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Cannot See Smaller Words On Whiteboard? *UpdatedA

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8/8/2022

Sjivan (M/16) came for eye examination, with complaint of slight blurry far vision with existing glasses. He sits at the last row in class, he is unable to see smaller words on whiteboard. He sometimes has headache once in a while.

Vision without glasses
R: cannot guess 6/60+1
L: cannot guess 6/60+1

Existing glasses of 2+years
R: -2.75/-0.50×160 (6/6-)
L: -2.75/-0.50×10 (6/9-)

Subjective Refraction
R: -3.25 (6/6) (+1.00 blur lens test: 6/12)
L: -3.50 (6/6) (+1.00 blur lens test: 6/15) L>R
Near: R>L
He did not like to lower shortsightedness.

Other assessments show:

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

Howell Card
Distance: 2 XP
Near: 6 – 8 – 10 XP
+1.00 Near: 12 XP
-1.00 Near: 4 XP
+2.00 Near: 18 XP
-2.00 Near: 0 – 1 EP

NRA
+2.00

PRA
-1.50

NPC
TTN, TTN, 6/8cm, 6/8cm, 7/9cm, 7/9cm

AA
R: 13D, 13D
L: 13D, 13D

MEM
R: +0.75
L: +1.00

Accommodation Facility (+/- 2.00)
BE: 11cpm, difficult minus lens
R: 12cpm, difficult minus lens
L: 12cpm, difficult minus lens
– BE sees better than with RE/LE

Fusional Reserves
Near, PFV: 6/8/2
Near, NFV: 14/16/12
Distance, PFV: x/8/4
Distance, NFV: x/10/8

Vergence Facility
Near: 13 cpm
Distance: 1 cpm
(double BO, double get closer with blink, before going far apart again)

Stereopsis
32″
12.5″ (with Add +0.75)

Interpupillary distance, IPD = 6.3cm

When asked whether or not Sjivan sees blurry or double on near print, he said he sees double when he really focuses on it.. ie, book will become two books. Even for his far vision, he will see two persons if he really focuses on the person. Not that he sees double when he starts losing focus/tired. (Physiological diplopia?)

Sjivan came for eye examination at night & he is in the morning session.. so we ask him to come early another day to confirm a few eye findings again.

Receded NPC.. low BO PFV@N, low BO VF@D.. CI?

*UpdatedA

Sjivan came back to let us to recheck on a few of the eye findings.

Howell Card
Distance: 2 XP
Near: 6 – 8 XP
+1.00 Near: 10 XP
-1.00 Near: 0 – 2 XP

NPC
TTN, TTN, TTN, TTN, TTN, TTN, TTN
(strong accom?)

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

Fusional Reserves
Near, PFV: x/6/4
Near, NFV: x/14/12

Vergence Facility
Near: 13 cpm
Distance: 1 cpm (double BO)

We prescribe
R: -3.00
L: -3.25

We prescribe Dot Card as well.

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)