18/6/2021
JPing (M/14) came back for follow up after 1+ year.
Vision with existing power
R: -3.25/-1.00X60 (6/7.5-)
L: -3.00/-1.00X80 (6/7.5-)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
small XP, Grade 2 recovery @Distance (more XP with repeated testing)
small XP, Grade 2 recovery @Near (more XP with repeated testing)
(normal value: orthophoria/NMD-No Movement Detected or small XP small recovery)
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
6cm, 6cm, 6cm
(normal value: less than 7.5cm)
AA (Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 7cm, 7cm, 7cm
L: 7cm, 7cm, 7cm
(normal value: TTN-to the nose or 8cm for a 12year old)
NRA (accommodation analysis – ability to relax accommodation)
+2.50 (normal value: +1.50 to +2.50)
PRA (accommodation analysis – ability to stimulate accommodation)
-1.75 (normal value: -1.37 to -3.37)
Examination of Eye Alignment (Howell Card)
Distance: 10 XP
Near: 20 XP
(normal value: 1 EP-0 or 0-3 XP @Distance & 0-6 XP @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
Examination of Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Distance, Base-Out/Convergent, PFV: 12/4
Distance, Base-In/Divergent, NFV: 18/10
Near, Base-Out/Convergent, PFV: 12/4
Near, Base-In/Divergent, NFV: 30/14
(normal value: Break/Recovery)
Distance, PFV: 4-18/5-9
Distance, NFV: 4-10/2-6
[Scheiman and Wick, 2002]
Near, PFV: 7-17/3-11
Near, NFV: 15-31/10-22
[Scheiman et al, 1989]
When exophoria was reported to be 10 XP at far vision & 20 XP at near vision – which is out of the normal range, we prompt if he sees any double vision at near or words on book/hp become out of focus after some time. He told us about near vision being affected, and he has been having this for quite a few years.
Normally, we go by complaint-based. If you have complaint, for eg. blurry near vision, then we will investigate & let you know how to go about solving the complaint & improving your vision. Since JPing did not tell us about this complaint, and he has never told his mum that something is not right/weird in his near vision, we will monitor his condition.
*UpdatedA 2/10/2022
JPing (M/15) came for follow up.
Vision without glasses
R: 6/45
L: 6/30-
Vision with existing glasses
R: -3.25/-1.00X60 (6/7.5-)
L: -3.00/-1.00X80 (6/7.5-)
Subjective Refraction
R: -3.50/-1.00X60 (6/6-) PH 6/6
L: -3.50/-1.00X80 (6/6-) PH 6/6 L>R
Near: L>R (adding up to +0.75 in RE, still L>R)
Other assessments show:
Cover Test
Distance: moderate XP, moderate recovery
Near: moderate XP, moderate recovery
Howell Card
Distance: 8 XP
Near: 8 – 10 XP
+1.00 Near: 12 – 14 XP
-1.00 Near: 4 – 6 XP
+2.00 Near: 20 XP
-2.00 Near: 0 – 2 XP
NRA
+1.75
PRA
-2.75
NPC
8/18cm, 8/18cm, 8/18cm, 8/18cm, 8/18cm, 8/18cm
NPC (with Add: +0.50)
8/18cm, 8/18cm, 8/18cm
AA
R: 13.5D, 13.5D, 13.5D (blur @end of RAF rule, clear @ 31cm)
L: 14D, 14D, 14D
MEM
R: +0.50
L: +0.25
Accommodation Facility (+/- 2.00)
BE: 13 cpm, difficult minus lens
R: 12 cpm, difficult minus lens
L: 13 cpm, difficult minus lens
Fusional Reserves
Near, PFV: x/12/10 (above break pt 8, double then single)
Near, NFV: x/16/14
Distance, PFV: x/12/10
Distance, NFV: x/18/16
Vergence Facility
Near: 5 cpm (slow BO)
Distance: 1 cpm (double BO)
Interpupillary distance, IPD = 6.6cm
We try
Subjective Refraction
R: -3.50/-0.50X60
L: -3.50/-0.50X80
DC 100 is favoured @N
Howell Card
Distance: 8 XP
Near: 14 – 16 – 18 XP
We ask JPing whether or not his far & near vision will be blurry sometimes.. he said his far vision is more affected especially when he is at school.. in which he will blink his eyes to see better.
Post 5 mins monocular occlusion
ACT
Distance: large XP, slow recovery
Near: large XP, slow recovery
Mother is concerned, we refer to co-manage with ophthalmologist & orthoptist.
2/3/2023
JPing (M/16) came for follow up.
Vision without glasses
R: 6/45- (squinting: 6/30+)
L: 6/45- (squinting: 6/30+)
Vision with existing glasses
R: -3.25/-1.00X60 (6/7.5- 6/6-)
L: -3.00/-1.00X80 (6/7.5-)
Subjective Refraction
R: -3.75/-0.50X50 (6/6-)
L: -3.75/-0.50X60 (6/6-)
Other assessments show:
Cover Test
Distance: small – moderate XP, fast recovery
Near: moderate – large XP, moderate recovery
Howell Card
Distance: 8 XP
Near: 20 XP
+1.00 Near: beyond 20 XP
-1.00 Near: 14 XP
NRA
+1.75
PRA
-3.75
NPC
5/8cm, 8/11cm, 11/14cm, 10/14cm, 12/16cm
AA
R: 15yo, 20yo, 25yo
L: 15yo, 20yo, 25yo
MEM
R: PL
L: -0.25
Accommodation Facility (+/- 2.00)
BE: difficult plus lens
R: difficult plus lens
L: difficult plus lens
Fusional Reserves
Near, PFV: 12/16/8 (above blur pt 12, double then single)
Near, NFV: x/20/18
Distance, PFV: x/20/18
Distance, NFV: x/18/16
Vergence Facility
Near: 10 cpm (slow BO)
Distance: 9 cpm (slow BO)
Post 5 mins monocular occlusion
ACT
Distance: large XP, slow recovery
Near: large XP, slow recovery