Alex (M/7) came for eye examination, mummy reported that he complains of headache especially with near work.
Examination showed:
R: -0.75/-2.00×180 (6/9+)
L: -0.25/-2.00×175 (6/9+)
Alex has mainly astigmatism in both eyes. With astigmatism, it is unlikely that the power will go down. To minimise power progression over the next 10years would be our ultimate goal, together.
Looking into caring for children’s eye with high astigmatism, one important thing we would want the child to know is that no rubbing his/her eyes. He must know that this habit is a big nono! Sometimes, it may be just a habit in which they find comfort. We would want to see your kid regularly, as we want to reinforce all these proper visual hygiene practices in them, until they are able to recite it out naturally, like how to recite their times tables.
Other times, it may be due to eye allergy that they have.. causing eye itch that brings about eye rubbing. With relation to eye allergy, you may bring your child to us to let us have a look, or alternatively to bring them to see an ophthalmology/eye doctor.
Alex has lazy eye/amblyopia, he cannot see the smallest line 6/6 on testing chart even after correction. But, his vision normally will pick up after full time of spectacle wear soon.
Alex is loving this sky blue flexible frame with an additional strap for more rigorous activities fitted with clear lenses.
Aunty is happy to see you cheerfully wearing your glasses Alexander.
Thank you Mr Kingsley, Michelle & Alex for your trust & support!
*Updated
(Alex did come by in the beginning of the year, achieving 6/6 vision at that time)
Alex (M/8) came in recently, mother complains that he sits very near to television & he has his digital device held very close to screen with existing glasses since a few months ago. He tends to rub his eyes and he also complains of headache.
Vision with existing single vision glasses of 1year:
R: -0.75/-2.00×180 (6/24)
L: -0.25/-2.00×175 (6/24-)
Examination shows:
R: -2.25/-3.00×180 (6/7.5-)
L: -2.25/-3.00×175 (6/7.5)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
orthophoria @Distance
small XP, fast recovery @Near
(normal value: orthophoria/NMD-No Movement Detected or small XP fast recovery)
ET = Esotropia is misalignment of the eye, eye is deviated inwards
XT = Exotropia is misalignment of the eye, eye is deviated outwards
Examination of Eye Alignment (Howell Card)
Distance: 0 – 1 EP
Near: 0 – 2 XP
+1.00 Near: 2 – 4 XP
(normal value: 1 EP-0 or 0-3 XP @Distance & 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)
+3.00
(normal value: +1.50 to +2.50)
PRA (accommodation analysis – ability to stimulate accommodation)
-1.25
(normal value: -1.37 to -3.37)
Alex’s shortsighted power has increased a lot, of about 200 in both eyes while his astigmatism also increases about 100 in both eyes. Due to too much of power increment in a little over half a year, we refer him to eye specialist clinic for cycloplegic refraction, to put eye drop to temporarily suspend eye muscles to ascertain whether or not his power progresses so much.
We also emphasise on myopia management on Alex, since he has strong family history of very high myopia (his father, our customer friend Mr Kingsley has very high myopia/shortsighted power of 1000 & mummy Michelle has significant astigmatism too).
Normally, we want to start on myopia management as soon as the child has myopia, even the slightest myopia. We also share about identifying pre-myopia, especially in children who have strong risk factors of becoming myopia.. to have them started on any of the myopia control strategies that the parents are comfortable.
Myopia progression tends to increase once they step into school.. as more near work is expected on them. We cannot do away with digital devices & computer.. on top of online PdPR learning during the pandemic.. and this gives rise to what they term as “Myopia Boom” – significant myopia increase in children due to being confined indoors with no outdoors time & sunlight. With recent announcement by KPM, we would expect young school children to be on the extended PdPR for online learning.
We can all play a role in keeping this myopia boom at bay by:
- arrange safe outdoor time of 2hours every day
- ensure that your child takes regular break in between near work (20-20-20 rule)
- to see digital devices at a healthy distance(an elbow distance to eyes)
- no eye rubbing
- to bring your child to see an optometrist or an ophthalmologist, should you notice your child exhibit signs & symptoms of existing glasses not giving good vision, or child complains of headache, or any eye complaints.
_________________________________
Updated 5/9/2021
Mother has showed us his cycloplegic refraction:
Cycloplegic refraction shows:
R: -2.25/-2.75×180 (6/7.5-)
L: -2.25/-2.75×175 (6/7.5)
Alex is on atropine eye drop(Myopine) now to slow the progression of myopia. Yes, children who have myopia will need myopia control intervention – be it eye drop, myopia control spectacle lenses or contact lenses or combination of these strategies.
Researchers have shown that the earlier the onset of myopia, the faster and longer lasting myopia progression. We want to do all we can to slow the progression.
We will see him in 3months.
*Updated (December 2021)
Alex came end of December 2021
Existing glasses
R: -2.25/-2.75×180
L: -2.25/-2.75×175
Vision with both eyes 6/7.5-, 6/6-
_____________________________
*Updated
Alex (M/8) came for 6 months follow up. We observe that he holds his reading material very upclose.
Existing glasses
R: -2.25/-2.75×180 (6/9-)
L: -2.25/-2.75×175 (6/7.5-) [L: left dominant eye]
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
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: 1 EP (yellow part)
Near: 0 (top arrow paces around 0, slightly to yellow & blue)
+1.00 Near: 2 XP (blue part)
-1.00 Near: 3 – 5 EP (yellow 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
+3.25
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-2.00
(normal value: -1.37 to -3.37)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.25/PL
L: +0.25
(normal value: +0.25 to +0.75)
Accommodation Facility – ability to change focus: far to near or near to far (by Flipper +/- 2.00)
BE: 14 cycle per minit(cpm)
R: 14 cycle per minit(cpm)
L: 9 cycle per minit(cpm), difficult with minus lens(2nd lens)
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-In/Divergent, NFV: 18/14
Near, Base-Out/Convergent, PFV: 14/8
Distance, Base-Out/Convergent, PFV: 16/12
Distance, Base-In/Divergent, NFV: 14/10
(normal value: Blur/Break/Recovery)
Near, PFV: x/15-31/10-22
Near, NFV: x/7-17/3-11
[Scheiman et al – Children 7-12yo Data]
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 8 YO, 8 YO, 8 YO, 8 YO
L: 8 YO, 8 YO, 8 YO, 8 YO
(normal value: AA goes according to age; YO=years old)
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)
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 9 cpm (slow to clear 3 Base In)
Distance: 8 cpm (slow to clear 12 Base Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary Distance = 6.4cm
All seem fine. We will see him after his appointment with eye doctor/ophthalmologist.