much lighter.

Vision without glasses
R: xguess 6/120
L: guess 6/120

Old glasses
R: -5.75/-1.25×175 (6/6-)
L: -4.50/-1.25×10 (6/6-)
Add: +2.25

New glasses of less than 1year
R: -5.75/-0.75×175 (6/6-)
L: -4.25/-1.25×10 (6/6-)
Add: +2.25

Subjective Refraction
R: -5.50/-0.75×175 (6/6) (+1.00 blur lens test: 6/12)
L: -4.00/-1.25×10 (6/6) (+1.00 blur lens test: 6/12)
Add: +2.00 (N5@55cm)

Other assessments show:

Cover Test
Distance: NMD
Near: NMD

Howell Card
Distance: 0
Near: 0
-1.00 Near: 1 – 3 EP
+1.00 Near: 0 – 2 XP

NRA
+0.25

PRA
-1.25

NPC
18/28cm, 18/28cm, 18/28cm, 20/30cm, 20/30cm, 20/30cm

NPC (with Add +2.50)
10/20cm, 10/20cm, 14/24cm, 14/24cm, 16/26cm, 16/26cm

MEM
R: -0.25
L: +0.25

Modified
R: -5.25/-0.75×175
L: -4.00/-1.25×10
Add: +2.25

Fusional Reserves
Near, NFV: x/14/12
Near, PFV: x/20/18
Distance, NFV: x/10/4
Distance, PFV: x/40/35

Vergence Facility
Near: no double reported (no eye movement detected)
Distance: 6 cpm (slow BO)

We repeated
Fusional Reserves (with Add +2.50)
Near, NFV: 12/16/14
Near, PFV: x/x/x (above break pt 20, double then single)

Interpupillary distance, IPD = 6.5cm

Slit Lamp
R: mild cataract
L: mild cataract

Fluorescein
R: -ve staining
L: -ve staining

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)

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/lights