KLi (F/27) came for eye examination, with complaint of sometimes blurry looking at car plate number when driving with existing glasses of about 2years.
Vision without glasses
R: 6/60-
L: cannot guess 6/60
Vision with existing glasses
R: -6.00/-0.50×5 (6/6)
L: -6.75 (6/6)
Examination shows:
R: -5.75/-0.50×5 (6/6) [R : dominant right eye]
L: -6.75/-0.25×25 (6/6)
Relax Add: +1.00
She prefers -6.00 in right eye binocularly
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
small EP, small then moderate recovery @Near
(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 (Howell Card)
Distance: 0 – 1 EP
Near: 1 -> 3.5 EP
+1.00 Near: 2 – 4 XP
(normal value: 0 – 1 EP or 0 – 3 XP @Distance & 0 – 6 XP @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
KLi shows esophoria at near, when prompted whether or not she has blurry near vision at near especially after prolonged near work, she reported that sometimes she does see blurry near vision. Her esophoria means that eyes move inwards more during near work, in turn causing the blurriness when seeing near for longer period of time. We prescribe Relax lens to help relax the eyes & we get 2 -4 XP upon Relax Add +1.00 at near, to normalise the alignment falling within normal value. High esophoria is no good. It may also mean that the person is more susceptible to myopia progression especially in children.
KLi has low Tears Break Up Time, TBUT.. this indicates that there is inadequate oil on top of eyes and thus, tears evaporate fast.. this in turn causes dry eyes. In this situation, if there is complaint of dry eye, we may use artificial tears that helps to replenish lipid/oil to overcome the dryness.
