12/12/2021
Daniel (M/29) came for eye examination, with complaint of dizziness after long hours of computer work and when he sees far away, far vision becomes blurry. He works in front of computer on long hours every day.
Vision without glasses
R: 6/120
L: 6/60
Vision with existing glasses of 1year
R: -3.75 (6/6) (+1.00 blur lens test 6/18-)
L: -2.25/-0.75×160 (6/6-)
Examination shows: (Delay Fogging)
R: -3.50 (6/6) (+1.00 blur lens test 6/12-) [R: right dominant eye]
L: -2.50/-0.25×160 (6/6) (+1.00 blur lens test 6/12-)
Vision fluctuation noted
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
small XP fast recovery @ Distance
small XP, fast to moderate recovery @ Near (N>D)
(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: 2 – 4 XP (blue part)
Near: 10 – 12 XP (blue part)
-1.00 Near: 1 EP <–> 0 <–> 2 XP (blue part)
+1.00 Near: 14 – 16 XP (blue part)
(normal value: 0-1 EP or 0-3 XP @Distance and 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
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
8/10cm, 8/10cm, 10/12cm, 11/13cm, 12/14cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
AA (Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: blurry
L: 32 YO, 32 YO, 32 YO
(normal value: AA goes according to age)
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+2.50
(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 (Accommodation lag – to measure accommodation response seeing near target)
R: +0.25
L: +0.25
(normal value: +0.25 to +0.75)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
R: 10 cycle per minit(cpm), difficult with minus lens(2nd lens)
L: 10 cycle per minit(cpm), difficult with minus lens(2nd lens)
BE: 14 cycle per minit(cpm), difficult with minus lens (2nd lens)
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Examination of Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 16/12
Near, Base-In/Divergent, NFV: 18/14
Distance, Base-Out/Convergent, PFV: 10/8
Distance, Base-In/Divergent, NFV: 10/8
(normal value: 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]
*UpdatedA
Daniel wants to wear contact lens every day now. Previously, we gave him eye exercise for convergence. He is working in Penang now.. and he said he will come back every 2months.
Contact lens (1st)
R: -3.75
L: -2.75
Howell Card
Near: 10 XP (blue part)
Contact lens (2nd)
R: -3.50
L: -2.50
We let him try two power of daily disposable.. to try seeing near.
We see whether or not he can come back for follow up before leaving on Tuesday.
………………….
Daniel likes (2nd) contact lens with more moisture material.. and he wants to try wearing every day.
We prescribe contact lens biweekly replacement, and we ask him to monitor his near vision when working on computer to see whether or not he sees near blurry frequently. He will come for follow up when he comes back again in 2months.
*Updated B 15/4/2023
Daniel L came for follow up.
Vision without glasses
R: 6/60-
L: 6/60
Vision with existing glasses 2+yrs
R: -3.75 (6/7.5- 6/6-)
L: -2.25/-0.75×160 (6/6-)
Examination shows:
R: -3.75 (6/6) (+1.00 blur lens test: 6/15+) (R: dominant eye)
L: -2.50/-0.50×160 (6/6) (+1.00 blur lens test: 6/12-)
Other assessments show:
Cover Test
Distance: NMD (alt minute XT?)
Near: small-mod XP, fast-mod recovery (alt XT?)
Howell Card (6BD on OD)
Distance: 0 – 2 XP
Near: 8 – 10 XP
+1.00 Near: 12 XP
-1.00 Near: 0 – 2 XP
NRA
+1.50 (alternate monocular occlusion: OD blur, OS blur)
PRA
-1.75
NPC (RAF rule)
10/12cm, 12/14cm, 14/16cm
AA (RAF rule)
R: 30yo, 35yo, 38yo
L: 35yo, 37yo, 39yo
Accommodation Facility (Flipper +/- 1.00)
BE: difficult plus lens
R: difficult minus lens
L: difficult minus lens
MEM
R: +0.50
L: PL
Fusional Reserves (Prism Bar)
Near, PFV: x/14/8
Near, NFV: x/14/12
Distance, NFV: x/10/8
Distance, PFV: x/18/14
Vergence Facility (Prism Flipper of 12BO & 3BI)
Near: 8 cpm (slow BO)
Distance: 5 cpm (slow BO)
Slit Lamp Examination
R: clear
L: clear
Fluorescein staining
R: -ve staining
L: -ve staining
Contact Lens (Oasys biweekly 8.4)
R: -3.75
L: -2.75
KIV EOM