Wei (M/11), Wing’s brother came for eye examination, with complaints of dry & grittiness in right eye since last month. He has been wearing his existing glasses for 2years, and he likes to wear it very low, seeing through the top portion of lenses. The lens coating has peeled off.
Vision with existing glasses
R: -4.50/-0.50×70 (6/12-)
L: -4.50/-0.50×170 (6/9-)
Examination shows:
R: -5.25/-0.75×45 (6/6-)
L: -4.75/-0.75×180 (6/6) (L: dominant left eye) L>R
Relax Add: +1.50
Vision fluctuation observed in right eye
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
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: 1 EP
Near: 1 -> 3 -> 5 EP (yellow part)
+1.00 (Near): 1 EP (yellow part) -> 0 – > 2 XP (blue part)
+1.50 (Near): 2 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
NRA (accommodation analysis – ability to relax accommodation with plus lenses)
+3.00
(normal value: +1.50 to +2.50)
PRA (accommodation analysis – ability to stimulate accommodation with minus lenses)
-1.50
(normal value: -1.37 to -3.37)
MEM (Accommodation lag – to measure accommodation response seeing near target)
R: +1.50
L: +1.00
(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: 5 cycle per minit(cpm) difficult with -ve lens
L: 5 cycle per minit(cpm) difficult with -ve lens
BE: 6 cycle per minit(cpm) difficult with -ve lens
(normal value:
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-In/Divergent, NFV: x/18/14
Near, Base-Out/Convergent, PFV: x/x/x
(normal value: Blur/Break/Recovery)
Near, PFV: 16/15-31/10-22
Near, NFV: 13/7-17/3-11
[Scheiman et al, 1989]
Wei has some dry eyes (PEE) in right eye, it may be the cause of his vision fluctuation. We prescribe non-preserved artificial tears (gel type) on right eye & we will see him again in 2 weeks.