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Inconvenient Wearing & Removing Glasses During Conference?

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Mrs Lee (F/50) came for eye examination, with complaint of inconvenience in wearing & removing reading glasses, especially during seminar/conferences. Vision with existing reading glasses made with us is fine.

Vision without glasses
R: 6/12
L: 6/12+

Existing glasses of 1year
R: +0.50/-0.25×110
L: +0.75/-0.25×40
Add: +2.00

Subjective Refraction (Delay Fogging +2.00 OU)
R: +1.00/-0.25×110 (6/6) (+1.00 blur lens test: 6/7.5)
L: +0.75/-0.25×40 (6/6) (+1.00 blur lens test: 6/7.5-)
Add: +2.00

Other assessments show:

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

Howell Card
Distance: 0
Near: 8 XP
-1.00 Near: 4 – 6 XP

NRA
+0.25

PRA
-0.25

NPC
TTN, TTN, 6/8cm, 8/10cm, 8/10cm, 8/10cm

MEM
R: +0.25
L: +0.25

Fusional Reserves
Near, PFV: x/10/8
Near, NFV: x/6/4
Distance, NFV: x/8/6
Distance, PFV: x/12/10

Vergence Facility
Near: 12 cpm (towards end of test: double BI, blink & single.. then double BO, blink & single)
Distance: 0 cpm (double BO, double did not get closer with blink)

We repeated
Fusional Reserves (Add: +1.50)
Near, PFV: x/18/16
Near, NFV: x/18/10

Interpupillary distance, IPD = 6.0cm

Slit Lamp
R: mild cataract
L: mild cataract

Fluorescein
R: -ve staining
L: -ve staining

Mrs Lee has some whitish lashes in her right eye.. she said it has been like this since she was 20yo.

Trial framing & prescribe
R: +0.75/-0.25×110
L: +0.75/-0.25×40
Add: +2.00

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, PFV: x/15-31/10-22
Near, NFV: x/7-17/3-11
Adult
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

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 
12.5″