LYau (F/14) came for eye examination, vision with existing glasses made with us is fine seeing far & near. She has atropine eye drop for a year and she just stopped the eye drop beginning of the year.
Vision without glasses
R: 6/30-
L: 6/30-
Vision with existing glasses
R: -2.00/-1.25×80 ( 6/12-)
L: -1.50/-1.00×90 (6/9-)
Examination shows: (Delay Fogging) [Axis on retinoscopy]
R: -2.50/-0.50×45 (6/6-) [+1.00 blur lens test: 6/12+]
L: -2.25/-0.50×145 (6/6-) [+1.00 blur lens test: 6/9] [L: left dominant eye] L>R
Near: L>R (adding +0.25 in right eye: R>L but not favoured)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: patient reported the target goes to her left .. when covering right eye, the target goes to her right)
small XP, fast recovery @Near
(alternating CT: upon covering left eye, patient reported the target goes to her left .. when covering right eye, the target goes to her right)
(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: 0 – 2 XP (blue part)
Near: 6 – 8 XP (blue part)
+1.00 Near: 12 XP (blue part)
-1.00 Near: 1 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
+1.25
(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, 6/8cm, 6/8cm, 6/8cm, 6/8cm
(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: 12 YO, 12 YO, 12 YO (pt reported target is clear @end of RAF rule) (target is better with -0.50DC than -0.75DC)
L: 12 YO, 12 YO, 12 YO (pt reported target is clear @end of RAF rule) (target is better with -0.50DC than -0.25DC)
(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: 12 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 11 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with right eye)
L: 12 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)
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/25/12
Near, Base-In/Divergent, NFV: x/30/18
Distance, Base-Out/Convergent, PFV: x/25/20
Distance, Base-In/Divergent, NFV: x/12/8
(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: 12 cpm (double with Base Out, single briefly with blink)
Distance: 10 cpm (double with Base Out, single briefly with blink)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD: 6.6cm