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Had Cataract Surgery In One Eye Already?

Madam Wong (F/78) came with complaint of nose pads of her existing specs are causing her some pain.. and discomfort in her left eye like something poking her eye. She feels her eyes are dry at end of day. She had cataract surgery in left eye 4years ago.

Vision without glasses
R: 6/12
L: 6/7.5-

Existing glasses of 4years
R: +2.50/-1.00×20 (6/30+)
L: -0.25/-1.00×5 (6/7.5-)
Add: +3.00

Subjective Refraction
R: +1.00 (6/9+) PHNI
L: -0.25 (6/6) (+1.00 blur lens test: 6/7.5-)
Add: +2.75 (N8+@40cm) closer rocv

Other assessments show:

Cover Test
Distance: NMD
Near: small XP, fast recovery

Howell Card
Distance: 1 EP
Near: 10 XP
-1.00 Near: 10 XP

NRA
+0.50

PRA
-0.50

NPC
10/24cm, 10/24cm, 12/24cm, 12/24cm, 14/24cm, 14/24cm

Fusional Reserves
Near, PFV: 4/x/x
Near, NFV: x/14/12
Distance, NFV: x/10/8
Distance, PFV: x/25/18

Vergence Facility
Near: no double reported
Distance: no double reported (pt said clear with 3BI)

Amsler Grid
R: all lines are straight
L: all lines are straight

W4D
Distance: 4 lights
Near: 3 lights

Slit Lamp
R: cataractous lens
L: no PCO

Fluorescein
R: no staining, TBUT 4s
L: no staining, TBUT 4s

Interpupillary distance, IPD = 6.3cm

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, 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)