Lydia (F/31) came for eye examination, with complaints of missing vertical lines on alphabets(computer prints) since about 1+ years ago in which she needs to rest from computer work. Otherwise, the incidence will be followed by migraine (frontal forehead & on left side) and it happens about less than 10 times so far. She has not changed job & the workload is about the same.
Vision without glasses
R: 6/60-2 (better)
L: 6/120
Vision with glasses
R: -4.75/-0.75×180 (6/6)
L: -4.00/-1.00×160 (6/6)
Add: +0.50
Examination shows: (Delay Fogging)
R: -4.25/-0.50×15 (6/6) (+1.00 blur lens test 6/9-) [R: right dominant eye] R>L
L: -4.25/-0.75×160 (6/6) (+1.00 blur lens test 6/15-)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
small EP, 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 – 1 EP
Near: 0 – 1 EP (yellow part) stops at 1 yellow
-1.00 Near: 7 – 9 EP (yellow part)
+1.00 Near: 1 EP – 0 – 2 XP (top arrow paces around 0, slightly move to yellow & blue)
(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
+0.75
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-1.00
(normal value: -1.37 to -3.37)
MEM (Accommodation lag – to measure accommodation response seeing near target)
R: +1.00
L: variable reflex
(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: 31 YO, 31 YO, 31 YO
L: 30 YO, 28 YO, 30 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
8/10, 8/10, 9/11, 9/11, 10/12, 10/12cm
(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 +/- 1.50
BE: 16 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 13 cycle per minit(cpm), difficult with minus lens(2nd lens)
L: 11 cycle per minit(cpm), difficult with plus lens(1st lens)
* see double with -2.00
(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-In/Divergent, NFV: 8/6
Near, Base-Out/Convergent, PFV: 30/20
Distance, Base-In/Divergent, NFV: 6/4
Distance, Base-Out/Convergent, PFV: 20/16
(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]
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
9/11, 9/11, 10/12, 11/13, 12/14, 12/14cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
– pt reported the split lines – 1 line appears closer to eye & another line is seen further away from eye
– pt also reported that after the lines become single, but it will be separated into two lines again when target line is pushed somemore further away from her eyes
Interpupillary Distance = 6.0cm
Lydia seems to have some receded convergence, her convergence gets weaker as she continues to keep seeing her screen. She may be using her accommodation/focusing to help sustain her near work.. causing focusing in left eye to be slightly stuck.. hence difficulty in plus lens-in relaxing back in left eye & variable reflex on MEM in left eye. Her focusing & aiming do not tally in both eyes, probably causing the split lines to be seen as closer & further away from eyes.
We prescribe Dot Card to get her eyes to aim together & we see her in 1 month.
– We will schedule her to go for cycloplegic refraction the next visit for suspected convergence excess.