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Blurry Seeing Whiteboard At School & Eye Rubbing?

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RAnn (F/6) came for eye examination with complaint of blurry seeing whiteboard at school.. and mother reported noticing her rubbing her eyes too. Parents have brought her to see eye specialist doctor/ophthalmologist last week & came in with cycloplegic refraction. Her eyes were still dilated last week, so we asked them to come back this week.

Vision without glasses
R: 6/7.5+
L: 6/7.5-

Cycloplegic Refraction
R: +2.50/-1.50×180 (6/6)
L: +3.00/-1.50×180 (6/6)
Pt is wobbly

Subjective Refraction
R: +2.25/-1.00×180 (6/6) R>L
L: +2.50/-1.00×180 (6/6)
Near: L>R

Other assessments show:

Cover Test
Distance: NMD
Near: NMD

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

NPC
TTN, TTN, TTN, TTN, TTN (vertical lines moves to her left)
(OS deviates @8cm)

AA
R: 16.5D, 16.5D, 16.5D
L: 16.5D, 16.5D, 16.5D

MEM
R: +0.75
L: +0.50

Accommodation Facility (+/- 2.00)
BE: 13cpm, difficult plus lens
R: 15cpm, difficult plus lens
L: 16cpm, difficult minus lens

Fusional Reserves
Near, NFV: x/30/8
Near, PFV: x/12/8
Distance, NFV: x/12/4
Distance, PFV: x/25/18

Vergence Facility
Near: 4 cpm (double BO, blink3 & single.. then double BI, blink & single)
Distance: 2 cpm (double BO, double did not get closer with blink)

Random Dot 3S
12.5″

Interpupillary distance, IPD = 5.2cm

Trial framing
R: +2.00/-0.75×180
L: +2.25/-0.75×180
Add: +0.50
Pt can dance along

We prescribe RAnn for full-time wear.

We will see her again in 6-8weeks.

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″