Mr Desmond (M/53) came for eye examination, with complaint of blurry near vision on computer & phone since about 9months ago with existing glasses of 2.5years.
Vision without glasses
R: 6/60
L: 6/60+1
Vision with existing glasses of 2.5years
R: -3.25/-1.25×180 (6/6)
L: -3.25 (6/6)
Add: +2.25
Examination shows: (Delay Fogging)
R: -3.00/-0.75×180 (6/6) [+1.00 blur lens test: 6/9+] (R: right dominant eye) R>L
L: -3.25 (6/6) [+1.00 blur lens test: 6/12] {on Retinoscopy, it seems to be an astigmatism of -0.25×105, but not preferred}
Add: +2.00 (N5@40cm) R>L (adding +0.25 in left eye, still R>L)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target stays at centre.. when covering right eye, the target goes to his right)
moderate XP, moderate recovery @Near
(alternating CT: upon covering left eye, patient reported the target stays at centre. when covering right eye, the target goes to his right)
(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: 12 – 14 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
+0.25
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.50
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
9/14cm, 9/16cm, 9/18cm, 10/20cm, 11/22cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/6/4
Near, Base-In/Divergent, NFV: x/6/4
Distance, Base-Out/Convergent, PFV: x/14/12
Distance, Base-In/Divergent, NFV: x/8/4
(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]
Amsler Chart (to check the integrity of macula)
R: normal
L: a few crocked/distorted lines
(normal value: all lines are straight)
Interpupillary distance: 6.4cm
# Near tests are all done with Add
Mr Desmond’s convergence is receded with low fusional reserves, we will prescribe exercise to strengthen fusional reserves as well.
We will see him in 4-6weeks.