CShan (F/18) came for eye examination, vision with existing glasses is fine seeing far & near. She wears her glasses to school only and she is able to copy from whiteboard – she sits at the mid row in her class. She usually does not wear her glasses at home. She will lie down to see her phone so she said she better removes glasses. We observe that she holds her phone very near. She wants to wear contact lens for weekend outings.
Vision without glasses
R: 6/45-
L: 6/45
Vision with existing glasses >3years
R: -2.50/-1.00×180 (6/12)
L: -2.75/-1.25×165 (6/15)
Prescription (she brought along)
R: -3.25/-1.75×180 (6/6-)
L: -3.75/-1.75×175 (6/6)
Examination shows:
R: -3.25/-1.75×180 (6/6) [+1.00 blur lens test: 6/9-] (R: right dominant eye) R>L
L: -3.25/-1.75×175 (6/6) [+1.00 blur lens test: 6/9-]
Near: L>R
Lowering -0.25 astigmatism binocularly is not favoured
Modified
R: -3.00/-1.75×180
L: -3.00/-1.75×175
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: patient reported NMD)
NMD @Near
(alternating CT: patient reported NMD)
(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 – 1 EP (yellow part)
Near: 0 – 2 XP (blue part)
+1.00 Near: 0 – 2 XP (blue part)
-1.00 Near: 0 – 2 XP (blue 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
+3.75?
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-2.75
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
LE deviates @6cm
(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 +/- 2.00
BE: 13 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 14 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)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.75
L: +0.25
(normal value: +0.25 to +0.75)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 18 YO, 18 YO, 18 YO (target is clear @end of RAF rule.. target is better with astigmatism -1.75DC than -1.50DC)
L: 18 YO, 18 YO, 18 YO (target is clear @end of RAF rule.. target is better with astigmatism -1.75DC than -1.50DC)
(normal value: AA goes according to age; YO=years old)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/x/x
Near, Base-In/Divergent, NFV: 20/x/x
Distance, Base-In/Divergent, NFV: x/x/x
Distance, Base-Out/Convergent, PFV: x/x/x
(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, blink3 eyes then single)
Distance: 15 cpm
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Worth4Dots (Binocular Perception)
Distance: 4 dots seen
Near: 4 dots seen
(normal value: 4 dots seen)
Interpupillary distance, IPD = 6.5cm
We prescribe daily disposable contact lens.
Modified
R: -3.00/-1.75×180
L: -3.00/-1.75×175
Upon removal astigmatism in both eyes, she can see 6/9 binocularly
We try contact lens
R: -3.25/-0.75×180
L: -3.25/-0.75×180
