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Full-time Contact Lens Wearer With No Glasses All These Years?

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Mr Chung (F/50) a driver, came for eye examination.. with complaint of blurry seeing his phone that is attached to windscreen. He is full-time contact lens wearer for many2 years(no glasses at all). His last eye examination was 8years ago. He also reported seeing double on car plate number sometimes, normally in the evening when his eyes are very tired since some years ago.. in which he blinks his eyes & vision is fine.

Vision without glasses
R: guess 6/120
L: guess 6/120

Contact lens
R: -5.25
L: -5.25

Subjective Refraction
R: -5.00/-0.25×90 (6/6) (+1.00 blur lens test: 6/12)
L: -5.00 (6/6) (+1.00 blur lens test: 6/12)
Add: +1.75

Other assessments show:

Cover Test
Distance: NMD
Near: small XP, fast recovery (no movement in RE, small-moderate XP in LE)

Howell Card
Distance: 0
Near: 6 – 8 XP
+1.00 Near: 6 XP

NRA 
+0.75

PRA 
-1.25

Modified
R: -5.00/-0.25×90
L: -5.00
Add: +1.25 (more comfortable seeing near than Add +1.50)

NPC
7/10cm, 7/10cm, 7/10cm, 7/10cm, 7/10cm, 7/10cm

AA
R: 3.8D, 3.8D, 3.8D
L: 4.2D, 4.2D, 4.2D

MEM
R: dim reflex (pupil very small)
L: dim reflex (pupil very small)

Fusional Reserves
Near, PFV: x/25/18
Near, NFV: x/20/18
Distance, NFV: x/10/8
Distance, PFV: x/30/12

Vergence Facility
Near: 11 cpm
Distance: 0 cpm (double BO, double did not get closer with blink)

Slit Lamp
R: mild neovas
L: mild neovas

Interpupillary distance, IPD = 6.5cm

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

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, PFV: x/15-31/10-22
Near, NFV: x/7-17/3-11
Adult
Near, PFV: x/10-28/7-21
Near, NFV: x/7-19/5-15
Distance, PFV: x/4-18/5-9
Distance, 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 
12.5″