Janni (F/27) came for eye examination, with complaint of headache & tired eyes when seeing laptop & phone since 1-2 years ago. She also complains of glaring and watery eyes when she is outdoors in the sun. She has not worn any glasses before.
Vision without glasses
R: 6/6- slow
L: 6/7.5-
Examination shows: (Delay Fogging)
R: +0.25/-0.25×110 (6/6) (+1.00 blur lens test 6/18-) [R: right dominant eye]
L: PL/-0.25×180 (6/6) (+1.00 blur lens test 6/18-)
Add: +0.75
– bigger near print seen with Add
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
small XP, fast recovery @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
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0 – 2 XP (blue part)
Near: 8 – 10 XP (blue part)
(normal value: 0-1 EP or 0-3 XP @Distance; and 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
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
16/26cm, 14/24cm, 12/22cm, 10/18cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
(with Add) 12/16cm, 14/18cm, 16/20cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+1.50 & above (blur then clear)
(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)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.25
L: +0.25
(normal value: +0.25 to +0.75)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 35 YO, 35 YO, 35 YO
L: 40 YO, 40 YO, 40 YO
(normal value: AA goes according to age; YO=years old)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
(with Add) R: 30 YO, 30 YO, 30 YO
(with Add) L: 35 YO, 35 YO, 35 YO
(normal value: AA goes according to age; YO=years old)
Accommodation Facility – ability to change focus: far to near or near to far (by Flipper +/- 1.50) (cannot clear +/-2.00)
BE: 10 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 8 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with right eye]
L: 7 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with left eye]
– when seeing through flipper plus lens, vision is blur then clear
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 8/12/4
Near, Base-In/Divergent, NFV: 12/18/14
Distance, Base-Out/Convergent, PFV: 8/10/8
Distance, Base-In/Divergent, NFV: x/10/6
(normal value: Blur/Break/Recovery)
Near, PFV: x/10-28/7-21
Near, NFV: x/7-19/5-15
Distance, PFV: x/4-18/5-9
Distance, NFV: x/4-10/2-6
[Scheiman – Adult Data]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 7 cpm (difficulty with Base-Out)
Distance: 0 cpm (cannot fuse Base-Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary Distance = 6.3cm