Mr Chong TW (M/49) came for eye examination.. with complaint of blurry seeing far & glaring when driving at night, glaring is worse with headlight of the vehicles coming from opposite side. Daytime driving is fine, but sometimes he realises that the car number plate will be blurry too.. those of few cars away. He has not worn any glasses before.
Vision without glasses
R: 6/6
L: 6/6- slow
Subjective Refraction
R: PL/-0.50×80 (6/6) (+1.00 blur lens test: 6/12)
L: PL/-0.50×90 (6/6) (+1.00 blur lens test: 6/7.5)
Add: +1.25
No hyperopia/long-sightedness is accepted mono & bino @far
Retinoscopy
R: PL/-0.50×80
L: PL/-0.50×90
Other assessments show:
Cover Test
Distance: NMD
Near: small XP, fast recovery
Howell Card
Distance: 0 – 1 EP
Near: 6 – 8 XP
-1.00 Near: 0 – 2 XP
NRA
+1.00
PRA
-0.25
NPC
16/24cm, 16/24cm, 16/24cm, 16/24cm, 16/24cm
NPC (with Add +1.75)
14/20cm, 14/20cm, 14/20cm
AA
R: 46 YO, 46 YO, 46 YO
L: 46 YO, 46 YO, 46 YO
Modified
R: PL/-0.50×80
L: PL/-0.50×90
Add: +1.50
Fusional Reserves
Near, PFV: x/14/12
Near, NFV: x/14/10
Distance, NFV: x/6/4
Distance, PFV: x/14/12 (above break pt 10, double then single)
Vergence Facility
Near: 0 cpm (double BO, double did not get closer with blink)
Distance: 0 cpm (double BO, double did not get closer with blink)
Pt reported seeing the diplopic images.. one higher than the other (pt’s left image is seen going up) before slowly becoming paralel
Worth 4 Dots
Distance: 4 dots
Slit Lamp
R: very mild cataract
L: very mild cataract
Fluorescein
R: -ve staining
L: -ve staining
Interpupillary distance, IPD = 6.8cm
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″