Mr Wong (M/48) came for eye examination, vision with existing single vision glasses of 4-5 years is fine seeing far but near vision is blurry.. in which he needs to tilt down his head to look beyond the top part of his lens to see near at upclose distance. He puts newspaper further away on his figure-four leg position to see slightly more comfortable at bigger print. No headache is reported.
Vision without glasses
R: 6/120
L: 6/120
Vision with own glasses
R: -5.00/-0.75×70 (6/6)
L: -5.25/-1.00×120 (6/6)
Examination shows:
R: -5.00/-0.75×70 (6/6) (+1.00 blur lens test 6/9) [R: right dominant eye] R>L
L: -4.75/-1.00×120 (6/6) (+1.00 blur lens test 6/9)
Add: +1.75 (N5@40cm)
We tried lower shortsightedness 025 binocularly, but he did not like it
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
small EP, fast recovery @Near – left eye is seen deviated inwards more
[ACT @Near: upon covering LE, RE sees target finger move; and upon covering RE, LE sees no movement] pt reported target moves front & back
(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: 1 – 3 – 5 – 7 – 9 – 5 – 3 – 1 EP (yellow part) [after blink, it goes back to lower number]
Add +1.75 Near: 0 – 1 EP (yellow part) not reaching yellow 1
Add +2.75 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
with Add: +0.50
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
with Add: -0.25
(normal value: -1.37 to -3.37)
Mr Wong enters presbyopia/”rabun dekat”/”lou fah” due to inelasticity of lens inside our eyes in changing shape to focus. Supporting our eyes with appropriate reading power according to different distances of our digital devices/material is all we need to do. Especially for high power like Mr Wong in which he needs to hold very near to see by removing his glasses.. causing him to tilt down his head to look beyond the top part of his lens to see near without having to remove his glasses. Imagine our eyes needing to see upgaze in order to see near clearly, eyes absolutely will be stressful in this strenuous position.. driving his esophoric eye posture?
Let us care for our eyes by giving the right power for them to work optimally.. by keeping our eye power updated by scheduling eye examination with your nearby eye care practitioner.