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Eye Pain & Headache?

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Wendy (F/50) came for eye examination, with complaint of eye pain & headache recently.. and she has gone to see eye doctor/ophthalmologist already.. was told that her eyes are all healthy. She previously felt that she has right eye pain.. but she also feels it in her left eye now. If she does not see her laptop & phone, and just laze around at home, then her eyes feel good.

Vision without glasses
R: 6/6
L: 6/6

Existing glasses of 2+years
R: PL (6/6)
L: PL (6/6)
Add: +1.25

Subjective Refraction
R: PL (6/6) [+1.00 blur lens test: 6/9] R>L
L: PL (6/6) [+1.00 blur lens test: 6/9]
Add: +1.50 (L>R)
No long-sightedness/hyperopia is accepted @far, mono/bino.

Other assessments show:

Cover Test
Distance: NMD
(upon ACT: pt reported seeing comfortably in RE, but feeling so bright in left eye)

Near: small XP, fast recovery
(upon ACT: pt reported RE sees the target being smaller & dimmer, LE sees the target as bigger & clearer)

Howell Card
Distance: 1 EP
Near: 4 XP
+1.00 Near: 6 XP
-1.00 Near: 2 XP

NRA
+0.75

PRA
-0.50

NPC
8/12cm, 8/12cm, 10/16cm, 10/16cm, 14/22cm, 14/22cm

AA
R: 47yo
L: 46yo

MEM
R: +1.00
L: +0.75

Fusional Reserves
Near, PFV: 14/16/14
Near, NFV: 8/10/8
Distance, NFV: x/6/4
Distance, PFV: x/12/10

Vergence Facility
Near: 7 cpm (slow BO & BI)
Distance: 0 cpm (double BO) 

Interpupillary distance, IPD = 5.8cm

Near tests are done with Add.

We adjusted Wendy’s glasses to sit higher & we prescribe her a separate pair for her near work as her computer is on eye level.

Computer use
R: +1.25
L: +1.25

Notes

Vision without glasses
6/6 – smallest testing line
6/7.5 – 2nd smallest line
6/9 – 3rd smallest line
6/12 – 4th smallest line
6/15 – 5th
6/18 – 6th
6/21 – 7th
6/24 – 8th

Examination of Eye Alignment
Cover Test, CT @ Distance & Near
– NMD(No Movement Detected) or
– small XP, fast recovery
EP = Esophoria is misalignment of eye, eye is deviated inwards
XP = Exophoria is misalignment of eye, eye is deviated outwards
ACT: alternating CT

Examination of Eye Alignment
(Maddox Rod) placed on RE

Examination of Eye Posture
(Howell Card) by 6^ BD OD
Distance:
– 0-3 XP (blue part) or
– 0-1 EP (yellow part)
Near:
– 0-6 XP (blue part)

Accommodation/Focusing analysis – ability to relax
NRA
+1.50 to +2.50

Accommodation/Focusing analysis – ability to focus
PRA
-1.37 to -3.37

Convergence, NPC – ability of eye to maintain a single clear near image (RAF rule)
Break/Recovery – within 10cm or TTN(to the nose)

AA(Amplitude Accommodation) – eye stamina (Dioptre, D) (RAF rule)
6yo – 16.5D | 6cm
9yo – 15.5D | 6.5cm
12yo – 14.5D | 7cm
15yo – 13.5D | 7.5cm
18yo – 12.5D | 8cm
21yo – 11.5D | 9cm
24yo – 10.5D | 10cm
27yo – 9.5D | 11cm
30yo – 8.5D | 12cm

MEM(Monocular Estimation Method) – measure accommodation response seeing near target
+0.25 to +0.75 (with movement)

Accommodation Facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
Monocular: 6cpm – 16cpm
Binocular: 4cpm – 14cpm
(1 cycle per minute, cpm = 2 words)

Fusional Reserves –
Convergent/Divergent reserve stamina (Prism Bar)
Blur/Break/Recovery
Children 7-12yo
Near, BO/PFV: x/15-31/10-22
Near, BI/NFV: x/7-17/3-11
Adult
Near, BO/PFV: x/10-28/7-21
Near, BI/NFV: x/7-19/5-15
Distance, BO/PFV: x/4-18/5-9
Distance, BI/NFV: x/4-10/2-6

Vergence Facility  – ability to make rapid repetitive vergence changes (Prism Flipper 12BO & 3BI)
Distance: 12-18 cpm
Near: 12-18 cpm)
(1 cycle = 2 times clearing target)

Random Dot 3S – 3D Vision/Stereopsis 
12.5″

Worth 4 Dots – Binocular Perception 4 dots