7/5/2021
WKay (F/10) came with complaint of slight blurry far vision looking at whiteboard at school. She needs to go to the front in order to copy. Her mother reported that she will complain blurry near vision sometimes when asked to read from textbook. Kay also reported seeing 4 – 5 colours like green, purple, yellow, red on wall or on spinning things like fan. She sees these colours when there is change in lighting condition – either dark to bright or bright to dark. This happens when she is with or without glasses and this also happens before or after rubbing eyes. No headache reported. She was prescribed patching therapy (cover left eye) & pencil push up test when she was about 7yo.
Vision with existing power of 2years(Cycloplegic Rx)
R: PL/-2.25X10 (6/6) N5@30cm
L: -0.25/-1.25X175 (6/6) N5@30cm
Examination shows:
R: PL/-2.25X10 (6/6) [+1.00 blur test: 6/9-] (w/ vision fluctuation: sometimes can see, s/times xsee)
L: PL/-1.50X175 (6/6) [+1.00 blur test: 6/7.5-]
Other assessments show:
Random Dot 3S
12.5″
Cover Test
Distance: small XP, fast recovery
Near: moderate XP, moderate recovery
Howell Card
Distance: 0 -> 2 -> 4 XP
Near: 20 -> 16 -> 12 -> 4 -> 8 -> 2 -> 6 -> 14 XP
+0.75 Near: 6 -> 8 XP
NPC (RAF rule)
no double line reported, but right eye is observed to deviate @ 10cm
AA (RAF rule)
R: no blur reported even to the nose
L: no blur reported even to the nose
NRA
+1.25 (with +0.75, she reported very clear at near print)
PRA
-2.25
Accommodation Facility (+/- 2.00)
BE: 10 cpm, difficult plus lens
R: 13 cpm, difficult plus lens
L: 13 cpm, difficult plus lens
*UpdatedA 10/10/2022
WKay (F/11) came for follow up.. with complaint of difficulty copying from whiteboard at school when she sits at the back of class.. as she will rotate sitting the first row to the last row. Near vision is sometimes blurry too.
Vision without glasses
R: 6/24
L: 6/12
Vision with existing power
R: PL/-2.25X10 (6/9-) N5-@33cm
L: -0.25/-1.25X175 (6/7.5-) N5@33cm
Examination shows:
R: -0.50/-2.25X10 (6/6-) [+1.00 test: 6/12+] (w/ vision fluctuation: sometimes can see, s/times xsee)
L: -0.50/-1.25X175 (6/6) [+1.00 test: 6/12-]
Other assessments show:
Random Dot 3S
16″ (slow)
Cover Test
Distance: small – moderate XP, moderate recovery (breaking down into RXT once or twice)
Near: large XP, moderate recovery
Howell Card
Distance: 2 XP (no blink), 10 XP (with blink)
Near: 18 – 20 XP
+1.00 Near: 12 XP
-1.00 Near: 10 XP
+2.00 Near: 20 XP
-2.00 Near: 16 XP
NRA
+2.50
PRA
-1.50
NPC
6/10cm, 8/12cm, 10/14cm, 12/16cm, 14/18cm, 16/20cm (s/times RE deviates @10cm, 12cm, 14cm)
AA
R: 15.5yo, 15.5yo, 15.5yo (N8)
L: 15.5yo, 15.5yo, 15.5yo (N5)
NPC (with Add +0.50)
16/20cm, 18/22cm, 20/24cm
Accommodation Facility (+/- 2.00)
BE: 15 cpm, difficult minus lens
R: 16 cpm, difficult minus lens
L: 20 cpm, difficult minus lens
MEM
R: +0.50
L: +0.75
Fusional Reserves (Prism Bar)
Near, PFV: x/12/8 (above break pt 6, double then single)
Near, NFV: 12/25/20
Distance, PFV: 6/12/10
Distance, NFV: x/8/6
Vergence Facility (Prism Flipper 12BO/3BI)
Near: 0 cpm (double BO) double goes further apart with blink
Distance: 3 cpm (initially double BO.. then no double with blink)
Interpupillary distance, IPD = 5.8cm
-gradient AC/A = 8:1, +gradient AC/A = 6:1
We refer to co-manage with ophthalmologist & orthoptist.
21/12/2022
WKay came to make new glasses.
Modified
R: -1.25/-1.50X10 (6/6)
L: -0.75/-1.25X175 (6/6)
Random Dot 3S
12.5″
She will do Dot Card VT.
TCA 2/12
UpdatedB 19/3/2023
WKay (F/12) came for follow up. She has been doing Dot card VT. She reported feeling tired eyes towards end of day that goes away with rest/nap.
Vision with new glasses
R: -1.25/-1.50X10 (6/6-) N5@33cm
L: -0.75/-1.25X175 (6/6) N5@33cm
Other assessments show:
Random Dot 3S
12.5″ (slow)
Cover Test
Distance: small XP, fast recovery (R Hypertropia?)
Near: moderate XP, moderate recovery
Howell Card
Distance: 0 – 2 XP
Near: 12 XP
+1.00 Near: 18 XP
-1.00 Near: 8 XP
Maddox Rod
Distance: orthophoria (after blink), R 3 BD (when no blink)
Near: not stable
NRA
+1.50 (alternate monocular occlusion: OD clear, OS clear)
PRA
-2.00
NPC
TTN, TTN, TTN, TTN, TTN
AA
R: 8yo, 10yo, 11yo
L: 8yo, 10yo, 10yo
Accommodation Facility (+/- 2.00)
BE: difficult minus lens
R: difficult plus lens
L: difficult minus lens
MEM
R: +0.75
L: +0.75
Fusional Reserves (Prism Bar)
Near, PFV: 18/25/20
Near, NFV: x/16/12
Distance, NFV: x/14/12
Distance, PFV: x/16/14
Vergence Facility (Prism Flipper 12BO/3BI)
Near: 12 cpm (slow BO sometimes)
Distance: 5 cpm (slow BO.. stimes slow BI)
She will continue Dot card VT.
KIV EOM 2/12