Gnalan (M/23) datang untuk pemeriksaan mata, mengadu mata penat & penglihatan kabur selepas hadap komputer beberapa jam. Beliau pakai spek bila hadap komputer saja & spek tertinggal kat pejabat.
Vision without glasses
R: 6/30-2
L: 6/9+2
Existing 1st pair of glasses of 1.5 years
R: -2.75/-2.50×180
L: -0.75/-2.50×180
Examination shows:
R: -1.75/-2.50×180 (6/9-) PHNI
L: -0.25/-2.25×180 (6/6)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance (on alternating CT: upon covering left eye, patient reported target goes up.. when covering right eye, target goes down)
NMD @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 – 2 XP (blue part)
Near: 4 – 6 XP (blue part)
+1.00 Near: 10 XP (blue part)
-1.00 Near: 6 – 8 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
-1.25
(normal value: -1.37 to -3.37)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: very dim
L: +0.50
(normal value: +0.25 to +0.75)
Accommodation Facility – ability to change focus: far to near or near to far (by Flipper +/-1.50)
BE: 14 cycle per minit(cpm), difficult with plus lens(1st lens)
R: 9 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) [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)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 12/x/x (above 18: very clear vision reported)
Near, Base-In/Divergent, NFV: 18/x/x
Distance, Base-Out/Convergent, PFV: x/14/8
Distance, Base-In/Divergent, NFV: 8/18/14
(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 – Adult Data]
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
6/8cm, 6/8cm, 8/10cm, 8/10cm, 9/11cm, 9/12cm
(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: 20 YO, 20 YO, 20 YO (keep blinking eyes)
L: 20 YO, 20 YO, 20 YO (keep blinking eyes)
(normal value: AA goes according to age; YO=years old)
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 10 cpm (after 5 cpm, double with Base Out for a while.. after blink blink eyes, can fuse Base Out)
Distance: 10 cpm
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary Distance = 6.5cm