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Had Cataract Surgery In Both Eyes Already?

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Yung jie (F/68) came for eye examination, she had cataract surgery in left eye 3months ago. . right eye was done 2years ago. She reported feeling something poking at the top of her right eyelid.. and sometimes feeling tired eyes. She sees perfectly fine far, and she does not see phone that much.

Vision without glasses
R: 6/6-
L: 6/9-

Subjective Refraction
R: +0.25 (6/6) (+1.00 blur test: 6/9)
L: -0.25 (6/6) (+1.00 blur test: 6/9)
Add: +2.25

Other assessments show:

Cover Test
Distance: NMD
Near: NMD

Howell Card
Distance: 0 – 1 EP
Near: 4 – 6 XP
-1.00 Near: 2 – 4 XP



14/18cm, 14/18cm, 14/18cm, 14/18cm, 14/18cm

Fusional Reserves
Near, PFV: x/30/20
Near, NFV: x/8/6
Distance, NFV: x/6/4
Distance, PFV: x/14/12

Vergence Facility
Near: 11 cpm
Distance: 4 cpm (slow BO & BI)

Interpupillary distance, IPD = 5.9cm

R: -ve staining
L: -ve staining

Slit Lamp
R: normal
L: nasal pterygium

R: 3s
L: 3s

Pterygium = whitish growth that grows onto cornea(front part of our eye)
We everted her right eyelid.. very mild concretion(yellowish dots)

Yung jie sometimes sees her phone without wearing glasses. We remind her to wear her reading glasses to see near so that her eyes will feel more comfortable.


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
– 0-3 XP (blue part) or
– 0-1 EP (yellow part)
– 0-6 XP (blue part)

Accommodation/Focusing analysis – ability to relax
+1.50 to +2.50

Accommodation/Focusing analysis – ability to focus
-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)
Children 7-12yo
Near, BO/PFV: x/15-31/10-22
Near, BI/NFV: x/7-17/3-11
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 

Worth 4 Dots – Binocular Perception 4 dots