LionelL (M/38) came for eye examination, with complaint of sometimes blurry far & near vision. He does not wear glasses for far vision & he has a pair of glasses for computer/hp.
Vision without glasses
R: 6/9-
L: 6/9-
Examination shows: (Delay Fogging)
R: +0.25/-1.25×85 (6/6) [+1.00 blur lens test: 6/7.5-] [R: right dominant eye]
L: PL/-1.00×95 (6/6) [+1.00 blur lens test: 6/9]
Adding +0.25/+0.50 monocularly in either eye/binocularly is not favoured
Add: +0.50
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance (pt reported – right eye sees target moving up & left eye sees target moving down upon alternating cover test]
small XP, fast 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/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0
Near: 2 XP (blue part)
+1.00 Near: 6 XP (blue part)
(normal value: 0-1 EP or 0-3 XP @Distance; and 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
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+1.75
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.25
(normal value: -1.37 to -3.37)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 44 YO, 44 YO, 44 YO
L: 44 YO, 44 YO, 44 YO
(normal value: AA goes according to age; YO=years old)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
9/12, 9/12, 9/12, 9/12cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 0.50
BE: cannot clear minus lens(2nd lens)
R: cannot clear minus lens(2nd lens)
L: cannot clear minus lens(2nd lens)
(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: 20/16
Near, Base-In/Divergent, NFV: 18/16
Distance, Base-In/Divergent, NFV: 8/6
Distance, Base-Out/Convergent, PFV: 14/10
(normal value: Blur/Break/Recovery)
Near, PFV: x/10-28/7-21
Near, NFV: x/7-19/5-15
Distance, PFV: x/4-18/5-9
Distance, NFV: x/4-10/2-6
[Scheiman – Adult Data]
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 41 YO, 41 YO, 41 YO
L: 41 YO, 41 YO, 41 YO
(normal value: AA goes according to age; YO=years old)
Test is repeated with Add: +0.50
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
10/12, 10/12, 10/12, 10/12cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Test is repeated with Add: +0.50
Interpupillary Distance = 6.6cm
Lionel has some plus power or longsightedness/hyperopia with astigmatism. When we are young, our accommodation/focusing is still strong, so eyes would be able to auto correct hyperopia & also masks some astigmatism in the process. So, we normally do not have any visual complaint at younger age. For power like this, we will start to notice blurriness when our eye stamina decreases with age or after exhausting our focusing with extensive near/computer work.
His eye alignment/posture, convergence/NPC & fusional reserves are all fine.. the issue is his accommodation/focusing that is in need of some help. He can continue to wear his computer glasses or he can explore a pair of relax glasses to the power of his eyes.. so that seeing far & near will be supported & more comfortable.
We understand that those of us who have not worn any glasses before, it would be difficult initially to suddenly needing to wear glasses always. You may explore and find a balance.. most of the time, all our eyes’ need is actually just the power of our eyes. Having the optimum power, will they be able to do what they do best! (accommodation & vergence jobs!)