Chrliz (F/10) Andrea’s sis, came for eye examination, with complaint of difficulty copying from TV at school.. and when she looks down on her book, sometimes she finds it blurry too.
Vision without glasses
R: 6/60-2
L: 6/45
Vision with existing 1st pair of glasses 3yrs
R: -2.25/-1.00×180 (6/30)
L: -2.00/-0.75×170 (6/9)
Subjective Refraction
R: -3.25/-1.25×180 (6/6) [+1.00 blur lens test: 6/9-] R>L
L: -2.00/-1.00×170 (6/9- 6/7.5- 6/6-) [+1.00 blur lens test: 6/12] (very2 dim retinoscopy reflex)
Near: +0.75
Lower DC xfavoured @N
Other assessments show:
Cover Test
Distance: NMD (ACT: pt reported RE sees target is bigger & closer & LE sees target is smaller & further away)
Near: NMD (ACT: pt reported RE sees target is bigger & closer & LE sees target is smaller & further away)
Howell Card
Distance: 0
Near: 4 – 6 XP
+1.00 Near: 8 XP
-1.00 Near: 2 XP
+2.00 Near: 6 XP
-2.00 Near: 1 EP
NRA
+2.25
PRA
-1.00
NPC
TTN, TTN, TTN, TTN, TTN, TTN
AA
R: 16.5D, 16.5D, 16.5D (blurry @end of RAF rule, clear @30cm, 28cm, 26cm)
L: 16.5D, 16D, 16D (blurry @end of RAF rule, clear @30cm, 28cm, 30cm)
Accommodation Facility (+/- 2.00)
BE: 10 cpm, difficult minus lens
R: 12 cpm, difficult minus lens
L: 14 cpm, difficult minus lens
MEM
R: +0.50
L: +0.75
Fusional Reserves
Near, PFV: x/35/30
Near, NFV: 8/14/6
Distance, NFV: x/10/6
Distance, PFV: x/25/20
Vergence Facility
Near: 9 cpm (slow BI)
Distance: 8 cpm (slow BO then eventually slow BI also)
Interpupillary distance, IPD = 6.1cm
Fluorescein
R: -ve staining
L: -ve staining
Chrliz plays sports.. we prescribe contact lens.
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/lights