19/8/2020
Bharathaan (M/9) first presented for eye examination last year, and his eye stamina was found to be reduced in both right & left eye. He was prescribed relax lens to help with focusing on near print. He lost his existing glasses during MCO. His mother also added that she has received complaint from teacher about his son’s spelling & writing recently.
Examination showed:
R: PL
L: PL
Addition: +1.00
Without glasses, Bharathaan can barely see the second smallest line on near chart & he cannot see the last smallest line. With Addition power, he can see the smallest line comfortably clear. Having lost his glasses, he may have written incorrectly that he did not realise the mistake.. as he could not see clearly on his book.
# Bharathaan previously came for follow up, he has no complaint with existing glasses.
*Updated
Bharathaan (M/12) came for eye examination, with complaint of blurry near vision & headache after 1-2 hours of near work after he lost his glasses recently.
Vision without glasses
R: 6/7.5
L: 6/7.5
Examination shows: (Delay Fogging)
R: +0.75/-0.25×180 (6/6) [+1.00 blur lens test: 6/9]
L: +0.75/-0.25×90 (6/6) [+1.00 blur lens test: 6/9] (L: left dominant eye) L>R
Add: +1.00
No further longsightedness/hyperopia is accepted monocularly/binocularly in far vision
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
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: 1 – 3 EP (yellow part)
+0.25 OU Distance: 0 – 1 EP (yellow part)
Near: 2 – 4 XP (blue part)
+1.00 Near: 4 – 6 XP (blue part)
-1.00 Near: 0 – 2 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
+1.50
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.25
(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/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: 8 YO, 12 YO, 12 YO
L: 8 YO, 12 YO, 12 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
8/10cm, 8/10cm, 8/10cm, 8/10cm, 8/10cm
(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 +/-2.00)
BE: 12 cycle per minit(cpm), difficult with plus lens(1st lens)
R: 16 cycle per minit(cpm), difficult with plus lens(1st lens) [both eyes see better than with right eye]
L: 16 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-Out/Convergent, PFV: x/14/12
Near, Base-In/Divergent, NFV: x/14/10
Distance, Base-In/Divergent, NFV: x/12/6
Distance, Base-Out/Convergent, PFV: x/14/12
(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]
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar (with Add)
Near, Base-Out/Convergent, PFV: x/12/10
Near, Base-In/Divergent, NFV: x/18/16
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 7 cpm (1st half: double with Base Out then single.. 2nd half: double with Base In then single)
Distance: 13 cpm (double Base Out, blink2 then single)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD = 6.2cm