YShen (M/11) came for eye examination, with complaint of sometimes blurry far vision looking at whiteboard at school since recently. Near vision is fine. He sometimes has headache after school.. in which he will take shower & it gets better. He has not worn any glasses before.
Vision without glasses
R: 6/7.5-
L: 6/9
Examination shows: (Delay Fogging)
R: PL (6/6) [+1.00 blur lens test: 6/12+]
L: PL (6/6) [+1.00 blur lens test: 6/9] (L: left dominant eye) L>R
Add: +0.50
Vision fluctuation @far noted in both right & left eye.. sometimes he can see & sometimes he cannot see when we ask him to read again
No hyperopia/long-sightedness is accepted monocularly/binocularly.
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 his left.. when covering right eye, the target goes to his right)
NMD @Near
(alternating CT: upon covering left eye, patient reported the target goes to his left.. when covering right eye, the target goes to his right)
(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/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 2 XP (blue part)
Near: 0 – 2 XP (blue part)
+1.00 Near: 2 – 4 XP (blue part)
-1.00 Near: 1 – 3 EP (yellow part)
(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
+1.50
(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)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.50
L: +0.50
(normal value: +0.25 to +0.75)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, 5/7cm, 5/7cm, 5/7cm, 5/7cm
(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: 11 YO, 11 YO, 8 YO
L: 11 YO, 11 YO, 8 YO
(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: 9 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 9 cycle per minit(cpm), difficult with minus lens(2nd lens) (right eye sees better than with both eyes)
L: 10 cycle per minit(cpm), difficult with minus lens(2nd lens) (left eye sees better than with both eyes)
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/12/10
Near, Base-In/Divergent, NFV: x/4/2
Distance, Base-Out/Convergent, PFV: x/25/20 (above break point 12, double then single)
Distance, Base-In/Divergent, NFV: x/8/6
(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: 5 cpm (double Base Out) (he also sees double with Base In.. but it becomes single swiftly)
Distance: 4 cpm (double Base Out then double Base In)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
All near tests are done without Add.
One pair
R: +0.50
L: +0.50
For all his near work (computer/tablet/hp/doing homework)
Separate pair
R: -0.25
L: -0.25
Spare pair.. to be used at school, only when he cannot copy from whiteboard
Interpupillary distance, IPD = 5.8cm