6/5/2021
Nee (F/20) complains of blurry far vision watching TV subtitles & sometimes blurry near vision after long hours of phone. She hasnt worn any glasses before.
Unaided VA (Vision without glasses)
R: 6/15-
L: 6/6
Examination shows: (Binocular Refraction)
R: -0.75/-0.75×175 (6/6)
L: PL/-0.50×10 (6/6)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance & small to moderate XP fast 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 (Howell Card)
Distance: 0 – 2 XP
Near: 6 – 8 XP
No glasses Near: 10 XP
(normal value: 1 EP-0 or 0-3 XP @Distance; 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
Nee has 075 shortsighted power/myopia with 075 of astigmatism in right eye and 050 of astigmatism in left eye that is giving her blurry vision looking at TV subtitles. Without glasses, when she looks at her phone, her eyes are drifted outwards more than normal, that may cause blurry near vision sometimes. When she wears her corrective power, the eye alignment is more normalised.
Nee will wear her glasses and we see how it goes.
*UpdatedA
Nee (F/21) came back for follow up.. she will wear her glasses when she is using computer only. She has right eyestrain after prolonged hours using computer.
Vision without glasses
R: 6/12-
L: 6/6
Existing glasses of 1year
R: -0.75/-0.75×175 (6/6)
L: PL/-0.50×10 (6/6)
Examination shows: (Delay Fogging)
R: -0.50/-1.00×175 (6/6) [+1.00 blur lens test: 6/12-] [R: right dominant eye]
L: PL/-0.50×10 (6/6) [+1.00 blur lens test: 6/12+] L>R
Near: L>R
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes to her left .. when covering right eye, the target goes to her right)
small XP, fast recovery @Near (RE shows NMD, LE shows XP movement)
(alternating CT: patient reported NMD)
(normal value: orthophoria/NMD-No Movement Detected or small XP, fast recovery)
EP = Esotropia/Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exotropia/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)
Near: 12 – 14 XP (blue part)
+1.00 Near: 10 – 12 XP (blue part)
-1.00 Near: 2 – 4 XP (blue part) (pt reported the numbers on scale is very blurry)
(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
+2.25
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.50
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
LE deviates @6cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 21 YO, 21 YO, 21 YO (pt reported target is clear @end of RAF rule) (target is better with -1.00DC than -0.75DC)
L: 25 YO, 25 YO, 25 YO (pt reported target is clear @end of RAF rule) (target is better with -0.50DC than -0.25DC)
(normal value: AA goes according to age; YO=years old)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
BE: 11 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 14 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with right eye)
L: 11 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with left eye)
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.75
L: +0.75
(normal value: +0.25 to +0.75)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 6/25/8
Near, Base-In/Divergent, NFV: 16/20/18
Distance, Base-Out/Convergent, PFV: 14/16/8
Distance, Base-In/Divergent, NFV: x/12/10
(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: 0 cpm (double with Base Out, the double images still remain at the same place despite continuous blinking)
Distance: 0 cpm (double with Base Out, the double images still remain at the same place despite continuous blinking)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD: 5.8cm
Vision with 0.5/1/2 BI OU @Near is not favoured.
We will prepare prism flipper & prescribe to Nee.
