Goh Seng Ching – 88 Optometry

Ching (F/43) came for follow up.. with complaint of difficulty seeing small, fine print at far. Vision seeing laptop is fine & she likes to remove glasses to see near by holding phone closer @20cm, but holding phone @40cm, vision with glasses is better.

Vision without glasses
R: 6/45
L: 6/45-

Vision with existing glasses
R: -2.50/-0.75×70 (6/6-) (R: right dominant eye)
L: -2.75/-0.50×110 (6/6)
Add: +1.00 (N5@40cm)
DC is favoured @D & N (DC 050 is better than 025 @N)

Other assessments show: (with existing glasses)

Cover Test
Distance: NMD
Near: NMD

Howell Card
Distance: 1 EP
Near: 2 XP (seeing through bottom portion of lens)
Near: 4 – 6 XP (seeing through top portion of lens)
+1.00 Near: 4 – 6 XP

NRA
+1.50

PRA
-0.75

NPC
6/10cm, 6/10cm, 8/12cm, 8/12cm, 10/14cm, 10/14cm

AA
R: 43yo, 43yo, 43yo
L: 43yo, 43yo, 43yo

MEM
R: +0.25
L: +0.25

Modified
R: -3.00 (6/6)
L: -3.00 (6/6)
Add: +1.00
(Pt prefers habitual DC @D & N)

Fusional Reserves
Near, PFV: x/20/18
Near, NFV: x/14/10
Distance, NFV: x/8/6
Distance, PFV: x/16/14

Vergence Facility
Near: 14 cpm (slow BI at the end)
Distance: 0 cpm (double BO)

Interpupillary distance, IPD = 6.1cm

All near tests are done using lower portion of lens.

We ask Ching if her job requires her to see small print at far.. if so, we may give higher shortsightedness so as to be able to see the print.

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