ZYew (M/16) came for eye examination, with complaint of blurry far vision since 1year ago. He sits at the back of class & he is unable to see whiteboard unless if he moves to the front.
Vision without glasses
R: 6/18-
L: 6/24
Examination shows: (Delay Fogging)
R: -1.00 (6/6) [+1.00 blur lens test: 6/18-] (R: right dominant eye)
L: -1.25 (6/6) [+1.00 blur lens test: 6/18+] L>R (adding +0.25 in left eye, R>L but not preferred)
Add: +0.50 L>R
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target stays the same.. when covering right eye, the target moves to his right)
NMD @Near
(alternating CT: upon covering left eye, patient reported the target seems smaller.. when covering right eye, the target seems bigger)
(normal value: orthophoria/NMD-No Movement Detected or small XP, fast recovery)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0 – 2 XP (blue part)
Near: 2 – 4 XP (blue part)
+1.00 Near: 6 – 8 XP (blue part)
-1.00 Near: 1 – 3 EP (yellow part)
(normal value: 0-1 EP (yellow part) or 0-3 XP (blue part) @Distance; and 0-6 XP (blue part) @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+1.50
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.25
(normal value: -1.37 to -3.37)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.75
L: +0.25
(normal value: +0.25 to +0.75)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 16 YO, 16 YO, 16 YO
L: 8 YO, 10 YO, 10 YO (target is blurry when further away, it comes into focus almost mid RAF rule)
(normal value: AA goes according to age; YO=years old)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
6/8cm, 6/8cm, 8/10cm, 8/10cm, 8/10cm, 9/11cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Accommodation Facility – ability to change focus: far to near or near to far (by Flipper +/-2.00)
BE: 6 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 10 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with right eye]
L: 11 cycle per minit(cpm), difficult with minus lens(2nd lens) [left eye sees better than with both eyes]
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/16/14
Near, Base-In/Divergent, NFV: 10/20/18
Distance, Base-Out/Convergent, PFV: x/12/8
Distance, Base-In/Divergent, NFV: x/10/6
(normal value: Blur/Break/Recovery)
Near, PFV: 10-28/7-21
Near, NFV: 7-19/5-15
Distance, PFV: 4-18/5-9
Distance, NFV: 4-10/2-6
[Scheiman et al – Adult Data]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 13 cpm
Distance: 2 cpm (double with Base Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD = 6.3cm
ZYew has short-sightedness of 100 & he plays basketball. Sometimes, it may not be entirely convenient to wear glasses to play sports. Sharing with him & his mummy Candy that he actually has an alternative to wear daily disposable contact lens to back him up.. on days when he wants to play sports with nothing holding him back.. to be off from glasses on specific occasion.
ZYew said that he finally sees clearly now❤️