Mrs Lee (F/52) came for eye examination, her vision is fine seeing far but seeing near is blurry with her exiting multifocal glasses of more than 5years. The lenses have scratches and lens coating has peeled.
Vision without glasses
R: 6/60
L: 6/60+1
Vision with existing glasses
R: -4.00/-0.25×170 (6/6)
L: -3.75/-0.25×35 (6/7.5-)
Add: +1.75
Examination shows: (Delay Fogging)
R: -3.75 (6/6) [R: dominant right eye]
L: -4.00 (6/6)
Add: +2.00 (N5@40cm)
We tried giving -0.25 on LE, but she did not like it
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @ Distance
small XP, fast recovery @ 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)
Distance: 2 XP (blue part)
Near: 10 – 12 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
Mrs Lee’s left eyelid seems to be lower (~2mm) as compared to the other eye. We prompt if her eyelids have been this way since young and she has not quite noticed the difference. We ask her to do an ice pack test.. to have an ice pack rested on left eye for a few minutes. Should the eyelid lift after removal of ice pack, it may suggest the condition of myasthenia graves, MG.
Mrs Lee’s near posture is slightly exophoric. First & foremost, we need you to wear your updated prescription for at least 4-6weeks before we check & repeat the assessments again. If she has symptoms of Convergence Insufficiency, CI.. or still having blurry near vision sometimes, we will check by doing a full Binocular Vision, BV workout as CI may occur in presbyopic patient too. (Presbyopia patients are all of us above 40s who need reading power to see clearly at near).
Binocular Vision, BV – as the name suggests.. it derives from both eyes taking into account our eye systems – accommodation & vergences. Those are the assessments we do to identify the system/binocular vision disorder that is causing the symptoms and in need of help.. which bring us to eye exercise in strengthening the defective system – we call the vision therapy, VT.
Not all visual symptoms are due to binocular vision anomalies.. we need to rule out pathological or nonfunctional causes to the your visual complaint too.