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Blurry Far Vision & Difficult Driving At Night?

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Mr Lee (M/68) came for eye examination, with complaint of slight blurry far vision, especially difficult driving at night & blurry near vision.. he wears a pair of ready-made reading glasses(he did not bring). He reads newspaper, and he normally is able to read for about 30mins before seeing blurry & dizzy.. in which he will stop reading & rest. He does not see his phone much.. just for listening to songs & making calls.

Vision without glasses
R: 6/12
L: 6/12

Subjective Refraction
R: +1.00/-0.25×90 (6/7.5) PHNI
L: +1.00/-0.25×90 (6/7.5+) PHNI
Add: +2.00

Other assessments show:

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

Howell Card
Distance: 0
Near: 12 XP
-1.00 Near: 10 XP



R: +1.00/-0.25×90
L: +1.00/-0.25×90
Add: +2.25

14/24cm, 14/24cm, 14/24cm, 14/24cm, 14/24cm, 14/24cm

R: -0.25
L: -0.25

Fusional Reserves
Near, PFV: 10/14/6
Near, NFV: 4/16/14
Distance, NFV: x/8/4
Distance, PFV: 10/14/12

Vergence Facility
Near: 8 cpm (slow BO)
Distance: 8 cpm (slow BO) 

Interpupillary distance, IPD = 6.7cm

Near tests are done with Add.

Slit Lamp
R: mild cataract
L: mild cataract

R: -ve staining
L: -ve staning

R: normal
L: some crooked lines

Colour Vision
R: normal
L: normal


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
– 0-3 XP (blue part) or
– 0-1 EP (yellow part)
– 0-6 XP (blue part)

Accommodation/Focusing analysis – ability to relax
+1.50 to +2.50

Accommodation/Focusing analysis – ability to focus
-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)
Children 7-12yo
Near, BO/PFV: x/15-31/10-22
Near, BI/NFV: x/7-17/3-11
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 

Worth 4 Dots – Binocular Perception 4 dots