Janet jie (F/54) came for eye examination, with complaint of slight blurry far vision with existing glasses that she uses for driving & when she goes out. She has another two separate pairs of specs for driving & seeing phone at home but she did not bring along.
Vision without glasses
R: 6/45
L: 6/45
Vision with existing glasses >5years (she wears her existing glasses of small rectangle frame higher than FH)
R: +1.75 (6/12)
L: +2.25 (6/15-)
Add: +2.00
Driving glasses (power reported by her)
R: +2.75
L: +3.00
Examination shows: (Delay Fogging)
R: +2.25/-0.25×120 (6/7.5+)
L: +2.75/-0.50×90 (6/7.5+) (L: left dominant eye) R>L
Add: +2.00 (N5@40cm) R>L
No longsightedness/hyperopia is accepted monocularly/binocularly
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target seems further & smaller.. when covering right eye, the target seems nearer & bigger)
NMD @Near
(alternating CT: upon covering left eye, patient reported the target seems slightly bigger.. when covering right eye, the target seems slightly smaller)
(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: 2 XP (blue part) – 0 – 1 EP (yellow part) [top arrow paces around 0, slightly touching blue & yellow alternately]
Near: 0 – 2 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
+0.25
(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
left eye deviates @ 9cm
no doubling is reported (patient reported that vertical line moves to her left side at end of RAF rule)
(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: 10/20/18
Near, Base-In/Divergent, NFV: x/12/10
Distance, Base-In/Divergent, NFV: 10/6
Distance, Base-Out/Convergent, PFV: 20/18
(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: 12 cpm
Distance: 11 cpm
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Amsler Chart (assess integrity of macula)
R: all lines are straight
L: slight wavy lines
(normal value: lines are straight with equal gaps in between lines)
Colour Vision
R: normal
L: normal
(normal value: normal)
Modified
R: +2.25/-0.25×120
L: +2.75/-0.50×90
Add: +2.25
All near tests are done with Add.
Interpupillary distance, IPD = 6.3cm