GAUTHAM A/L SOMASUNDARAM

Gtham (M/14) came for eye examination, with complaint of blurry far vision looking at whiteboard at school recently. He also has frequent headache usually towards end of the day, in which he takes a nap to relieve it or his dad will massage his head for him.

Vision without glasses
R: 6/12- slow
L: 6/15- slow

Subjective Refraction
R: +0.25/-1.00×10 (6/6) (+1.00 blur lens test: 6/15-) R>L (adding +0.25 R>L, adding +0.50 L>R)
L: +0.25/-1.25×170 (6/6) (+1.00 blur lens test: 6/21+)
Add: +0.75/+0.50 (L>R)

Other assessments show:

Cover Test
Distance: NMD
(upon ACT: pt reported RE sees target moving to his left, LE sees target moving to his right)
Near: small XP, fast recovery
(upon ACT: pt reported RE sees target moving to his right, LE sees target moving to his left)

Howell Card
Distance: 0 – 2 XP
Near: 4 – 6 XP
+1.00 Near: 8 XP
-1.00 Near: 4 XP
+2.00 Near: 10 – 12 XP
-2.00 Near: 4 XP (blurry scale)

NRA
+1.50
(upon +1.50 OU, upon monocular occlusion – RE sees blurry, LE sees better)

PRA
-0.25

NPC
36/42cm, 36/42cm, 36/42cm, 38/44cm, 38/44cm, 38/44cm

NPC (with Add +0.50)
12/14cm, 14/16cm, 14/16cm

AA
R: 8.5D, 8.5D, 8D
L: 10.5D, 11.5D, 11.5D

Accommodation Facility (+/- 2.00)
BE: 13cpm, difficult minus lens
R: 15cpm, difficult minus lens (pt reported seeing closer & bigger with plus lens, smaller & further away with minus lens)
L: 15cpm, difficult minus lens

MEM
R: +1.25
L: +1.00

Fusional Reserves
Near, PFV: x/6/4
Near, NFV: x/14/12
Distance, NFV: x/8/6
Distance, PFV: x/6/4

Vergence Facility
Near: 0 cpm (double BO)
Distance: 1 cpm (double BO)

Fusional Reserves (with Add +0.50)
Near, PFV: x/12/10
Near, NFV: x/10/8

Interpupillary distance, IPD = 6.2cm

Pseu CI

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
ACT: alternating CT

Examination of Eye Alignment
(Maddox Rod) placed on RE

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)

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

Worth 4 Dots – Binocular Perception 4 dots