Vena (F/36) complains of always having headache with near work & blurry near vision sometimes since she changed into her existing spec 2years ago. She used her previous glasses just for reading/near work without issue (but were broken 2years ago). A history of sinus & migraine reported with headache on right side – usually at the back of head for a long time already. She is seeing 1 floater in her right eye after a history of head trauma 10+years ago. No eye surgery is reported.
Vision without glasses
R: 6/6
L: 6/6
Vision with existing glasses
R: -0.50/-0.25×175 (6/6)
L: -0.50 (6/6)
Examination shows: (Binocular Refraction)
R: +0.25 (6/6) [+1.00 6/9-] N5-@40cm
L: +0.25/-0.50×75 (6/6), [+1.00 6/9-] N5-@40cm
Relax Add is not favoured
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
small XP, fast Grade 1 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
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
12cm, 13cm, 14cm
(normal value: less than 10cm)
AA (Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 20cm, 22cm, 25cm
L: 20cm, 22cm, 25cm
(normal value: less than 14cm)
NRA (accommodation analysis – ability to relax accommodation)
+0.50
(normal value: +1.50 to +2.50)
PRA (accommodation analysis – ability to stimulate accommodation)
-0.50
(normal value: -1.37 to -3.37)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
R: 0 cycle per minit(cpm) difficult with plus lens & minus lens
L: 2 cycle per minit(cpm) difficult with plus lens
BE: 2 cycle per minit(cpm) difficult with plus lens
(normal value:
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Examination of Eye Alignment (Howell Card)
Distance: 0
Near: 8-10 XP
+1.00 Near: 10-12 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
Examination of Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 35/x/x (35=blur point, x=no break/double/recovery reported)
Near, Base-In/Divergent, NFV: 16/8
(normal value: Break/Recovery)
Near, PFV: 7-17/3-11
Near, NFV: 15-31/10-22
[Scheiman et al, 1989]
Vena has been wearing her glasses with not-updated power. Some people may tolerate okay with shortsighted overpower of 050, some may not. It depends on your focusing ability. If your focusing is strong, you will do fine. Otherwise, like in Vena, she will develop headache with near work.
We will see Vena in 1month of full-time wear of new updated prescription. We will assess her accommodation & convergence again. In event her accommodation is found to be stuck (otot mata sudah kejang), we will refer her for cycloplegic refraction, to put eye drop to paralyse eye muscles temporarily.