Mr Lee HM (M/62) came for eye examination, with complaint of blurry far vision with existing multifocal glasses since middle of last year. He reported seeing far blurry especially when he shifts his gaze from hp to far vision.. in which he needs to see far, far away for some time before vision gets slightly better. His frame was broken previously, in which he changed into existing frame.. and the frame is not in good alignment now. He has hypertension and no trauma/eye surgery is reported.
Vision with existing lenses >5years
R: -5.50/-1.00×90 (6/6) (+1.00 blur lens test 6/9-)
L: -6.75/-0.75×90 (6/6-)
Examination shows:
R: -5.50/-1.25×105 (6/6) (+1.00 blur lens test 6/9) [R: right dominant eye]
L: -6.00/-1.25×105 (6/6) (+1.00 blur lens test 6/9-)
Add: +2.50 (N5@40cm)
Binocular double vision reported (no double vision on near)
Other assessments show:
Cover Test
Distance: NMD (ACT: pt reported RE sees target going down & left and LE sees target going up & right)
Near: moderate XP, moderate recovery (ACT: pt reported RE sees target going down & left and LE sees target going up & right)
Maddox Rod
Distance: R 6 BD, 5 BI
Near: R 5 BD, 18 BI
Howell Card (8BD on OD)
Distance: 2 – 4 XP
Near: 10 – 12 XP (after blink: 8 XP)
Random Dot 3S
400″
BHTT
no significant hyperphoria seen
Prism trial framing
R: -5.50/-1.25×105 4 BD
L: -6.00/-1.25×105
Add: +2.50
* UpdatedA 24/12/2021
Mr Lee came and told us that no double vision is seen. He reported that blurry vision is seen only when his eyes are tired.
Prism trial framing
R: -5.25/-1.25×105 (6/6) 1 BD
L: -6.25/-1.25×105 (6/6) 1 BU
Add: +2.50
No double vision reported, but vision with prism is clearer
BHTT
R hyperphoria
vision is worse on right gaze (we asked pt to report: vision is worse on right/left gaze)
vision is worse on right tilt (we asked pt to report: vision is worse on right/left tilt)
– after lie down, no difference in his BHTT
Maddox Rod
Distance: R 4 BD, 7 BI
Near: R 4 BD, 20 BI
* Updated
Vision without glasses
R: 6/18- slow
L: 6/21-
Examination shows: (Delay Fogging)
R: -4.25/-1.00×110
L: -4.50/-1.00×110
He can see 6/6 binocularly.. but reported blurry wordings on non-lit poster.. he needs to top up -0.75 binocularly to see the wordings
Retinoscopy reflex is very dim in both eyes
Howell Card (8BD on OD)
Distance: 0 – 2 XP
* UpdatedAB 11/2/2022
Mr Lee has mild cataract in both eyes & he has been diligently doing his daily Dot Card eye exercise prescribed by orthoptist. He reported that the crossing point initially was seen double.. now he can see all single throughout the dots. Well done Mr Lee!
Vision with existing lenses
R: -5.50/-1.00×90
L: -6.75/-0.75×90
BCVA OU: 6/9-
Examination shows:
R: -5.25/-1.25×105
L: -6.25/-1.25×105 [BCVA OU: 6/9-]
Add: +2.50 (N5@40cm)
ROCV: 20cm to 45cm [Add +2.00 still same ROCV: 20cm to 45cm]
Other assessments show:
Howell Card (6BD on OD)
Distance: 0 – 2 XP (stop at 0)
Add: +2.50 Near: 6 – 8 XP -> 2 XP -> 0 (stop at 0)
Add +1.50 Near: 4 – 6 XP -> 2 XP -> 0 (stop at 0)
We fix the lenses into a new frame while he will go for his follow up with orthoptist soon & we will see how it goes after the appointment.
* Updated 11/5/2022
We prescribe him:
R: -5.50/-1.25×105 2BD
L: -6.50/-1.25×105 2BU
Add: +2.50
He let us know that he sees shadow but no double vision.. and glaring/light dispersed upon oncoming headlights when driving at night. Daytime vision is fine so does near vision. Faint shadow is seen at bottom of each testing alphabet & glaring/light dispersed is seen from right eye.
Lenses made by supplier:
R: -5.50/-1.25×105
L: -6.50/-1.25×105 4BU
Add: +2.50
*Updated 26/7/2022
Mr Lee came back & he reported no double.. but he needs to open his eyes wide in order to be able to see far better.
*UpdatedABC 7/12/2022
Mr Lee came back for follow up. He reported seeing double horizontally.
Existing glasses
R: -5.50/-1.25×105 (6/9+)
L: -6.50/-1.25×105 4BU (6/12)
Add: +2.50
Examination shows:
R: -6.50 2BD (6/7.5-) [PH 6/7.5-] [R: right dominant eye]
L: -7.00/-0.50×105 2BU (6/7.5-) [PH 6/7.5-]
Add: +2.50 (N5@40cm)
Other assessments show:
Cover Test
Distance: (ACT: pt reported RE seeing target going down, LE seeing target going up)
Near: moderate XP, moderate recovery
Howell Card (8BD on OD)
Distance: 1-3 EP
Near: 10 XP
+1.00 Near: 14 XP
-1.00 Near: 14 XP
Maddox Rod
Distance: 3 BI, R 5 BD
Near: 14 BI, R 4 BD
Other assessments show:
NRA
+0.50
PRA
-0.25
NPC (RAF rule)
22/44cm, 22/44cm, 22/44cm, 22/44cm
Accommodation Facility (+/-0.50)
BE: difficult plus lens
R: difficult plus lens
L: difficult plus lens
Fusional Reserves (Prism Bar)
Near, PFV: x/12/6
Near, NFV: x/18/14
Distance, NFV: x/4/(keep double)
Distance, PFV: x/4/2
Vergence Facility (Prism Flipper 12BO/3BI)
Near: 0 cpm (double BO)
Distance: 0 cpm (double BO)
Vertical Fusional Reserves (Prism Bar)
Distance, BD: x/5/4
Distance, BU: x/1/1
Near, BD: x/6/5
Near, BU: x/3/2
Vertical Fusional Reserves (Prism Bar) [with R 2BD L 2BU]
Distance, BD: x/3/2
Distance, BU: x/3/2
Trial framing
R: -6.50 2BD
L: -7.00/-0.50×105 2BU
Add: +2.50
Vision is fine seeing far & near during trial framing. He will continue to do eye exercise prescribed by orthoptist.
Lenses made by supplier
R: -6.50
L: -7.00/-0.50×105 4BU
Add: +2.50
