Nadia – 88 Optometry

14/9/2022

Nadia (F/43) CTM datang untuk pemeriksaan mata, mengadu tak nampak dekat, sakit mata & mata berair tengok hp.. beliau ada kerja cashier kaunter. Dulu2 akak selalu rasa mata sakit & berair, sekarang ada kurang sikit.

Vision without glasses
R: 6/7.5-
L: 6/7.5-

Subjective Refraction
R: PL/-0.50×160 (6/6-) (+1.00 blur test: 6/12)
L: PL/-0.50×30 (6/6-) (+1.00 blur test: 6/12)
Add: +1.50 (N5@40cm)

Other assessments show:

Cover Test
Distance: NMD
Near: small to moderate XP, fast recovery (LE shows bigger XP movement than in RE)

Howell Card
Distance: 0
Near: 10 XP
-1.00 Near: 10 XP

NRA
+0.25

PRA
-0.25

NPC
14/18cm, 14/18cm, 14/18cm, 14/18cm, 14/18cm

NPC (Add +2.00)
14/18cm, 14/18cm, 14/18cm

Fusional Reserves
Near, PFV: x/x/x
Near, NFV: 10/16/14
Distance, NFV: x/12/4
Distance, PFV: x/12/6

Vergence Facility
Near: 6 cpm (slow BO)
Distance: 0 cpm (double BO)

We repeated
Fusional Reserves
Near, NFV: x/12/10

Interpupillary distance, IPD = 6.0cm

Fluorescein
R: -ve staining
L: -ve staining

Slit Lamp
R: mild cataract
L: mild cataract, nasal pterygium

UpdatedA (17/2/2023)

NPC
28/38cm, 28/38cm, 28/38cm, 28/38cm, 28/38cm, 28/38cm

Fusional Reserves (with 1BI OU)
Near, PFV: x/20/12
Near, NFV: 10/16/14

Fusional Reserves
Distance, NFV: x/8/4
Distance, PFV: x/12/8

Vergence Facility
Near: 6 cpm (slow BI)
Distance: 0 cpm (double BO)

We repeated
Fusional Reserves
Near, PFV: 14/20/10

We prescribe Brock string.

Notes

Vision without glasses
6/6 – smallest testing line
6/7.5 – 2nd smallest line
6/9 – 3rd smallest line
6/12 – 4th smallest line
6/15 – 5th
6/18 – 6th
6/21 – 7th
6/24 – 8th

Examination of Eye Alignment
Cover Test, CT @ Distance & Near
– NMD(No Movement Detected) or
– small XP, fast recovery
EP = Esophoria is misalignment of eye, eye is deviated inwards
XP = Exophoria is misalignment of eye, eye is deviated outwards
ACT: alternating CT

Examination of Eye Alignment
(Maddox Rod) placed on RE

Examination of Eye Posture
(Howell Card) by 6^ BD OD
Distance:
– 0-3 XP (blue part) or
– 0-1 EP (yellow part)
Near:
– 0-6 XP (blue part)

Accommodation/Focusing analysis – ability to relax
NRA
+1.50 to +2.50

Accommodation/Focusing analysis – ability to focus
PRA
-1.37 to -3.37

Convergence, NPC – ability of eye to maintain a single clear near image (RAF rule)
Break/Recovery – within 10cm or TTN(to the nose)

MEM(Monocular Estimation Method) – measure accommodation response seeing near target
+0.25 to +0.75 (with movement)

Accommodation Facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
Monocular: 6cpm – 16cpm
Binocular: 4cpm – 14cpm
(1 cycle per minute, cpm = 2 words)

Fusional Reserves –
Convergent/Divergent reserve stamina (Prism Bar)
Blur/Break/Recovery
Children 7-12yo
Near, BO/PFV: x/15-31/10-22
Near, BI/NFV: x/7-17/3-11
Adult
Near, BO/PFV: x/10-28/7-21
Near, BI/NFV: x/7-19/5-15
Distance, BO/PFV: x/4-18/5-9
Distance, BI/NFV: x/4-10/2-6

Vergence Facility – ability to make rapid repetitive vergence changes (Prism Flipper 12BO & 3BI)
Distance: 12-18 cpm
Near: 12-18 cpm)
(1 cycle = 2 times clearing target)

Random Dot 3S – 3D Vision/Stereopsis
12.5″

Worth 4 Dots – Binocular Perception 4 dots