24/1/2021
YShan (F/9), younger sister of YWei, came for eye examination, vision with existing glasses of 2years is fine. Mother Wai Yee reported that she does rub her eyes sometimes.
Examination shows:
R: -0.25/-1.50×5 (6/6)
L: -0.25/-1.75×180 (6/6)
Other assessments show:
NRA (Accommodation analysis – ability to relax accommodation)
+1.50
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation)
-0.75
(normal value: -1.37 to -3.37)
*Updated
YShan came back for follow up, vision with existing glasses of 1+ years is blurry seeing far & near vision is fine. Mother reported that she will turn her head sideways to see far.
Vision without glasses
R: 6/21-
L: 6/30-
Vision with existing glasses
R: -0.25/-1.50×5 (6/18)
L: -0.25/-1.75×175 (6/24-)
Examination shows: (Delay Fogging)
R: -0.75/-1.50×5 (6/6) [+1.00 blur lens test: 6/12-1]
L: -1.50/-1.75×180 (6/6) [+1.00 blur lens test: 6/15-] (L: left dominant eye) L>R {adding +0.25 in left eye, R>L}
Near: R>L
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 her right.. when covering right eye, the target goes to her left)
small XP, fast recovery @Near
(alternating CT: upon covering left eye, patient reported the target goes to her left.. when covering right eye, the target goes to her right)
(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: 0 – 2 XP (blue part)
Near: 4 – 6 XP (blue part)
+1.00 Near: 6 – 8 XP (blue part)
-1.00 Near: 2 – 4 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
+1.75
(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)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +1.25
L: +1.00
(normal value: +0.25 to +0.75)
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
L: 20 YO, 20 YO, 20 YO
– target is blurry further away, only comes into focus at mid RAF rule (same with both eyes)
(normal value: AA goes according to age; YO=years old)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
6/8cm, 8/10cm, 12/16cm, 14/20cm, 16/24cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
When prompted whether or not she sees blurry near vision on phone/computer/books, she said print on book will move/jump after a while.. in which she will rub her eyes & vision becomes clear for a couple of minutes before becoming blurry again. When it becomes blurry again, she will stop reading.
Accommodation Facility – ability to change focus: far to near or near to far (by Flipper +/-1.00)
BE: 10 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 13 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with right eye]
L: 13 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with left eye]
– patient cannot clear -2.00 & -1.50
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/4/-4
Near, Base-In/Divergent, NFV: x/4/-6
Distance, Base-Out/Convergent, PFV: x/6/4
Distance, Base-In/Divergent, NFV: x/6/4
(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 – Adult Data]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 1 cpm (double with Base-Out)
Distance: 1 cpm (double with Base-Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule (with Add +0.50 in both eyes,BE)
6/8cm, 10/14cm, 10/16cm, 10/20cm, 12/24cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar (with 2Base-In in BE)
Near, Base-Out/Convergent, PFV: x/4/2
Near, Base-In/Divergent, NFV: x/18/16
Distance, Base-Out/Convergent, PFV: x/10/6
Distance, Base-In/Divergent, NFV: x/6/4
(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 – Adult Data]
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar (with Add +0.50 & 2Base-In in BE)
Near, Base-Out/Convergent, PFV: x/2/1
Interpupillary Distance = 6.0
When we let her compare her near vision with & without 2Base-In in both eyes, she said vision is better without.
When we let her compare her near vision with & without Add:+0.50, she said vision is better with.
YShan’s fusional reserves are very low at near.. she reported seeing double early on the test & taking a long time to regain single clear vision.