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Blurry Far Vision & Near Vision Is Fine?

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YJie (F/20) came for eye examination.. with complaint of blurry far vision & her near vision is fine. She wears her glasses full time. She recently lost her glasses.

Vision without glasses
R: 6/30
L: 6/18

Subjective Refraction
R: -1.50 (6/6) (+1.00 blur lens test: 6/9-) R>L
L: -1.00 (6/6) (+1.00 blur lens test: 6/15+)
Near: L>R

Retinoscopy
R: -0.75
L: -0.25

Other assessments show:

Cover Test
Distance: NMD
(upon ACT: pt reported RE sees the target going to her right & down.. LE sees the target going to her left & up)
Near: NMD
(upon ACT: same like Distance)

Howell Card
Distance: 1 – 3 EP
Near: 1 EP
+1.00 Near: 4 XP
-1.00 Near: 3 – 5 EP
+2.00 Near: 6 XP
-2.00 Near: 5 EP

NRA 
+0.50
(blur binocularly, clear monocularly)

PRA 
-0.75

NPC
14/18cm, 14/18cm, 16/20cm, 16/20cm, 18/22cm, 18/22cm

NPC (with Add +0.75)
18/22cm, 18/22cm, 18/22cm

MEM
R: +1.00
L: +1.00

Accommodation Facility (+/- 2.00)
BE: 7 cpm, difficult minus lens
R: 10 cpm, difficult plus lens
L: 10 cpm, difficult plus lens

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

YJie came at night.. her eyes kept closing during examination. We observe that her left eyelid tends to close intermittently.

We advise her to come back another day to confirm back a few findings.

Interpupillary distance, IPD = 6.0cm

………………………………………………………………………………

YJie came back in the morning.

NPC
6/8cm, 6/8cm, 6/8cm, 6/8cm, 6/8cm, 6/8cm

AA 
R: 13.5D, 13.5D, 13.5D
L: 13.5D, 13.5D, 13.5D

Fusional Reserves
Near, NFV: x/12/8
Near, PFV: x/6/4
Distance, NFV: x/10/4
Distance, PFV: x/25/14

Vergence Facility 
Near: 8 cpm 
(double BI initially)
Distance: 5 cpm
(double BO, blink & single)

Fusional Reserves (with 1BI OU)
Near, PFV: x/30/25
Near, NFV: x/12/10
Pt did not like 1BI OU for near.

We ask YJie whether or not she sees blurry/moving prints/losing focus after some time seeing near/computer, she said her near vision is fine. Previous glasses were reported to be -200 in RE & -150 in LE.

Trial framing
R: -1.50
L: -1.00
Pt reported vision is slightly shadowy seeing far2 away

We let YJie know if she sees blurry near vision or losing focus seeing near, to come back & let us know.

KIV

VT for CI

She did not like astigmatic correction seeing laptop.

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

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, PFV: x/15-31/10-22
Near, NFV: x/7-17/3-11
Adult
Near, PFV: x/10-28/7-21
Near, NFV: x/7-19/5-15
Distance, PFV: x/4-18/5-9
Distance, 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″