Alina N (F/32) came for eye examination, vision with existing glasses of 5years is fine seeing far & near. No headache is reported. She wears contact lens of power -2.00 to work & during outings on an average of 12hours/day with no issue and she wears glasses on weekends.
Vision without glasses
R: 6/30+
L: 6/24+
Vision with existing glasses 5years
R: -2.25/-0.75×110 (6/6-)
L: -2.00/-0.75×10 (6/6-)
Examination shows: (Delay Fogging)
R: -2.25/-0.75×135 (6/6) [+1.00 blur lens test: 6/9] (R: right dominant eye) R>L
L: -2.00/-0.75×35 (6/6) [+1.00 blur lens test: 6/9-]
Near: L>R
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes to her right. when covering right eye, the target goes to her left)
NMD @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
Near: 1 – 3 EP (yellow part)
+1.00 Near: 1 – 3 EP (yellow 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
We tried lowering her power, let her compare with own glasses & this power is accepted
R: -2.25/-0.50×135
L: -2.00/-0.50×35
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0
Near: 0 – 1 EP (yellow part)
+1.00 Near: 1 – 3 EP (yellow part)
-1.00 Near: 7 EP (yellow 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
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+1.25
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-1.50
(normal value: -1.37 to -3.37)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.25
L: PL
(normal value: +0.25 to +0.75)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 30 YO, 30 YO, 30 YO
L: 30 YO, 30 YO, 30 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, TTN, TTN
no doubling is reported (patient reported that vertical line moves to her right side at end of RAF rule)
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Accommodation Facility – ability to change focus: far to near or near to far (by Flipper +/-1.50)
BE: 14 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 11 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with right eye]
L: 10 cycle per minit(cpm), difficult with plus lens(1st lens) [both eyes see better than with left eye]
(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: x/6/2
Near, Base-Out/Convergent, PFV: x/14/12
Distance, Base-In/Divergent, NFV: 10/16/10
Distance, Base-Out/Convergent, PFV: 10/20/18
(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 et al – Adult Data]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 6 cpm (double with Base Out, blink then slowly can see single back)
Distance: 0 cpm (double with Base Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar (with Add +0.75)
Near, Base-In/Divergent, NFV: x/14/12
Near, Base-Out/Convergent, PFV: x/25/18
Add is not favoured.
Interpupillary distance, IPD = 6.3cm