Mr Ho (M/39) came for eye examination.. with complaint of sometimes blurry far vision driving at night since 6-7years ago. He does not wear any glasses. No headache is reported.
Vision without glasses
R: 6/6
L: 6/6
Examination shows:
R: PL (6/6) [+1.00 blur lens test 6/7.5]
L: PL (6/6) [+1.00 blur lens test 6/7.5]
Add: +1.00 (N5@40cm)
No hyperopia is accepted @D
Other assessments show:
Cover Test
Distance: NMD (ACT: pt reported RE sees target move to his R, LE sees target move to his L
Near: small EP, fast recovery
Howell Card
Distance: 3 – 5 EP
Near: 0 – 2 XP (with Add)
Near: 7 – 9 EP (unaided)
+2.00 Near: 4 – 6 XP
-2.00 Near: 19 EP
NRA
+0.75
PRA
-1.00
NPC
7/10cm, 7/10cm, 7/10cm, 7/10cm, 7/10cm, 7/10cm
AA
R: 40yo, 42yo, 43yo
L: 40yo, 42yo, 43yo
Accommodation Facility (+/- 1.00)
BE: 11 cpm, difficult plus lens
R: 10 cpm, difficult plus lens
L: 15 cpm, difficult plus lens
MEM
R: +0.50
L: +0.50
Fusional Reserves
Near, PFV: x/16/14
Near, NFV: x/8/6
Distance, NFV: x/4/2
Distance, PFV: x/10/8
Vergence Facility
Near: 3 cpm (slow BI & BO)
Distance: 0 cpm (double BI)
Maddox Rod
Distance: R 1BU, 8BO (pt reported the vertical white line will still move apart after intersecting with red spotlight)
Near: no vertical white line seen, only red spotlight @Horizontal & Orthophoria @Vertical
Interpupillary distance, IPD = 6.6cm
+gradient AC/A = 7:1, -gradient AC/A = 6:1
All near tests are done with Add.
Decompensated EP @D
DI
LttHyperopia?
We refer to co-manage with ophthalmologist & orthoptist.
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 OD
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/lights