Dee (M/16) MS.NG’S SON came for eye examination, vision with existing glasses is fine seeing far & near. He sometimes has headache after school.
Vision without glasses
R: 6/30
L: 6/45+
Vision with existing glasses (broken)
R: -3.75
L: -4.00/-0.25X155
Examination shows: (Delay Fogging)
R: -3.25/-0.50×5 (6/6) [+1.00 blur lens test: 6/12]
L: -3.75 (6/6-) [+1.00 blur lens test: 6/12] [L: left dominant eye] L>R
Lowering short-sightedness monocularly/binocularly is not favoured
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes to his left .. when covering right eye, the target goes to his right) (earlier, he said that the target slides up & down on alternating CT)
small XP, fast recovery @Near
(alternating CT: upon covering left eye, patient reported the target goes to his left .. when covering right eye, the target goes to his right)
(normal value: orthophoria/NMD-No Movement Detected or small XP, fast recovery)
EP = Esotropia/Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exotropia/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: 6 – 8 XP (blue part)
+1.00 Near: 10 XP (blue part)
-1.00 Near: 2 XP (blue 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
+1.25
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-1.00
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, 6/8cm, 6/8cm, TTN, TTN
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 8 YO, 8 YO, 8 YO (pt reported target is clear @end of RAF rule) (target is better with -0.50DC than -0.25DC)
L: 8 YO, 8 YO, 8 YO (pt reported target is clear @end of RAF rule) (target is better without any astigmatism)
(normal value: AA goes according to age; YO=years old)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
BE: 10 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 11 cycle per minit(cpm), difficult with plus lens(1st lens) (right eye sees better than with both eyes)
L: 11 cycle per minit(cpm), difficult with plus lens(1st lens) (left eye sees better than with both eyes)
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: PL
L: PL
(normal value: +0.25 to +0.75)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/8/6
Near, Base-In/Divergent, NFV: x/20/18 (AE has low BI @Near?)
Distance, Base-In/Divergent, NFV: x/10/8
Distance, Base-Out/Convergent, PFV: x/16/10
(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: 2 cpm (double with Base Out, blink3 & single before splitting the next second again
Distance: 6 cpm (double with Base Out, blink3 & single)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD: 6.6cm
We ask Dee whether or not his far vision is blurry for a while when he looks back at far vision after seeing near.. and he said yes. We recalled that at the beginning, he somehow said wearing & not wearing his glasses is about the same.
