MKei (F/37) came for follow up, vision with existing glasses of 10months is fine seeing far & near.. but she reported night driving is blurry sometimes.. daytime driving is fine. No headache is reported.
Vision without glasses
R: guess 6/120
L: guess 6/120
Vision with existing glasses
R: -5.50/-1.00×20 (6/6)
L: -5.75/-0.50×165 (6/6)
Examination shows: (Delay Fogging)
R: -5.25/-0.50×20 (6/6) [+1.00 blur lens test: 6/15]
L: -5.50/-0.50×165 (6/6) [+1.00 blur lens test: 6/12-] [L: left dominant eye]
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes smaller.. when covering right eye, the target goes bigger)
NMD @Near
(alternating CT: upon covering left eye, patient reported the target goes smaller.. when covering right eye, the target goes bigger)
(normal value: orthophoria/NMD-No Movement Detected or small XP, fast recovery)
EP = Esotropia/Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exotropia/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: 1 – 3 EP (yellow part) (reducing shortsightedness binocularly still 1-3 EP, lowering astigmatism yields higher EP)
Near: 2 XP (blue part)
+1.00 Near: 2 – 4 XP (blue part)
-1.00 Near: 7 – 9 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)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, TTN
(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: 35 YO, 35 YO, 35 YO (pt reported target is clear @end of RAF rule)
L: 35 YO, 35 YO, 35 YO (pt reported target is clear @end of RAF rule)
(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 +/- 1.00
BE: 13 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 12 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with right eye)
L: 13 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with left eye)
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)R: +0.50
– bigger print is seen with plus lens & smaller print is seen with minus lens
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)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/20/18
Near, Base-In/Divergent, NFV: x/12/10
Distance, Base-In/Divergent, NFV: x/10/8
Distance, Base-Out/Convergent, PFV: x/20/18
(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: 9 cpm (double with Base Out, blink & single)
Distance: 12 cpm (double with Base Out, blink & single.. then also double with Base In, blink & single)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
We tried
0.5/1/2 BO OU @Far but she did not like it.
Interpupillary distance, IPD: 5.8cm