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Lebih Suka Buka Spek Tengok Dekat?

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Kak Zieyah (F/46) datang untuk pemeriksaan mata, mengadu kabur tengok dekat dengan spek multifocalnya, beliau akan buka spek untuk tengok dekat.

Vision without glasses
R: 6/45-
L: 6/60+

Own glasses 1+years
R: -2.50/-0.25×20 (6/6-)
L: -3.25/-1.25×15 (6/6-)
Add: +1.25

Retinoscopy
R: -2.00
L: -2.75/-0.50×15

Subjective Refraction (Delay Fogging +2.00 OU)
R: -2.50 (6/6) (+1.00 blur test: 6/18-) R>L
L: -3.25/-0.50×15 (6/6) (+1.00 blur test: 6/18-)
Add: +1.50 L>R

Other assessments show:

Cover Test
Distance: NMD
(alternating CT: pt reported RE sees target going up & to her left.. LE sees target going down & to her right)
Near: NMD
(alternating CT: pt reported RE sees target is further.. LE sees target is nearer)

Howell Card
Distance: 1 EP
Near: 2 XP
-1.00 Near: 3 – 5 EP

NPC
TTN, TTN, TTN, TTN, TTN

NRA
+0.25

PRA
-0.25

MEM
R: +0.50
L: +0.50

Accommodation Facility (+/- 0.50)
BE: 9cpm, difficult minus lens
R: cannot clear minus lens
L: cannot clear minus lens

Fusional Reserves
Near, PFV: x/8/6
Near, NFV: x/16/10
Distance, NFV: 4/6/4
Distance, PFV: 8/10/6

Vergence Facility
Near: 3 cpm
(double BI, double did not go closer with blink)
Distance: 0 cpm
(double BO.. double go closer slightly with blink but still very far)

We repeated
Fusional Reserves
Near, PFV: x/14/10

Fluorescein
R: -ve
L: -ve

Slit Lamp Fluorescein
R: very mild cataract
L: very mild cataract

Interpupillary distance, IPD = 6.1cm

Prescribe
R: -2.50 (6/6) (+1.00 blur test: 6/18-) R>L
L: -3.25/-0.50×20 (6/6) (+1.00 blur test: 6/18-)
Add: +1.75 (near vision is better wearing spec) L>R
[Add: +1.50 (still near vision is better by removing spec)]

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

Examination of Eye Posture
(Howell Card) by 6^ BD OD | (Maddox Rod)
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)

AA(Amplitude Accommodation) – eye stamina (Dioptre, D) (RAF rule)
6yo – 16.5D | 6cm
9yo – 15.5D | 6.5cm
12yo – 14.5D | 7cm
15yo – 13.5D | 7.5cm
18yo – 12.5D | 8cm
21yo – 11.5D | 9cm
24yo – 10.5D | 10cm
27yo – 9.5D | 11cm
30yo – 8.5D | 12cm

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, PFV: x/15-31/10-22
Near, NFV: x/7-17/3-11
Adult
Near, PFV: x/10-28/7-21
Near, NFV: x/7-19/5-15
Distance, PFV: x/4-18/5-9
Distance, 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)