7/9/2021
Sha (F/13) came for eye examination, complaining of intense headache especially with near work recently. She has a pair of glasses of about 2years, but found the glasses to be dizzy.
Vision without glasses
R: 6/24-
L: 6/24-
Examination shows:
R: -1.00 (6/6) [+1.00 6/7.5] (R: dominant right eye)
L: -1.25/-0.50×180 (6/6) [+1.00 6/9]
With vision fluctuation
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
NMD @Near
(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
NRA (accommodation analysis – ability to relax accommodation)
+0.50
(normal value: +1.50 to +2.50)
PRA (accommodation analysis – ability to stimulate accommodation)
-0.50
(normal value: -1.37 to -3.37)
Examination of Eye Alignment (Howell Card)
Distance: 1 – 3 EP
Near: 2 XP -> 1 EP
+1.00 Near: 2 XP -> 0
(normal value: 0 – 1 EP or 0 – 3 XP @Distance & 0 – 6 XP @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
We refer her for cycloplegic refraction for suspected pseudomyopia due to overstimulation from excessive near work.
*Updated
Sha came back with eye prescription from optometrist:
R: +1.00/-0.75×170 (6/6)
L: +0.75/-0.50×175 (6/6)
Sha has longsighted power (indicated with + sign) of 100 & 075 and astigmatism power of 075 & 050 in right & left eye respectively. Normally, children can auto correct their longsighted power that also mask their astigmatism as well (as their eyes & eye muscles are still strong). Only when they do a lot of near work or use digital devices/computer on long hours, will they start to complain of headache or sometimes blurry near vision or even blurry far vision. Eyes need to auto correct the longsighted power for far vision, eyes also need to auto focus when seeing near.. this means double the demand required on our eyes. Continuous usage of digital devices easily exhausts our eyes hence those complaints.
Sha has a new pair of glasses of the prescription & she will wear her glasses full time.
*Updated
Sha came back a few days later complaining of having headache again. She is wearing her glasses full time now. Examination is around the corner & she has been using her phone on long hours daily. When prompted the distance that she holds her phone, her mother shared that she will hold very near and she sometimes lies down on bed & holds phone closely facing upwards/sideways.
The working distance in which you hold your phone is actually very important. The nearer you hold your phone, the more stressful your eyes will be.. as both eyes need to move inwards a lot in order to sustain seeing near print clearly for you. The smaller the digital device, the nearer you tend to hold the device.
Other examination shows:
NRA (accommodation analysis – ability to relax accommodation)
+2.00
(normal value: +1.50 to +2.50)
PRA (accommodation analysis – ability to stimulate accommodation)
-0.75
(normal value: -1.37 to -3.37)
MEM (to measure Accommodation response seeing near target)
R: +0.75
L: +0.75
(normal value: +0.25 to +0.75)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
R: 13 cycle per minit(cpm)
L: 13 cycle per minit(cpm)
BE: 11 cycle per minit(cpm)
(normal value:
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
We prescribe a separate pair of glasses specifically just for seeing near . She will wear her existing glasses for her everyday use. We also reinforce proper visual hygiene.. apart from holding her phone at a healthy distance (an elbow distance to eyes), taking regular break in between near work (20-20-20 rule) also goes hand in hand. After 20minutes of near work, to look at 20feet away(or far away).. for 20seconds.. this is for your eye muscles to take a break/to relax.
We cannot emphasise enough on proper visual hygiene especially during this pandemic. Let’s continue to remind each other.. your children, your spouse, your colleagues, and everyone around us! We can do this together.. for our eyes!
*Updated 14/12/2021
Sha dropped by to service her glasses. We asked whether or not she wears her glasses, she said that she wears her glasses 24/7 now, coz she is scared of having headache again. With proper visual hygiene – holding phone at a healthy elbow distance, taking regular break in between near work & proper posture, she does not need the separate pair of reading glasses already.
Sha is otw to Melaka for a short getaway with her parents.. enjoy your holidays with mummy Sumathi & father!
Happy to hear that Sha no longer has headache now?