Mrs Yap (F/44) came for eye examination, with complaint of blurry near vision & dizziness with or without her reading glasses. She does not really wear her glasses to see near.
Vision without glasses
R: 6/6-
L: 6/6-
Vision with existing reading glasses of 4-5years
R: +0.50/-0.25×115 (Oc at the edge of lens)
L: +0.50/-0.25×90
Examination shows: (Delay Fogging)
R: PL (6/6) [+1.00 blur lens test: 6/9-] (R: right dominant eye)
L: PL (6/6) [+1.00 blur lens test: 6/12]
Add: +1.50 (L>R)
No hyperopia/longsightedness is accepted monocularly/binocularly
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: pt reported NMD)
(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 (yellow part)
Near: 2 XP (blue part)
-1.00 Near: 0
(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
-0.25
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
12/18cm, 12/18cm, 12/18cm, 12/20cm, 12/20cm
(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: 45 YO, 45 YO, 45 YO (target is clear @end of RAF rule)
L: 45 YO, 45 YO, 45 YO (target is blurry @end of RAF rule, clear@38cm)
(normal value: AA goes according to age; YO=years old)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.25
L: +0.25
(normal value: +0.25 to +0.75)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/18/16 (above break point of 6, double then single)
Near, Base-In/Divergent, NFV: x/14/10
Distance, Base-In/Divergent, NFV: x/8/6
Distance, Base-Out/Convergent, PFV: x/x/x
(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: 14 cpm
Distance: 13 cpm
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Fluorescein (assess integrity of front surface of eye, cornea)
R: -ve staining
L: -ve staining
All near tests are done with Add.
Interpupillary distance, IPD = 6.2cm
Mrs Yap does not like the hassle of wearing & removing her reading glasses, we prescribe multifocal contact lens.
Contact lens (1st)
R: PL Add: +1.50 D
L: PL Add: +1.50 N
Far vision: 6/6 (R>L), Near vision: N5 (L>R)
Over Refraction
R: -0.25 (but pt prefers to remove -0.25 for near)
L: PL
Mrs Yap, Esther reported near vision is fantastic but far vision is slightly “fat” (alphabets look fat)
Contact lens (2nd)
R: PL Add: +1.00 D
L: PL Add: +1.50 N
Esther reported far vision is foggy.. she prefers the 1st ones minus the “fatness” in the vision hehe
Contact lens (3rd)
R: -0.25 Add: +1.50 D
L: PL Add: +1.50 N