Andreea Ang Yao Xin – 88 Optometry

5/6/2022

Andrea (F/12) came for eye examination, vision with existing glasses is fine seeing far & near. Mother reported that dad has high power & astigmatism previously.. but he has done vision correction about 10years ago and he has some power now.

Vision without glasses
R: cannot guess 6/120
L: cannot guess 6/120

Vision with existing glasses of 2years (frame was changed due to broken frame)
R: -6.75/-1.25×180 (6/9+1)
L: -6.75/-1.25×175 0.3BU (6/21-)

Examination shows: (Delay Fogging)
R: -7.00/-1.25×180 (6/6) [+1.00 blur lens test: 6/9+] [R: right dominant eye] L>R
L: -7.75/-1.25×175 (6/9+) PHNI
Adding +0.75 in left eye: R>L

Modified
R: -7.00/-1.25×180
L: -7.00/-1.25×175

Other assessments show:

Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes slanting down & to her left.. when covering right eye, the target goes slanting up & to her right
small XP, fast recovery @Near
(alternating CT: upon covering left eye, patient reported the target goes to her left.. when covering right eye, the target goes to her right)
(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 10^ Base Down on Right eye
Distance: 0 – slight on blue (blue part)
Near: 4 – 6 XP (blue part)
+1.00 Near: : 8 – 10 XP (blue part)
-1.00 Near: : 4 XP (blue 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
+1.75
(normal value: +1.50 to +2.50)

PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-3.50
(normal value: -1.37 to -3.37)

MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +1.00
L: scissors reflex along 45°
(normal value: +0.25 to +0.75)

NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, TTN, TTN, TTN, TTN
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)

AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 6 YO, 6 YO, 6 YO (target is blurry @end of RAF rule, only comes into focus starting @26cm -> 24cm -> 22cm)
L: 6 YO, 6 YO, 6 YO (target is blurry @end of RAF rule, only comes into focus starting @18cm -> 16cm -> 14cm)
(normal value: AA goes according to age; YO=years old)

Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 1.50
BE: 8 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 7 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with right eye)
L: 3 cycle per minit(cpm), difficult with minus lens(2nd lens) & difficult plus lens(1st lens) also (both eyes see better than with left eye)
– cannot clear +/-2.00
(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-Out/Convergent, PFV: x/25/20
Near, Base-In/Divergent, NFV: x/25/20
Distance, Base-Out/Convergent, PFV: x/30/25
Distance, Base-In/Divergent, NFV: x/16/14
(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: 5 cpm (double Base Out, blink2 eyes single.. then double Base In, blink2 eyes single.. then double Base Out & double Base In)
Distance: 3 cpm (double Base Out, blink2 eyes single)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)

Interpupillary distance, IPD = 6.6cm

We asked again if she has any visual complaint.. she reported having slight difficulty seeing far after seeing near.

Andrea is fine wearing spectacles or contact lens.

We prescribe her flipper eye exercise and we will see her in 4-6weeks.

*Updated

We prescribe monthly disposable

Contact Lens
R: -6.50/-1.25×180 (R>L) N5
L: -6.50/-1.25×180 N6-
VA OU: 6/7.5-, 6/6-

She said her far vision is fine.

*UpdatedA

30/7/2022

Power
R: -7.00/-1.25×180
L: -7.50/-1.25×175 L>R

Modified
R: -7.00/-1.25×180 R>L
L: -7.25/-1.25×175

3D Vision (Random Dot 3S)
20″
(normal value: 12.5″)

3D Vision (Titmus Fly)
25″
(normal value: 12.5″)

Other assessments show:

Cover Test
Distance: NMD
Near: small XP, fast recovery

Howell Card
Distance: 0 – 2 XP
Near: 4 – 6 XP
+1.00 Near: 6 XP
-1.00 Near: 2 XP
+2.00 Near: 8 XP
-2.00 Near: 2 XP

NRA
+2.25

PRA
-3.75

NPC
TTN, TTN, TTN

AA
R: 16.5D, 16.5D, 16.5D (blurry @end of RAF rule, clear @32, 30, 28cm)
L: 16.5D, 16.5D, 16.5D (blurry @end of RAF rule, clear @26, 24, 22cm)

MEM
R: +1.00
L: +1.00

Accommodation Facility (+/- 2.00)
BE: 11cpm, difficult minus lens
R: 8cpm, difficult minus lens
L: 7cpm, difficult minus lens
– Both eyes see better than seeing monocularly

Vergence Facility
Near: 10 cpm
(double BO & BI, blink & single)
Distance: 14 cpm
(double BO & BI, blink & single)

Cover Test (on own glasses.. lenses were refitted into current frame, RE PD is decentred inwards)
NMD @Distance
(alternating CT: patient reported NMD)

Cover Test (trial frame)
NMD @Distance
(alternating CT: patient reported RE sees target slanting down & to her left.. LE sees target goes slanting up & to her right

*UpdatedB

Andrea came for follow up.

Subjective Refraction
R: -7.00/-1.25×175 (6/6) [+1.00 blur lens test: 6/12] R>L
L: -7.50/-1.50×170 (6/9- 6/7.5- 6/6- slow)

Other assessments show:

Random Dot 3S
25″
12.5″ (with Add +0.75)

Cover Test
Distance: NMD
Near: NMD

Howell Card
Distance: 0
Near: 4 XP
+1.00 Near: 10 XP
-1.00 Near: 4 XP
+2.00 Near: 8 XP
-2.00 Near: 2 XP

NRA
+3.00

PRA
-4.50

NPC
LE deviates @8cm

AA
R: 16.5D, 16.5D, 16.5D (blurry @end of RAF rule, clear @28cm, 26cm, 24cm)
L: 16.5D, 16.5D, 16.5D (blurry @end of RAF rule, clear @26cm, 24cm, 22cm)

Accommodation Facility (+/- 2.00)
BE: 11 cpm, difficult minus lens
R: 13 cpm, difficult minus lens
L: 9 cpm, difficult minus lens

MEM
R: +1.00
L: +1.00

Fusional Reserves
Near, PFV: x/25/20
Near, NFV: x/25/20
Distance, NFV: x/16/14
Distance, PFV: x/35/25

Vergence Facility
Near: 13 cpm
Distance: 14 cpm

Interpupillary distance, IPD = 6.7cm

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/lights