You are currently viewing Dizziness & Headache? *Updated

Dizziness & Headache? *Updated

14/7/2022

Mr Albert (M/63) came for eye examination, with complaint of dizziness recently with existing glasses made with us. He shared that he has headache since many2 years ago.. not really associated with near work.. but near work will make the headache worse. Also, he told us that his far vision will be blurry slightly before seeing clear. He had cataract surgery last year.. one eye was done a year earlier.

Vision without glasses
R: 6/12 (better)
L: 6/9

Vision with existing glasses of about 1year
R: +0.75
L: +0.25/-0.75×95

Examination shows: (Delay Fogging)
R: +0.75 (6/6) [+1.00 blur lens test: 6/7.5+]
L: -0.25/-0.50×95 (6/6) [+1.00 blur lens test: 6/12] [L: left dominant eye]
Add: +2.75/+2.25 (R>L)

Other assessments show:

Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance 
(alternating CT: patient reported NMD)
small XP, fast recovery @Near
(alternating CT: patient reported NMD)
(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: 3 EP (yellow part) 
Near: 8 XP (blue part) 
-1.00 Near: 8 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

Modified
R: +1.00
L: PL/-0.50×95
Add: +2.50/+2.25

Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 1 EP (yellow part) 

NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+0.50
(normal value: +1.50 to +2.50)

PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens 
-1.25
(normal value: -1.37 to -3.37)

NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, 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: pt reported N8 target is clear @end of RAF rule, better without astigmatism
L: pt reported N8 target is clear @end of RAF rule, better with -0.50DC
(normal value: AA goes according to age; YO=years old)  

Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/x/x
Near, Base-In/Divergent, NFV: x/x/x
Distance, Base-In/Divergent, NFV: x/16/8
Distance, Base-Out/Convergent, PFV: x/18/12
(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: 10 cpm
Distance: 9 cpm (double with Base Out, blink & single)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)

Left eye

*Updated

Mr Albert came with complaint of hazy vision seeing far & near vision.. vision is same with & without glasses. Night driving & rainy days are especially difficult. He said that he can see clearly sometimes, but at other times his vision will be blurry.. making him very confused.

Vision without glasses
R: 6/9-
L: 6/30-

Existing glasses
R: +1.00 (6/6-)
L: PL/-0.50×95 (6/21+)
Add: +2.50/+2.25

Slit Lamp

Left eye
Right eye

Maddox Rod
Distance: 2 Base In
(pt reported centre part of vertical line is missing sometimes, at other times he can see the whole vertical line)
(pt reported horizontal line is slanting.. 5 incyclo)
Near: 5 Base In
(pt reported there is 4 breaks(in black colour) in between vertical line)

Worth 4 Dots
Distance: 4 dots
Near: 4 dots

We refer to see eye specialist doctor/ophthalmologist.