Alice (F/21) came for eye examination yesterday, complaining very glaring with existing glasses of 3years and the coating of her glasses is fine.
Vision with existing glasses:
R: -2.75/-0.50×5 (6/6-)
L: -2.00/-0.75×175 (6/9)
Examination showed:
R: -2.75/-1.00×5 (6/6)
L: -2.25 (6/6)
Add: +0.75 (N5@40cm)
Other assessments showed:
Examination of Eye Alignment/Vergence (Cover Test)
Orthophoria @Distance & Near
(normal value: Orthophoria/NMD-No Movement Detected or small XP small recovery)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
6cm, 6cm, 6cm
(normal value: less than 10cm)
AA (Accommodation/eye stamina – ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 9cm, 9cm, 9cm
L: 9cm, 9cm, 9cm
(normal value: 9cm for a 21year old)
NRA (Accommodation analysis – ability to relax accommodation)
+0.75
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation)
-1.00
(normal value: -1.37 to -3.37)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
R: 4 cycle per minit(cpm) – difficult with plus lens
L: 4 cycle per minit(cpm) – difficult with plus lens
BE: 10 cycle per minit(cpm) – difficult with plus lens
(normal value:
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
MEM (to measure Accommodation response seeing near target)
R: +0.25
L: +0.25
(normal value: +0.25 to +0.75)
Alice’s power is about the same and she does not seem to have astigmatism in her left eye. Why did she emphasize so much about her glaring issue? When we checked her near vision & put in Relax power of +0.75, she gave a convincing response that can tell she is seeing good… after she sees the distinct difference between seeing clearly at near & seeing slightly blurry & termed as “glaring” in her usual vision.
Comparatively, if your accommodation/focusing system is well & you are already seeing good near vision all the while, probably you won’t report any difference or there is just minimal vision improvement it brings about when we put Relax lens during near vision check.
From the result, we know that she has Accommodation issue:
- did not pass Monocular Accommodation Facility,MAF in both right & left eye
- NRA is very low – she has difficulty in relaxing her focusing/accommodation due to suspected eye muscles having spasm/“kejang”
- PRA is pretty low – ability to stimulate focusing/accommodation is slightly weaker
We let Alice know about:
- to put cycloplegics eye drop to relax eye muscles from Eye Specialist Clinic to get true eye power
- to reassess Accommodation assessments 1week after cycloplegics
- if Accommodation results were the same, she can change spectacle lenses to Relax lens with new power
- to strengthen/improve his accommodation/focusing ability by vision therapy
Alice lives in KK, Sabah.. and she is on her flight back to Sabah today. So, we will pass her case to our colleague in Sabah for further management. When prompted, Alice said that she has experienced blurry near vision since many years back since she was in secondary school.
Thank you Alice for your trust & support!?