Mr Khim (M/49) came for eye examination, vision with existing multifocal glasses is fine seeing far but he sometimes sees slightly blurry far vision and he removes glasses to see near. He notices that both his eyes will deviate out alternatingly since 3+ years ago. He has hypertension & on medication. No history of trauma/surgery is reported.
Vision without glasses
R: 6/60
L: 6/45
Vision with existing glasses of 2years
R: -4.00/-0.75×165 (6/6)
L: -4.00/-0.50×90 (6/6-)
Add: +2.00
Examination shows:
R: -3.75/-0.75×165 (6/6)
L: -3.25/-1.00×90 (6/6) [L: dominant left eye]
Add: +2.00 (N5@40cm)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
alternating XT @ Distance
alternating XT @ Near (D>N)
(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 (Maddox Rod)
Distance: > 10 BI
Near: > 10 BI
(normal value: 0-1 EP or 0-3 XP @Distance and 0-6 XP @Near)
BO/EP = Base Out/Esophoria is misalignment of the eye, eye is deviated inwards
BI/XP = Base In/Exophoria is misalignment of the eye, eye is deviated outwards
Examination of 3D Vision/Stereopsis (Random Dot 3S)
12.5″
(normal value: 12.5″)
Mr Khim has intermittent alternating exotropia at far & near. His wife, Peng said it was first noticed after his friend told him about the outward movement of his eyes. We refer him for further examination.
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Mr Khim came back to let us know that orthoptist has prescribed pencil push up and he is scheduled to go back for follow up in 3months. He also asked to proceed in making a new pair of glasses. Sometimes, overpower is prescribed to aid in better controlling the intermittent exotropia.. since the vision with current glasses is still fine, we suggest to remain with the current glasses while we also agree to work on VT.
VT works but you will need to be motivated to do the pencil push up homework every day for a period of time. Keep pressing on & push forward.. the exercise is simple & it is achievable. It takes bit of your concerted effort to make it happen.. just boring doing it over & over again. You know you can.. and we know you can pull through too! Never try never know what the result is.
We have faith in you like the way you have faith in us!
We will see him after his follow up with orthoptist soon.