Chua Jun Ying – 88 Optometry

18/6/2021

JYing (M/13) came back for follow up after 1+ year.

Vision without glasses
R: 6/15
L: 6/15

Vision with existing power
R: -0.75/-0.50X80 (6/6)
L: -0.75/-0.50X115 (6/6)

Examination shows:
R: -0.75/-0.50X80 (6/6) N5@38cm
L: -0.75/-0.50X115 (6/6) N5@38cm

Other assessments show:

Examination of 3D Vision (Random Dot 3S)
12.5″
(normal value: 12.5″)

Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
small XP, fast Grade 1 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

NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, TTN
(normal value: TTN, To The Nose or 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: 8cm for a 13year old)

NRA (accommodation analysis – ability to relax accommodation)
+2.00
(normal value: +1.50 to +2.50)

PRA (accommodation analysis – ability to stimulate accommodation)
-2.00
(normal value: -1.37 to -3.37)

Examination of Eye Alignment (Howell Card)
Distance: 2 XP
Near: 4-6 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

*UpdatedA

JYing (M/14) came for follow up.

Vision without glasses
R: 6/12
L: 6/12

Vision with existing glasses
R: -0.75/-0.50×80 (6/6)
L: -0.75/-0.50×115 (6/6)

Subjective Refraction
R: -0.75/-0.50×80 (6/6) (+1.00 blur lens test: 6/12)
L: -0.75/-0.50×115 (6/6) (+1.00 blur lens test: 6/9-)
DC is favoured @N

Other assessments show:

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

Howell Card
Distance: 2 XP
Near: 8 XP
+1.00 Near: 12 XP
-1.00 Near: 4 XP
+2.00 Near: 12 XP
-2.00 Near: 2 XP

NRA
+1.75

PRA
-2.00

NPC
6/8cm, 6/8cm, 6/8cm, 6/8cm 6/8cm, 6/8cm

AA
R: 14D, 14D, 14D
L: 14D, 14D, 14D

MEM
R: +0.75
L: +1.00 (dim)

Accommodation Facility (+/- 2.00)
BE: 10 cpm, difficult minus lens
R: 12 cpm, difficult minus lens
L: 12 cpm, difficult minus lens

Fusional Reserves
Near, PFV: x/25/8
Near, NFV: x/14/12 (above break pt 10, double then single)
Distance, PFV: x/14/12
Distance, NFV: x/10/6

We tried
R: -1.25
L: -0.75

Howell Card
Distance: 2 XP
Near: 10 – 12 XP
+1.00 Near: 12 XP
-1.00 Near: 6 XP
+2.00 Near: 12 XP
-2.00 Near: 4 XP

Fusional Reserves
Near, PFV: x/10/4
Near, NFV: x/12/8

Vergence Facility
Near: 2 cpm (slow BO)
Distance: 7 cpm (initially slow BO & BI, after a while was fine)

Interpupillary distance, IPD = 6.3cm

Lid & Adnexa
heavy looking upper lid (OS)

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
ACT: alternating CT

Examination of Eye Alignment
(Maddox Rod) placed on RE

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)

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, BO/PFV: x/15-31/10-22
Near, BI/NFV: x/7-17/3-11
Adult
Near, BO/PFV: x/10-28/7-21
Near, BI/NFV: x/7-19/5-15
Distance, BO/PFV: x/4-18/5-9
Distance, BI/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/Stereopsis
12.5″

Worth 4 Dots – Binocular Perception
4 dots/lights