Mr Lee PL (M/56) came with complaint of seeing horizontal shadow binocularly with his prism incorporated glasses some time ago especially after long hours of seeing his phone (he removes glasses to see near). He first started seeing diplopia about 20years ago & he had his first prism incorporated glasses 15+ years ago.. he has had 3 previous pairs of prism glasses.
Unaided Vision
R: 6/60-
L: 6/60
Existing SV glasses of 6years
R: -4.00/-1.00×50 4BO (6/7.5-)
L: -3.50/-2.00×120 6BO (6/7.5)
Examination shows:
R: -5.25/-0.25×50 6BO (6/6) [+1.00 blur test: 6/12-]
L: -4.25/-0.75×120 7BO (6/6) [+1.00 blur test: 6/7.5-] [L: left dominant eye] L>R
Add: +2.00 (N5@40cm) R>L
Other assessments show:
Cover Test
Distance: moderate – large Esophoria, moderate – slow recovery
Near: NMD
Maddox Rod
Distance: 17 BO
Near: 4 BO
Other assessments show:
NRA
+1.00
PRA
-0.75
NPC (RAF rule)
12/14cm, 12/14cm, 12/14cm, 12/14cm, 12/14cm, 12/14cm
Accommodation Facility (+/-1.00)
BE: same difficulty w/ plus & minus lenses
R: difficult plus lens
L: difficult plus lens
MEM
R: PL
L: PL
Fusional Reserves (Prism Bar)
Near, NFV: 6/14/12 (above blur pt 6, double then single)
Near, PFV: x/20/18
Distance, NFV: x/4/2
Distance, PFV: 12/30/18
Vergence Facility (Prism Flipper 12BO/3BI)
Near: 0 cpm (double BI)
Distance: 5 cpm (slow BO)
Slit Lamp
R: vy mild cataract
L: vy mild cataract
Fluorescein
R: -ve staining
L: -ve staining
Trial framing
R: -5.25/-0.25×50 6BO
L: -4.25/-0.75×120 7BO
Add: +2.00
Lowering prism or DS mono/binocularly is xfavoured seeing far2 away
We refer pt to see orthoptist first.
