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Blurry & Dizziness Working On Computer? *UpdatedAB

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28/12/2021

Sue jie (F/48) came for eye examination, with complaint sometimes blurry vision & dizziness on computer.. she seems to have this complaint since many2 years ago, even before she needs reading glasses. She will stop working on computer & see far, far away to relieve the dizziness. She lost her hearing in right ear 15years ago due to trauma & she was told of having mild stroke on right side after giving birth last time.

Vision without glasses
R: 6/6
L: 6/6

Existing reading glasses
R: +1.75
L: +1.75

Examination shows: 
R: PL/-0.25×90 (6/6) (+1.00 blur lens test 6/9)
L: PL/-0.25×90 (6/6) (+1.00 blur lens test 6/9) [L: left dominant eye]
Add: +1.75 (N5@40cm) 
Intermediate Add (computer @100cm): +0.75

Other assessments show:

Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
small to moderate XP, fast to moderate recovery
(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 (Maddox Rod)
Distance: 3 BI
Near: 16 BI
(normal value: 0-1 EP or 0-3 XP @Distance and 0-6 XP @Near)
BO/EP = Base Out/Esophoria is misalignment of the eye, eye is deviated inwards
BI/XP = Base In/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 – 2 XP (blue part) 
Near: 16 – 18 XP (blue 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

Examination of 3D Vision/Stereopsis (Random Dot 3S) 
12.5″
(normal value: 12.5″)

Sue jie has significant exophoria at near, we prescribe her pencil push up to do with her existing reading glasses first. She reported having imbalance due to her hearing.. so we will let her try prism & see how it goes in the next follow up. She also shared some of her past history.. know that God loves us all & won’t challenge us with something beyond what we can handle.. let’s enjoy every moment & celebrate life jie! U have done great so far❤️

*UpdatedA

19/4/2022

Sue jie has been doing pencil push up recently.

Our record
R: PL/-0.25×90 (6/6)
L: PL/-0.25×90 (6/6)
Add: +1.75 (N5@40cm) 

Other assessments show:

Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0
Near: 12 – 14 XP (blue part)
-1.00 Near: 16 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

Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Distance, Base-Out/Convergent, PFV: x/6/-1
Distance, Base-In/Divergent, NFV: x/14/12
Near, Base-In/Divergent, NFV: 6/8/4
Near, Base-Out/Convergent, PFV: 4/6/4
(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 – Adult Data]

Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 0 cpm (double with Base-Out)
Distance: 0 cpm (double with Base-Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)

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 
-0.25
(normal value: -1.37 to -3.37)

Modified
R: PL/-0.25×90
L: PL/-0.25×90
Add: +2.00

With Add +2.00 & 2Base In in both eyes

Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Distance, Base-Out/Convergent, PFV: x/6/4
Distance, Base-In/Divergent, NFV: x/12/8
Near, Base-In/Divergent, NFV: 6/8/4
Near, Base-Out/Convergent, PFV: 4/6/4
(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 – Adult Data]

With Add +2.25

Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Distance, Base-Out/Convergent, PFV: x/6/-1
Distance, Base-In/Divergent, NFV: x/16/12

Sue jie’s exophoric near posture has improved slightly. She will continue to do pencil push up.

Jie has picked up a new hobby.. into planting these days.. that’s good! Let’s do the things that makes us happy & focus on it.. the joy & laughter are right here with us.. jia you jie!❤️

*UpdatedAB

Sue jie came for follow up. She has been doing pencil push up for a while. She does not take any medicine, just some vitamins.

Our record
R: PL/-0.25×90 (6/6)
L: PL/-0.25×90 (6/6)
Add: +1.75 (N5@40cm) 

Other assessments show:

Howell Card
Distance: 0
Near: 16 XP (blink: 12 XP)

Fusional Reserves
Near, PFV: x/4/2
Near, NFV: x/12/10
Distance, NFV: x/6/4
Distance, PFV: x/8/6

Vergence Facility
Near: 0 cpm (double BO & BI)
Distance: 0 cpm (double BO)

CI

Sue jie is keen to do eye exercise. We prescribe her Dot Card eye exercise this time. We will see her in 2-3months.

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 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)

AA(Amplitude Accommodation) – eye stamina (Dioptre, D) (RAF rule)
6yo – 16.5D | 6cm
9yo – 15.5D | 6.5cm
12yo – 14.5D | 7cm
15yo – 13.5D | 7.5cm
18yo – 12.5D | 8cm
21yo – 11.5D | 9cm
24yo – 10.5D | 10cm
27yo – 9.5D | 11cm
30yo – 8.5D | 12cm

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 
12.5″