James Lai Choon Hai – 88 Optometry

Mr James Lai CH (M/44) came for eye examination, with complaint of sometimes blurry driving in dim light condition especially when light hits on his eyes or during rainy days. Near vision is slightly blurry sometimes in which he needs to extend his arms further away to see.

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

Subjective Refraction
R: PL/-0.25×100 (6/6) {+1.00 blur lens test 6/9-} [R: right dominant eye] R>L
L: PL/-0.50×80 (6/6) {+1.00 blur lens test 6/12}
Add: R: +1.00 / L: +1.25 (L>R)
DC is favoured @N

Other assessments show:

Cover Test
Distance: NMD (ACT: pt reported RE sees the target go slanting up, LE sees the target go to his left)
Near: small XP, fast recovery

Howell Card
Distance: 0 – 1 EP
Near: 10 – 12 XP
+1.00 Near: 12 XP
-1.00 Near: 12 – 14 XP

NRA
+1.00

PRA
-0.50

NPC
14/20cm, 14/20cm, 14/20cm, 14/20cm, 14/20cm, 14/20cm

AA
R: 44yo, 44yo, 44yo
L: 44yo, 44yo, 44yo

MEM
R: +0.25
L: +0.25

Fusional Reserves
Near, PFV: x/20/18
Near, NFV: x/18/14
Distance, NFV: x/6/4
Distance, PFV: x/12/8

Vergence Facility
Near: 10 cpm (slow BO)
Distance: 12 cpm

Interpupillary distance, IPD = 7.2cm

Near tests are done with Add.

Slit Lamp
R: no cataract
L: no cataract, mild pinguecula

Fluorescein
R: -ve staining
L: -ve staining

Having mild astigmatism/”san gong”.. he needs a pair of glasses for driving. Entering presbyopia (when we are above the age of 40), we will have “lou fah” in which we need reading glasses to see near comfortably.. and this is normal. Normally, we prescribe glasses according to your lifestyle.. should you need correction for near.. we can prescribe a pair of reading glasses.. you put on your spec when you want to see near & remove when seeing far away. The same goes to your far vision.. but Mr James would still find his near vision to be blurry with his driving glasses due to “lou fah”. Or sometimes we see people having their reading specs sitting on lower nose in order to see near.. that would work too. Alternatively, we may opt for multifocal/progressive – seeing simultaneously clear from far to near vision without the need to put on & remove your glasses repeatedly. Still able to see clearly with glasses/contact lens.. and that’s good! If you absolutely do not want to wear glasses/contact lens, you may get vision correction from eye specialist doctor/ophthalmologist.. no matter what the method of vision correction is, as long as we do not strain our eyes.. it is fine. Let’s sayang our eyes.. our one & only pair of eyes!

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
ACT: alternating CT

Examination of Eye Alignment
(Maddox Rod) placed on RE

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)

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)

Random Dot 3S – 3D Vision/Stereopsis
12.5″

Worth 4 Dots – Binocular Perception
4 dots/lights