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MOHD HELMI BIN ABDUL AZIZ

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En. Helmi (M/43) datang untuk pemeriksaan mata, mengadu kabur.. tak nampak signboard.. kena sampai dekat baru nampak. Beliau hanya pakai spek semasa memandu saja.. biasanya tak pakai spek.

Vision without glasses
R: 6/12
L: 6/9-

Vision with existing glasses of 5years
R: -0.50 (6/9+)
L: -0.50 (6/6)

Examination shows:
R: -1.25 (6/6) [+1.00 blur lens test: 6/15-] (R: right dominant eye) R>L
L: -0.75 (6/6) [+1.00 blur lens test: 6/12]
Add: +1.00 (N5@40cm) L>R (Near vision is better than vision without glasses @Near)
After delay fogging, we gave him R: -1.00 L: -0.50, but he reported wordings far, far away seem to stick together, needing a while to come into focus.

Other assessments show:

Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes up & to his left.. when covering right eye, the target goes down & 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 = 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: 6 – 8 XP (blue part)
-1.00 Near: 2 – 4 XP (blue part)
No spec: 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
+1.00
(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
8/10cm, 10/14cm, 12/16cm, 14/18cm, 12/16cm
(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: 43 YO, 44 YO, 45 YO
L: 43 YO, 43 YO, 43 YO
(normal value: AA goes according to age; YO=years old) 

Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 16/18/12
Near, Base-In/Divergent, NFV: 14/16/14
Distance, Base-Out/Convergent, PFV: x/12/10
Distance, Base-In/Divergent, NFV: x/10/8
(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]

BHTT Head Tilt Test
no hypertropia on head tilt

AHP Head Posture
mild head tilt to right observed

Fluorescein
L: -ve staining
L: -ve staining

Interpupillary distance: 6.6cm

# Near tests are all done with Add

We prescribe
R: -1.25
L: -0.75
Add: +1.00

Eye findings En. Helmi semua elok, hanya convergence/penumpuan ada semakin menurun. Beliau kata penglihatan dekat tak ada masalah. Disebabkan kerja shift, mata beliau ada nampak sikit merah & kelihatan penat. Semasa pemeriksaan separuh jalan selepas fusional reserves test, beliau tertidur pulak haha.. nanti kita baru sambung sikit test lagi.

Sebelum pemeriksaan bermula, kita akan berbual-bual tanya:

  1. komplen mata (komplen semasa buat far task atau near task) &
  2. daily visual needs(ie. hadap komputer seharian, driving the whole day)

Kalau ada apa komplen mata, bagitahu kita.. kita akan cuba troubleshoot, tengok sama ada berkenaan dengan penglihatan. Kita tak pasti boleh setelkan tak, tapi kita boleh cuba.. kalau ada apa-apa, kita akan refer.

Kita pantau balik convergence beliau nanti.