Mr Hassan (F/49) came for eye examination, with complaint of tired eyes. He uses a pair of reading glasses.
Vision without glasses
R: 6/6-
L: 6/6
Examination shows: (Delay Fogging)
R: +0.25/-0.75×90 (6/6) [+1.00 blur lens test: 6/7.5-] (R: right dominant eye)
L: PL (6/6) [+1.00 blur lens test: 6/9] L>R
Add: +2.00 (N5@40cm)
No further hyperopia/long-sightedness is accepted monocularly or binocularly
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes to his right.. when covering right eye, the target goes to his left)
small XP, fast recovery @Near
(alternating CT: upon covering left eye, patient reported the target goes to his left.. when covering right eye, the target goes to his right)
(normal value: orthophoria/NMD-No Movement Detected or small XP, fast recovery)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0 – 1 EP (yellow part)
Near: 4 – 6 XP (blue part)
(normal value: 0-1 EP (yellow part) or 0-3 XP (blue part) @Distance; and 0-6 XP (blue part) @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+0.50
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.25
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
12/16cm, 14/18cm, 16/20cm, 12/16cm, 18/22cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/10/6
Near, Base-In/Divergent, NFV: x/6/4
Distance, Base-In/Divergent, NFV: x/4/2
Distance, Base-Out/Convergent, PFV: x/10/8
(normal value: Blur/Break/Recovery)
Near, PFV: 10-28/7-21
Near, NFV: 7-19/5-15
Distance, PFV: 4-18/5-9
Distance, NFV: 4-10/2-6
[Scheiman et al – Adult Data]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 0 cpm (double with Base-Out)
Distance: 0 cpm (double with Base-Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
With 2Base-In OU (in both eyes, BE) @ Distance & Near
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/12/10
Near, Base-In/Divergent, NFV: x/8/6
Distance, Base-In/Divergent, NFV: x/2/1
Distance, Base-Out/Convergent, PFV: x/14/12
(normal value: Blur/Break/Recovery)
Near, PFV: 10-28/7-21
Near, NFV: 7-19/5-15
Distance, PFV: 4-18/5-9
Distance, NFV: 4-10/2-6
[Scheiman et al – Adult Data]
We try
R: +0.50/-0.75×90
L: +0.25
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Distance, Base-In/Divergent, NFV: x/8/6
Distance, Base-Out/Convergent, PFV: x/10/8
Mr Hassan’s vision is fine seeing far and he uses reading glasses to see near. We asked if he got the tired eyes from doing far task or near task, he reported feeling tired from driving as he drives a lot these days. He has some hyperopia/long-sightedness, tapi sebab mata ada tegang sekarang, eyes do not accept hyperopic power now.
Hyperopia is the power that can be auto-corrected by our eyes, sebab itu kita masih boleh nampak jelas walaupun tak pakai kanta pembetulan. Biasanya, kita tak mengadu mata penat pada waktu pagi(mata fresh lagi kan), tapi bila dah masuk petang sikit, mata dah mula penat, memang payah nak mata kerja lagi untuk auto fokuskan.. hence mata penat & kabur penglihatan memandu waktu malam.
When we look at his initial divergent fusional reserves, NFV at far, its break point is 4 & its recovery point is 2.. then it boosts his NFV to break point 8 & recovery point 6.. just by adding +0.25 in both eyes. This goes to show that simply wearing your power, despite the slightest power, it does wonder to our eye systems. In his context, we know that full time wear of glasses will normalise his fusional reserves at far.. which then alleviates his complaint of tired eyes.
His convergence, NPC is receded too, but he did not complain about losing focus at near task. He will wear his glasses full time.. and we will review his NPC again soon.