30/10/2022
Natalie (F/7) came for eye examination, with complaint of sometimes blurry seeing whiteboard at school (she sits at the back of class) & headache when she strains her eyes to see whiteboard. Mother reported noticing her eye turning out (not sure which eye) towards end of day or when she is tired.
Vision without glasses
R: 6/12
L: 6/12
VA OU: 6/9- 6/7.5- (with frowning)
Examination shows:
R: -0.50 (6/6) [+1.00 blur test: 6/6- 6/7.5- 6/9-] with vision fluctuation, N5-@33cm
L: -0.50 (6/6) [+1.00 blur test: 6/6- 6/7.5- 6/9-] with vision fluctuation, N5-@33cm
– ret shows PL or mild hyperopia OU
– with +1.00 OU seeing near: OD blurry OS okay
Other assessments show:
Random Dot 3S
40″
12.5″ (when focused)
Cover Test
Distance: intermittent, alternating XT (mostly fixing OS, sometimes straight)
Near: intermittent, alternating XT (sometimes straight)
Howell Card (6BD on OD)
Distance: 1 EP (sometimes 7 EP)
Near: mostly at 10 XP (sometimes 4 XP)
+1.00 Near: 16 XP
-1.00 Near: 5 EP
+2.00 Near: 18 XP
-2.00 Near: 8 EP
Other assessments show: (unaided)
NRA
+1.00
PRA
-0.75
NPC (RAF rule)
RE deviates @10cm, LE deviates @10cm, 12/18cm, 10/14cm, LE deviates @10cm, RE deviates @10cm
AA (RAF rule)
R: 8.5D, 10.5D (N8) better with +0.50
L: 8.5D, 10.5D (N8) better with +0.50
MEM
R: PL
L: PL
Accommodation Facility +/-2.00 (single letter target 20/30)
BE: 16 cpm, difficult plus lens
R: 20 cpm, difficult plus lens
L: 20 cpm, difficult plus lens
Fusional Reserves (Prism Bar)
Near, PFV: x/1/-1
Near, NFV: x/6/4
Distance, NFV: 14/20/18 (blur point 14-double then single)
Distance, PFV: x/12/10
Vergence Facility (Prism Flipper 12BO/3BI)
Near: 4 cpm (slow BO & BI sometimes)
Distance: 4 cpm (slow BO & BI sometimes)
We repeated
Fusional Reserves
Near, PFV: x/1/-1
Assessing Control of IXT
Subjective
Clinic Control
Distance: score 1 (fair control)
Near: score 1 (fair control)
Objective
Binocular VA
Distance: 6/9
Interpupillary distance, IPD = 5.6cm
+gradient = 6:1/12:1, -gradient = 15:1/9:1
We ask Natalie whether or not she realises that her eyes will turn out.. she said her right eye will turn out & she is able to pull back her eye. When we ask about her left eye, she said no.
We prescribe Dot card eye exercise & a pair of glasses -0.50 OU for her to use to copy from whiteboard.
*UpdatedA
10/12/2022
Natalie came back for 2months follow up.
Vision without glasses
R: 6/12- 6/9-
L: 6/12- 6/9- 6/7.5-
Examination shows:
R: -1.00 (6/6) [+1.00 blur test: 6/9-] with vision fluctuation, N5-@33cm
L: -0.75 (6/6) [+1.00 blur test: 6/12-] with vision fluctuation, N5-@33cm
Other assessments show:
Random Dot 3S
20″
12.5″ (with Add: -0.50)
Cover Test
Distance: Right XT
Near: alternating XT
Howell Card (6BD on OD)
Distance: 3-5 EP (without blink), 6-8 XP (with blink)
Near: 20 XP
+1.00 Near: 1 EP (sometimes 13 EP)
-1.00 Near: 10 XP
+2.00 Near: beyond 20 XP
-2.00 Near: 5 EP
Maddox Rod
Distance: 20 BI
Near: 2 BI
Other assessments show:
NRA
+1.75 (mono occlusion: RE better, LE blurry)
PRA
-2.00 (mono occlusion: RE better, LE better)
NPC (RAF rule)
RE deviates @10cm, 12cm, 14cm
AA (RAF rule)
R: 16.5D, 16.5D, 15.5D (blur @end of RAF rule, clear @30cm)
L: 16.5D, 14.5D, 12.5D (blur @end of RAF rule, clear @24cm, 34cm)
MEM
R: PL
L: PL
Accommodation Facility +/-2.00 (single letter target 20/40)
BE: 20 cpm, difficult plus lens
R: 16 cpm, difficult plus lens
L: 20 cpm, difficult plus lens
Fusional Reserves (Prism Bar)
Near, PFV: x/12/10
Near, NFV: x/16/14
Distance, NFV: x/x/x
Distance, PFV: x/35/30
Vergence Facility (Prism Flipper 12BO/3BI)
Near: no double reported (once or twice double BI)
Distance: no double reported (once or twice double BO & BI)
Worth 4 Dots
Distance: initially 5 lights (then 3 lights)
Near: 3 lights
We refer her to co-manage with ophthalmologist & orthoptist.
