Ergian (M/9) datang untuk pemeriksaan mata, mengadu kabur tengok jauh sejak beberapa bulan ini. Beliau ada sakit kepala.. biasanya rasa sakit kepala selepas habis sekolah. Penglihatan dekat masih okay.
Vision without glasses
R: 6/15, N5
L: 6/24 (we ask him to read again: 6/21), N5
Examination shows: (Delay Fogging)
R: -0.25
L: -0.25
VA OU: 6/6- (vision fluctuation noted)
Near: R>L (adding +0.25 in left eye: L>R) (Add is not favoured)
Modified
R: -0.25
L: PL
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)
NMD @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: 1 EP (yellow part)
Near: 1 EP (yellow part)
+1.00 Near: 1 EP (blue part)
-1.00 Near: 3 EP (yellow 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
+1.00
(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
TTN, TTN, TTN, TTN, TTN (pt reported the vertical line drifts to his right)
(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 N8 target is clear @end of RAF rule, N5 target is blurry)
L: 8 YO, 8 YO, 8 YO (pt reported N8 target is clear @end of RAF rule, N5 target is blurry)
(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: 13 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 9 cycle per minit(cpm), difficult with plus lens(1st lens) (both eyes see better than with right eye)
L: 9 cycle per minit(cpm), difficult with minus lens(2nd 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)
– pt holds it @20cm to see better
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.25
L: PL
(normal value: +0.25 to +0.75)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-In/Divergent, NFV: x/10/8
Near, Base-Out/Convergent, PFV: x/8/2
Distance, Base-In/Divergent, NFV: x/6/4
Distance, Base-Out/Convergent, PFV: x/4/2
(normal value: Blur/Break/Recovery)
Near, PFV: x/15-31/10-22
Near, NFV: x/7-17/3-11
[Scheiman et al – Children 7-12yo Data]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 0 cpm (double with Base Out, blink3 & the double gets closer before going far apart again)
Distance: 0 cpm (double with Base Out, blink3 & the double do not move closer at all)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD: 5.6cm
We did not prescribe glasses.
We will prepare eye exercise for Ergian to do.