Khai (M/21) came for eye examination.. with complaint of blurry vision during big movement.. ie. big jump during sports, or when he laughs loudly during funny moment with friends. Vision with existing glasses of 4-5years is fine seeing far & near. He also complains about seeing computer/phone blurry instantly with contact lens.
Vision without glasses
R: cannot see 6/60 (squeeze eye, can see 6/45-)
L: cannot see 6/60 (squeeze eye, can see 6/45-)
Contact lens (Daily disposable BC 8.6)
R: -5.25
L: -5.25
Vision with existing glasses
R: -5.50/-0.75×5 (6/6)
L: -5.50/-1.25×160 (6/6)
Add: +0.75
Subjective Refraction
R: -5.75/-0.25×5 (6/6) (+1.00 blur lens test: 6/9-)
L: -5.50/-0.50×150 (6/6) (+1.00 blur lens test: 6/6)
Near: L>R (adding +0.50 in RE: R>L)
Retinoscopy
R: -5.00
L: -4.50
Other assessments show:
Cover Test
Distance: NMD
(ACT: pt reported RE sees target going down & to his right, LE sees target going up & to his left)
Near: NMD
(ACT: pt reported RE sees target going down & to his right, LE sees target going up & to his left)
Howell Card
Distance: 1 EP
Near: 3 EP
+1.00 Near: 0
-1.00 Near: 1 EP
+2.00 Near: 0
-2.00 Near: 1 – 3 EP
NRA
+1.50
PRA
-1.25
NPC
TTN, TTN, TTN, TTN, TTN, TTN
(pt reported the vertical line moves to his right before going back to centre at end of RAF rule)
AA
R: 13.5D, 13.5D, 13.5D
L: 12D, 12D, 12D
Accommodation Facility (+/- 2.00)
BE: 10 cpm, difficult minus lens
R: 12 cpm, difficult minus lens
L: 12 cpm, difficult minus lens
MEM
R: +1.00
L: +1.00
Fusional Reserves
Near, NFV: 8/10/4
Near, PFV: 14/20/18
Distance, NFV: x/6/4
Distance, PFV: x/18/16
Vergence Facility
Near: 9 cpm (slow BI)
Distance: 6 cpm (slow BO & BI)
Fluorescein
R: -ve staining
L: -ve staining
Interpupillary distance, IPD = 6.7cm
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
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)
Random Dot 3S – 3D Vision
12.5″