Celine (F/19) came for eye examination, with complaint of dry, tired eyes with near work.. especially worse with contact lens wear (without astigmatism/”san guang” correction) in which she can work on her computer for 2-3hours only before having symptoms since 2 years ago. She is a full-time contact lens wearer now. She reported having issue with her colour lens with astigmatism previously (previous contact lens power with astigmatism was unknown).
Vision without glasses
R: 6/60
L: 6/45-1
Vision with existing glasses of 3 years
R: -3.50/-1.75×180 (6/6)
L: -3.00/-2.00×5 (6/6)
We tried to lower astigmatism binocularly, she reported shadowy on 6/6 line.
Examination shows: (Delay Fogging)
R: -3.00/-1.75×180 (6/6) [+1.00 blur lens test: 6/9-]
L: -2.50/-2.00×5 (6/6) [+1.00 blur lens test: 6/9] (L: left dominant eye) L>R
Near: R>L
Upon removing astigmatism in both eyes, she can see 6/9- (astigmatism power not as high?)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance (alternating CT: upon covering left eye, patient reported the target goes down & looks smaller.. when covering right eye, the target goes up & looks bigger)
small XP, fast recovery @Near (alternating CT: upon covering left eye, patient reported the target looks further.. when covering right eye, the target looks closer)
(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
+0.25 BE Distance: 0
Near: 4 XP (blue part)
+1.00 Near: 6 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
-1.25
(normal value: -1.37 to -3.37)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.25
L: +0.25/PL
(normal value: +0.25 to +0.75)
Accommodation Facility – ability to change focus: far to near or near to far (by Flipper +/-2.00)
BE: 9 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 14 cycle per minit(cpm), difficult with plus lens(1st lens) [both eyes see better than with right eye]
L: 13 cycle per minit(cpm), difficult with plus lens(1st lens) [both eyes see better than with left eye]
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
10/12cm, 10/12cm, 12/14cm, 12/14cm, 14/16cm
(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: 15 YO, 15 YO, 18 YO
L: 15 YO
(normal value: AA goes according to age; YO=years old)
Interpupillary Distance = 6.1cm
We are half way through the examination.. and her father needs to leave. We will check the few remaining tests when she comes back the next round.
*Updated
Contact lens
R: -3.25/-1.25×180
L: -3.50/-1.25×180 L>R {adding +0.25 in left eye, 6/6- BE)
Near: R>L