Mr Chia (M/67) came for eye examination, with complaint of blurry far & near vision with existing glasses of more than 10years.. lenses have many scratches with peeled lens coating. He made a new pair of specs previously but were broken. He drives a lot, near vision (phone) is particularly reduced when there is glaring during bright sunlight.. but near vision is fine during night time. When he is at home, he does not really wear glasses.. and he is fine seeing phone without glasses.
Vision without glasses
R: cannot guess 6/120
L: 6/45-
Vision with existing glasses
R: -4.00/-1.00×90 (6/45)
L: -3.25/-1.00×125 (6/6)
Examination shows:
R: -5.50/-1.00×90 (6/15-)
L: -4.00/-1.00×105 (6/12-)
Add: +2.00 (N6@40cm)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
small XP, fast recovery @Near
(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
Near: 12 – 14 XP (blue part)
-1.00 Near: 10 – 12 XP (blue 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
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
14/20cm, 14/20cm, 14/20cm, 14/20cm, 14/20cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/20/18 (above 14 break point, double then single back again)
Near, Base-In/Divergent, NFV: x/10/8
Distance, Base-In/Divergent, NFV: x/4/2
Distance, Base-Out/Convergent, PFV: x/10/8 (above 6 break point, double then single back again)
(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: 5 cpm (double with Base Out at the end of test)
Distance: 14 cpm
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD = 6.6cm
Colour Vision
R: normal
L: normal
(normal value: normal)
Amsler Chart (assess integrity of macula)
R: some gaps are seen bigger, lines are straight
L: some gaps are seen bigger, lines are straight
(normal value: lines are straight with equal gaps in between lines)
We refer him to see ophthalmologist.