Ms Y came for eye examination, with complaint of blurry near vision with existing reading glasses made during her last eye check up 15 years ago. She will enlarge the screen on her phone or screenshot & enlarge it to see. She does not wear her reading glasses to see her phone (she has set the font size to big size).. only when she needs to write/see very small print does she wear her glasses. Seeing far is slightly blurry too but she has no complaint on her far vision.
Vision without glasses
R: 6/9+
L: 6/18- slow
Power of reading glasses
R: +1.75/-0.50×60
L: +1.50/-0.50×70
Examination shows: (Delay Fogging)
R: -0.25/-0.50×30 (6/6) [+1.00 blur lens test: 6/12-] R>L {if R: PL/-0.50×30 L>R}
L: -0.75/-1.00×70 (6/6 slow) [+1.00 blur lens test: 6/18-]
Add: +2.50 (N5-@40cm) (L=R)
Near vision is better than her reading glasses but N5 line is still not as focused & clear.
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
moderate XP, moderate 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 – 2 XP (blue part)
Near: 12 – 14 XP (blue part)
-1.00 Near: 12 XP (blue part) [the numbers are blurry]
(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
When prompted whether or not she sees blurry near vision after some time, Ms Y shared that she has been taking sleeping pills due to insomnia since 15years ago. If she does not take the medicine, her heart will beat faster than usual & she will feel anxious & uncomfortable. If she has important task to do the next day, she will increase the dosage the night before.. otherwise, she would not be able to wake up early & tackle the day.
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+0.25
(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)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 6/20/10
Near, Base-In/Divergent, NFV: x/25/18
Distance, Base-Out/Convergent, PFV: 10/12/8
Distance, Base-In/Divergent, NFV: 8/10/6
(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]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 1 cpm (double with Base-Out)
Distance: 1 cpm (double with Base-Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
We tried with prism 2Base-In in both eyes. She reported more comfortable near vision initially, but after a while, when we asked again, vision reported to be fuzzy a bit.. but it is better than vision without prism.
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar (with 2Base-In BE)
Near, Base-Out/Convergent, PFV: x/14/2
Near, Base-In/Divergent, NFV: x/20/18
Upon Brock string, the bead (furthest away from her) looks single when it is about 40cm.. when we pushed the bead closer to her, the bead became double.
Amsler Chart
R: all lines are straight
L: all lines are straight.. lines seem to move a bit
(normal value: all vertical & horizontal lines are straight with no crooked/distorted lines)
Colour Vision
R: normal
L: normal
Interpupillary Distance = 6.7cm
We are not sure whether or not her near exophoric eye posture is due to her medication. We refer her to see the specialist.