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Blurry Seeing Whiteboard Despite Sitting In The Front Row? *UpdatedA

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29/7/2022

KXing (M/12) came for eye examination, with complaint of blurry far vision with existing glasses made with us.. despite sitting in the front row. He wears his glasses when he goes to school only. He removes glasses when he is at home.. not that he feels more comfortable seeing near without glasses. He said that he does not wear glasses because they are troublesome.

Vision without glasses
R: 6/30-
L: 6/45-

Own glasses 1year 4mths
R: -1.00/-0.25×180
L: -1.25/-0.50×160

Subjective Refraction (Delay Fogging +2.00 OU)
R: -1.50/-0.25×180 (6/6) (+1.00 blur test: 6/15-2)
L: -2.00/-0.25×160 (6/6) (+1.00 blur test: 6/15-2) (L>R)
Add: +1.00 (R>L)

Retinoscopy
R: -1.50/-0.25×180
L: -2.00/-0.25×160

Other assessments show:

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

Howell Card
Distance: 0 – 2 XP
Near: 6 XP
+1.00 Near: 4 XP
-1.00 Near: 2 XP
+2.00 Near: 8 XP
-2.00 Near: 0

NRA
+2.00

PRA
-1.25

NPC
6/8cm, 7/11cm, 8/12cm, 9/13cm, 9/14cm

Jump Convergence
prompt & smooth convergence movement from distant fixation to nearer one

AA
R: 16D, 16D, 16D (blurry @end of RAF rule, clear @30cm)
L: 16D, 16D, 16D (blurry @end of RAF rule, clear @25cm)

Accommodation Facility (+/- 2.00)
BE: 13cpm, difficult plus lens
R: 9cpm, difficult minus lens
L: 9cpm, difficult minus lens
– Both eyes see better than seeing
monocularly

Fusional Reserves
Near, PFV: x/18/16
Near, NFV: x/16/10
Distance, PFV: 12/18/10
Distance, NFV: x/10/4

Vergence Facility
Near: 0 cpm
(double BO, double got closer with blink before drifting far apart again)
Distance: 3 cpm
(double BO, blink3 & single)

Fluorescein
R: -ve
L: -ve

Interpupillary distance, IPD = 6.0cm

*UpdatedA

KXing came to make glasses.

Trial framing
R: -1.50/-0.25×180
L: -2.00/-0.25×160
Add: +0.75

We repeated:

NPC
10/20cm, 10/20cm, 12/22cm, 12/22cm

AA (with Add)
R: 14.5D, 11.5D, 8.5D
L: 8.5D, 8.5D, 8.5D

Accommodation Facility (+/- 2.00) with Add
BE: 10cpm, difficult plus lens
R: 12cpm, difficult minus lens
L: 12cpm, difficult minus lens

MEM (no Add)
R: +1.00
L: +1.25

MEM (with Add)
R: +0.25
L: +0.50

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)