Louis (M/13) came for eye examination, vision with existing glasses is fine seeing far & near.. only difficult seeing very small print on whiteboard at school.
Vision without glasses
R: guess incorrectly 6/120
L: guess incorrectly 6/120
Vision with existing glasses about few years (fixed pad plastic worn very close to eyes)
R: -6.50/-1.25×175 (6/7.5-)
L: -6.25/-1.25×175 (6/7.5-)
Examination shows: (Delay Fogging)
R: -7.00/-1.25×175 (6/6) (+1.00 blur lens test 6/15+) [R: right dominant eye] R>L
L: -6.50/-0.75×175 (6/6) (+1.00 blur lens test 6/12-)
Near: R>L (adding +0.50 in left eye: L>R)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target is smaller and goes down & to his left .. when covering right eye, the target is bigger and goes up & to his right)
small XP, fast recovery @Near
(alternating CT: upon covering left eye, patient reported the target goes to his left .. when covering right eye, the target goes to his 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
Near: 4 – 6 XP (blue part)
+1.00 Near: 8 –> 10 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
+0.75
(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)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, TTN, TTN, 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: 8 YO, 8 YO, 8 YO (pt reported target is clear @end of RAF rule)
L: 8 YO, 8 YO, 8 YO (pt reported target is blurry @end of RAF rule, comes into focus @36cm) (target is better with -0.75DC than -0.50DC)
(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: 12 cycle per minit(cpm), difficult with minus lens(2nd lens)
– pt cannot clear -2.00 & -1.50 binocularly
Flipper +/-1.50 monocularly
R: 8 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with right eye)
L: 10 cycle per minit(cpm), difficult with minus lens(2nd lens) (left eye sees better than with both eyes)
(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: +0.25
L: PL
(normal value: +0.25 to +0.75)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/20/16
Near, Base-In/Divergent, NFV: x/12/10
Distance, Base-In/Divergent, NFV: x/8/6
Distance, Base-Out/Convergent, PFV: 16/25/20
(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: 10 cpm
Distance: 12 cpm
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD: 5.6cm
We ask whether or not Louis sees slightly blurry looking back to far vision after seeing near, he said it’s fine.
Modified
R: -7.00/-1.25×175
L: -6.50/-0.75×175
Add: +0.50