Joann (F/45) came for eye examination, she is having a pair of reading glasses of +1.75.
Vision without glasses
R: 6/9- slow
L: 6/6-
Examination shows:
R: +1.25 (6/6) [+1.00 blur lens test 6/7.5+] (R: dominant right eye)
L: +0.75 (6/6) [+1.00 blur lens test 6/9-]
Add: +1.50 (N5@40cm)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @ Distance
small XP, fast then moderate 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)
Distance: 0 – 2 XP (blue part)
Near: 10 – 12 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 with Addition
12/14cm, 13/15cm, 14/16cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Joann has longsightedness/hyperopia.. higher in right eye. Her near posture is exophoric with reduced & receded convergence. We prescribe multifocal for her.. let her wear her glasses full-time and we will assess her exophoria & NPC again. We also prescribe pencil push up for her to do along with her multifocal glasses.
Previously, we prescribed monthly multifocal contact lens and she came back to report about irritation & difficult to focus on near. She shared that she also got daily multifocal contact lens from another practice and found it to be uncomfortable too. We missed her data on eye alignment previously.. these pieces of information may shed light on the possibility of her near exophoric posture that is causing her near visual complaint. As we know plus power may make exophoria worse.
However, most importantly now is to let her wear optimum power and we will have a look at her eye systems again.