22/6/2020
Mr Mhsan (M/57) previously came to change frame of his multifocal glasses as the frame was broken. He came in recently for eye examination in which he complained eyes feeling sandy sometimes. He reported vision with existing glasses is still okay for far & near vision.
Upon examination, his new power is:
R: -5.00/-1.00×30 (6/6-)
L: -5.25/-0.50×160 (6/6-)
Add: +2.25 (N5@40cm)
Mr Mhsan’s shortsighted power is slightly reduced in both eyes while his reading power has increased 025. Yes, shortsighted power may reduce with age but reading power increases with age. So, we see this trend here in his new power, which is absolutely normal. He is seeing 6/6-, 6/6- means that he may miss one or two alphabets on 6/6 line, our smallest line on chart. This is due to him having mild cataract in both eyes. Cataract is our natural transparent lens inside our eyes that has become yellowish. The thicker the cataract is, we may start to miss smaller print/target. What we can do to slow the progression of cataract is to wear sunglasses whenever we are outdoors. If you do wear glasses, you may go for fit-over, sunglasses that you can wear on top of your usual glasses. And even if it is not sunny, we still do get UV from the sun. Or even if we stay under shades of tree too, we also still get UV. So, let us always have a pair of sunglasses with us, always ready wherever we are.
On slit lamp (microscope) examination, we can see that he has a circular whitish ring around his eye, we call Arcus Senilis. Sometimes, just by our naked eyes, we may notice this whitish ring around iris, the coloured black/brown portion of our eye. This is normally associated with cholesterol, we may go for a body check up, and to have our cholesterol checked. Eyes are slightly reddish, but no dry spots, he is advised to use non-preservative artificial tears when he feels his eyes are dry/sandy/gritty.
Mr Mhsan, happy to hear that “the specs are great, no dizziness or disorientation. And the fit is great.”
Thank you Mr Mhsan for your trust & support!
* Updated
Mr Mhsan (M/59) came for eye examination, he shared about being diagnosed with lymphoma in April 2021. He has just completed all his chemo sessions. He is having some headache with near work, near vision is affected as well as some blurry far vision.
Vision without glasses
R: guess 6/120
L: 6/60-2
Prescription
R: -6.00/-1.00×50 (6/6) (+1.00 blur lens test 6/9-) [R: right dominant eye]
L: -5.50/-1.00×90 (6/6) (+1.00 blur lens test 6/9-)
Add: +2.75 (N5@40cm)
Modified
R: -6.00/-0.75×50
L: -5.50/-0.75×90
Add: +2.50
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance (pt reported – target moves down upon covering LE & target moves up upon covering RE alternatingly)
small XP, fast recovery @Near
(normal value: orthophoria/NMD-No Movement Detected or small XP, fast recovery)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0 – 1 EP (yellow part) stops at 1 yellow
Near: 0 – 2 XP (blue part)
(normal value: 0-1 EP or 0-3 XP @Distance; and 0-6 XP @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+0.50
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.75
(normal value: -1.37 to -3.37)
Mr Mhsan has quite some changes on his refractive error/power. His shortsightedness/myopia has increased 100 & 025 in right & left eye respectively. Axis has drastic change too.. from 30 to 50 in right eye & 160 to 90 in left eye. Comparing between the two Axis, he likes the new ones. With sudden big change in Axis, it may cause some dizziness.. so we let him walk with the new power. We are not sure whether or not the change is due to his condition. He was told about having mild cataract in both eyes too. Glad that he feels fine with the power changes. Know that we are all here to cheer for you Mr Mhsan❤️ wifey Kak Jega has also been to our practice & we have checked her eyes too❤️
*Updated 12/2/2022
Existing glasses
R: -6.00/-1.00×50
L: -5.50/-1.00×90
Add: +2.75
He can see but far vision is not distinct, edges are not well-defined.. in which he has to have his head tilted up to see far sharper. When we put on trial frame, he also needs to tilt head up/chin up to see far better.
Other assessments show:
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 1 – 3 EP (yellow part)
Near: 6 – 8 XP (blue part)
(normal value: 0-1 EP (yellow part) or 0-3 XP (blue part) @Distance; and 0-6 XP (blue part) @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
Examination of Eye Alignment/Posture (Maddox Rod)
Distance: 3 Base Out [white vertical line is initially at his left side(red spotlight on right) before drifting to his right(red spotlight on left)]
Near: orthophoria
(normal value: 0-1 EP (yellow part) or 0-3 XP (blue part) @Distance; and 0-6 XP (blue part) @Near)
Base Out/EP = Esophoria is misalignment of the eye, eye is deviated inwards
Base In/XP = Exophoria is misalignment of the eye, eye is deviated outwards
We tried to lower the power of his short-sightedness or astigmatism but he did not like it.
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+0.50
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.25
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, TTN, TTN
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/x/x
Near, Base-In/Divergent, NFV: 20/x/x
Distance, Base-In/Divergent, NFV: 8/12/8
Distance, Base-Out/Convergent, PFV: 8/12/8
(normal value: Blur/Break/Recovery)
Near, PFV: 10-28/7-21
Near, NFV: 7-19/5-15
Distance, PFV: 4-18/5-9
Distance, NFV: 4-10/2-6
[Scheiman – Adult Data]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 8 cpm
Distance: 7 cpm (double with Base Out after repeated flips)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary Distance = 6.8cm
*Updated
We are so sorry Mr Mhsan, as you still find that your distance vision is not as sharp.. edges are blurry & indistinct.
We prepared single vision of two powers to fit into his previous frame & let him try:
Power One
R: -6.00/-1.00×50
L: -5.50/-1.00×90
Power Two
R: -6.00/-0.75×50
L: -5.50/-0.75×90
When he looked at leaves on tree, he reported that vision with Power One is sharper & the leaves are much more distinct. Also, his vision is even better tilting his head up/chin up.
Existing glasses (Delay Fogging)
R: -6.00/-1.00×50 (retinoscopy reflexes seem to be at 90 & 180)
L: -5.50/-1.00×90
Add: +2.75
We let him compare on Right axis, he still prefers 50.
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
(alternating CT: upon covering LE, pt reported target moves to his right + when covering RE, target stays centre)
small XP, fast recovery @Near
(alternating CT: upon covering LE, pt reported target stays centre + upon covering RE & target moves to his right)
(normal value: orthophoria/NMD-No Movement Detected or small XP, fast recovery)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 3 – 5 EP (yellow part)
Near: 2 – 4 XP (blue part)
-1.00 Near: 4 – 6 XP -> 2 – 4 XP (blue part)
(normal value: 0-1 EP (yellow part) or 0-3 XP (blue part) @Distance; and 0-6 XP (blue part) @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
Examination of Eye Alignment/Posture (Maddox Rod)
Distance: 3 Base Out [white vertical line stays on his right & red spotlight on his left]
Distance (head tilt up/chin up): he reported white line is somemore further apart from red spotlight
Near: 5 Base In, R 0.5 Base Down
(normal value: 0-1 EP (yellow part) or 0-3 XP (blue part) @Distance; and 0-6 XP (blue part) @Near)
Base Out/EP = Esophoria is misalignment of the eye, eye is deviated inwards
Base In/XP = Exophoria is misalignment of the eye, eye is deviated outwards
We tried
R: -6.00/-1.00×50 1 Base Out
L: -5.50/-1.00×90
He said far vision is better with prism but vision is even better when he tilts up his head.
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, 6/8cm, TTN, TTN, 6/8cm, TTN, 6/8cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/x
Near, Base-In/Divergent, NFV: 12/8
Distance, Base-In/Divergent, NFV: 8/4
Distance, Base-Out/Convergent, PFV: 20/18
(normal value: Break/Recovery)
Near, PFV: 10-28/7-21
Near, NFV: 7-19/5-15
Distance, PFV: 4-18/5-9
Distance, NFV: 4-10/2-6
[Scheiman – Adult Data]
After we did fusional reserve testing, and we were about to start Vegence Facility, VF.. he reported seeing double on the target column of VF even on VA 6/21 & 6/24.. another shadow appeared to be on top of each testing alphabet. We took a break, had him close & rest his eyes every now & then.. but he still saw shadow. We did Maddox Rod, but there is still no deviation on vertical component @Distance.
BHTT Head Tilt Test
No hypertropia
vision is about the same on right/left gaze (patient reports: vision is worse on right/left gaze)
vision is about the same on right/left tilt (patient reports: vision is worse on right/left tilt)
We also tried
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar (2 BI OU)
Near, Base-Out/Convergent, PFV: x/x
We refer him to see ophthalmologist & orthoptist.
