Madam Loo (F/51) came for eye examination, with complaint of blurry outdoor vision during daytime since 1year ago. Vision indoor is fine. She had cataract surgery in right eye about 6years ago. She uses a pair of ready-made reading glasses.
Vision without glasses
R: 6/9+
L: 6/12-
Examination shows: (Delay Fogging)
R: +0.50/-0.25×180 (6/7.5) PHNI (Retinoscopy: black patch detected temporally)
L: -0.50/-0.25×25 (6/7.5) PHNI (L: left dominant eye) (Retinoscopy: black patch detected centrally)
Add: +2.00 (N5@40cm)
[On pinhole for RE, pt reported that she has to turn her face slightly to be able to see through the pinhole]
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported no movement)
small XP, fast recovery @Near
(alternating CT: upon covering left eye, patient reported the target goes to her left & upon covering right eye, the target goes to her right)
(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: 8 XP (blue part)
-1.00 Near: 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
+0.50
(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
14/20cm, 14/20cm, 14/20cm, 14/20cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: PL
L: +0.25
(normal value: +0.25 to +0.75)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 18/25/14 (above break point 18, double then single)
Near, Base-In/Divergent, NFV: x/8/6
Distance, Base-In/Divergent, NFV: x/8/6
Distance, Base-Out/Convergent, PFV: x/20/16 (above break point 14, double then single)
(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: 6 cpm (double Base Out when trial frame slides down on nose.. when we hold trial frame up, no double with Base Out)
Distance: 0 cpm (triple with Base Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD = 6.6cm
Binocular Perception (Worth 4 Dots)
Distance: 4 dots seen
Near: 4 dots seen
(normal value: 4 dots seen = normal, 3 dots seen = Right suppression, 2 dots seen = Left suppression)
Fluorescein (to assess integrity of cornea)
R: -ve staining
L: -ve staining
Amsler Chart (to assess integrity of macula)
R: all lines are straight, but slightly blurry
L: some lines darker, some lines lighter
(normal value: lines are straight with equal gaps in between lines & no brown/black patch/spot)
Colour Vision
R: normal
L: normal
All near tests are done with Add.
Interpupillary distance, IPD = 6.4cm
We refer her to see eye specialist doctor/ophthalmologist for opacification post cataract surgery in right eye.