Alan Wong Chun Wing – 88 Optometry

Alan W (M/10) came for follow up, vision with existing glasses is fine seeing far & near.

Vision without glasses
R: 6/15-
L: 6/15-

Vision with existing glasses of 10mths
R: -1.00/-1.00×180 (6/6) (+1.00 blur lens test: 6/12-) R>L
L: -1.25/-0.75×180 (6/6) (+1.00 blur lens test: 6/12-)
Near: L>R

Other assessments show:

Cover Test
Distance: NMD
Near: NMD

Howell Card
Distance: 0 – 2 XP
Near: 2 XP
+1.00 Near: 6 XP
-1.00 Near: 0 – 1 EP
+2.00 Near: 8 XP
-2.00 Near: 5 EP

NRA
+1.75
(OD blurry, OS clear)

PRA
-1.25 (1st)
-2.75 (2nd)

NPC
TTN, TTN, TTN, RE deviates @8cm

AA
R: 16D, 14D, 12D
L: 16D, 14D, 12D

NPC (with Add +0.50)
TTN, TTN, TTN, RE deviates @8cm

AA (with Add +0.50)
R: 16D, 14D, 12D
L: 16D, 14D, 16D, 14D

Accommodation Facility (+/- 2.00)
BE: 17 cpm, difficult minus lens
R: 16 cpm, difficult minus lens
L: 17 cpm, difficult plus lens

MEM
R: +0.25
L: PL

Fusional Reserves
Near, PFV: x/6/4
Near, NFV: x/6/4
Distance, NFV: x/6/4
Distance, PFV: x/8/4

Vergence Facility
Near: 6 cpm (slow BO & BI)
Distance: 6 cpm (slow BO)

Interpupillary distance, IPD = 6.4cm
+gradient AC/A = 4:1, -gradient AC/A = 2:1

Mother reported noticing more twitching in his left eye.. and we also notice the left twitching during examination. We ask Alan whether or not his near vision is fine, he said his near vision is okay.

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