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Complaint Of Glaring & Reflection? *UpdatedAB

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11/8/2020

Christine (F/11) came for eye examination complaining of blurry far vision & glaring looking at whiteboard at school for a long time already.

Eye examination showed:

R: -3.00/-1.25×180 (6/9-)

L: -2.00/-1.00×5 (6/7.5)

Christine hasn’t worn any glasses before. With this significant yet uncorrected shortsighted power & astigmatism, she has lazy eye/amblyopia in which she cannot see the smallest lines that other kids can see, even now with full power correction. Her right eye cannot see two smallest lines and her left eye cannot see the smallest line on testing chart. Christine must wear her glasses full time, and we will see her again in 1 month.  Sometimes, vision can pick up itself after full-time wear of optimum correction. Otherwise, we will try with vision therapy to see what we can do in improving the lazy eye.

# Christine came back for follow-up last year & she can see the smallest line 6/6.

*UpdatedA

30/4/2022

Christine (F/13) came for eye examination, with complaint of blurry far vision with existing glasses of almost 2years.

Vision without glasses
R: 6/60-
L: 6/60-

Vision with existing glasses
R: -3.00/-1.25×180 (6/12)
L: -2.00/-1.00×180 (6/18-)

Examination shows: (Delay Fogging)
R: -3.50/-1.25×180 (6/6) [+1.00 blur lens test: 6/12] (R: right dominant eye) R>L
L: -3.00/-1.25×180 (6/6) [+1.00 blur lens test: 6/12-]
Add: +0.50

Other assessments show:

Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
NMD @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 – 1 EP (yellow part)
Near: 0 – 1 EP (yellow part)
+1.00 Near: 0 – 2 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
+2.00
(normal value: +1.50 to +2.50)

PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens 
-2.50
(normal value: -1.37 to -3.37)

MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.50
L: +0.50
(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: 13 YO, 13 YO, 13 YO
L: 13 YO, 13 YO, 13 YO
(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, 6/10cm, 8/10cm, 8/10cm
(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: 13 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 14 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with right eye]
L: 14 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with left eye]
– with minus lens.. vision is blur then clear
(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-In/Divergent, NFV: x/20/16
Near, Base-Out/Convergent, PFV: x/25/16
Distance, Base-In/Divergent, NFV: x/10/8
Distance, Base-Out/Convergent, PFV: 12/25/20
(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 In then single)
Distance: 12 cpm
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)

Interpupillary distance, IPD = 6.0cm

*UpdatedAB

Christine came back for follow up. New pair of glasses is fine seeing far & near.

New glasses
R: -3.50/-1.25×180 (6/6)
L: -3.00/-1.25×180 (6/6)
Add: +0.50

Other assessments show: (with own glasses)

Howell Card
Distance: 0 – 1 EP
Near: 0 – 1 EP
Near: 0 – 2 XP (looking through bottom part of lens)

NRA 
+1.00

PRA 
-1.50

NPC
6/8cm, 6/8cm, 6/8cm, 8/10cm, 8/10cm

AA
R: 13 YO, 13 YO, 13 YO
L: 13 YO, 13 YO, 13 YO

MEM
R: +0.50
L: +0.50

Fluorescein
R: -ve staining
L: -ve staining

All’s good.

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″