Kean (M/24), FeeN’s brother came for eye examination, complaining of sometimes blurry far vision especially after long hours of computer work. He removes glasses to see near even when he was still at school back then.
Vision without glasses
R: 6/45 (R>L)
L: 6/45
Vision with existing glasses of 1year
R: -1.75 (6/6-)
L: -2.00 (6/6-)
Examination shows:
R: -1.75 (6/6-) (R: dominant right eye)
L: -1.75 (6/6-)
Relax Add: +0.75/+1.00 (L>R)
Slight vision fluctuation in both eyes with blink (sometimes C looks like O, F looks like R)
Other assessments show:
Examination of Eye Alignment (Cover Test)
NMD @Distance
NMD @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 – 1 EP (yellow part)
Near: 0 – 1 EP (yellow part)
+1.00 Near: 2 – 4 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
TTN, TTN, TTN
(normal value: less than 10cm or to the nose, TTN)
AA (Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 14cm, 14cm, 14cm
L: 14cm, 14cm, 14cm
(normal value: 10cm for 24yo)
NRA (Accommodation analysis – ability to relax accommodation/focusing)
+2.00
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation/focusing)
-0.75
(normal value: -1.37 to -3.37)
MEM (Accommodation lag – to measure accommodation response seeing near target)
R: +1.25
L: +1.25
(normal value: +0.25 to +0.75)
Facility (Accommodation facility – ability to change focus: far to near or near to far in 1 minute) by Flipper +/- 2.00
R: 10 cycle per minit(cpm) – difficult with -ve lens
L: 10 cycle per minit(cpm) difficult with -ve lens
BE: 10 cycle per minit(cpm) difficult with -ve lens
(normal value:
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Examination of Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-In/Divergent, NFV: 8/16/4
Near, Base-Out/Convergent, PFV: 18/25/20
Distance, Base-In/Divergent, NFV: 8/12/8
Distance, Base-Out/Convergent, PFV: 8/14/12
(normal value: Blur/Break/Recovery)
Near, NFV: 13/7-17/3-11
Near, PFV: 16/15-31/10-22
[Scheiman et al, 1989]
Kean has Accommodation Insufficiency.. his eye stamina is reduced. He should be able to see clearly up to 10cm (as per his age), but he reported blurry vision at 14cm. This correlates to him removing his glasses to see near. His near posture of 1 esophoria shows that his eyes tend to move inwards towards nose. Esophoria at near is no good, it potentially leads to near visual symptoms such as intermittent blurry far & near vision and/or eye fatigue especially after long hours of near work & it is also a risk factor of myopia progression.
Kean can opt for relax power to support his near vision with vision therapy to increase his eye stamina. Alternatively, if he is open to the option of contact lens, relax/multifocal contact lens or orthokeratology will be beneficial in his condition.