Ng Chen Hee – 88 Optometry

7/2/2022

CHee (M/10) came to make glasses with cycloplegic eye prescription & he was prescribed pencil push up.

Cycloplegic refraction
R: -2.25/-1.00×180 (6/6-)
L: -4.75/-1.00×180 (6/6-)

Vision without glasses
R: 6/24-
L: 6/120

Other assessments show:

Cover Test
Distance: alternating exotropia
Near: alternating exotropia (D>N), sometimes eyes are seen straight

Howell Card (6BD on OD)
Distance: no double arrow seen (6/8/10^ Base Down on Right eye)
Near: 8 – 10 – 12 XP
-1.00 Near: 1 – 3 XP
-0.50 Near: 2 – 4 XP

Modified power
R: -2.75/-1.00×180
L: -5.25/-1.00×180

Other assessments show:

NRA
+2.50

PRA
-1.50

MEM
R: +0.75
L: +0.75

Accommodation Facility (+/- 1.50 *cannot clear -2.00)
BE: 8 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 9 cycle per minit(cpm), difficult with minus lens(2nd lens)
L: 8 cycle per minit(cpm), difficult with minus lens(2nd lens)

Fusional Reserves (Prism Bar)
Near, PFV: x/x
Near, NFV: 6/4
Distance, PFV: x/x
Distance, NFV: x/x (observed: eye to deviate @16^)

Random Dot 3S
1st time: 160″
2nd time: 40″

AHP Head Posture
face turn to left

*UpdatedA 19/4/2022

CHee (M/10) came back for 2months follow up.. he has been wearing his glasses full time. Mother reported that his eyes no longer turn outwards already.

Existing glasses
R: -2.75/-1.00×180 (6/6)
L: -5.25/-1.00×180 (6/6)

Other assessments show:

Cover Test
Distance: moderate XP, moderate recovery
Near: small XP, fast recovery

Howell Card
Distance: 0 – 2 XP
Near: 4 – 6 XP

Other assessments show:

NRA
+2.50

PRA
-1.50

MEM
R: +0.75
L: +0.75

Accommodation Facility +/- 2.00
BE: 12 cpm, difficult minus lens
R: 13 cpm, difficult minus lens
L: 13 cpm, difficult minus lens

Fusional Reserves (Prism Bar)
Near, PFV: 30/x/x
Near, NFV: x/10/8
Distance, PFV: x/25/20
Distance, NFV: x/18/16

Vergence Facility (Prism Flipper of 12BO & 3BI)
Near: 13 cpm
Distance: 14 cpm

Random Dot 3S
25″
Add +1.00: 25″
(normal value: 12.5″)

AHP Head Posture
normal

He will continue to do his pencil push up.

We will see him in 2months.

*UpdatedB 25/6/2022

CHee came for follow up.

Vision without glasses
R: 6/60
L: cannot guess 6/120

Existing glasses
R: -2.75/-1.00×180 (6/6) (R: right dominant eye)
L: -5.25/-1.00×180 (6/6) L>R

Other assessments show:

Cover Test
Distance: small XP, fast recovery
Near: small XP, fast recovery

Howell Card
Distance: 0 – 2 – 4 XP
Near: 4 – 6 XP

Other assessments show:

NRA
+0.25

PRA
-0.25

MEM
R: +0.75
L: +0.50

Accommodation Facility +/- 2.00
BE: 9 cpm, no difficulty
R: 12 cpm, difficult minus lens
L: 9 cpm, difficult minus lens

Fusional Reserves
Near, PFV: x/14/8 (above break point 6, double then single)
Near, NFV: x/10/8
Distance, PFV: x/x/x
Distance, NFV: x/14/12

Vergence Facility
Near: 6 cpm (slow BI, blink2 eyes then single)
Distance: 14 cpm

Random Dot 3S
40″

Titmus Fly
20″

AHP Head Posture
slight face turn to left

Mother reported that CHee sometimes has his face turn to left slightly.. and he told mum that he has tired eyes.

Modified
R: -2.75/-1.00×180 (6/6) R>L
L: -4.75/-1.00×180 (6/6)
Near: R=L

We prescribe Dot card eye exercise.

*UpdatedC 15/10/2022

CHee (M/10) came for follow up in the morning. He said he no longer has tired eye in left eye already.

Vision without glasses
R: 6/45
L: guess 6/120

Subjective Refraction
R: -2.25/-0.75×170 (6/6) [+1.00 blur lens test: 6/9-] N5
L: -4.75/-0.75×180 (6/6-) [+1.00 blur lens test: 6/12-] N5
New DC is better than habitual DC @N

Other assessments show:

Cover Test
Distance: NMD
Near: small XP, fast recovery

Howell Card
Distance: 0 – 2 – 4 XP (more on 2 XP)
Near: 6 – 8 – 10 XP
+1.00 Near: 10 – 12 XP
-1.00 Near: 0 – 2 XP
+2.00 Near: 12 – 14 XP
-2.00 Near: 3 – 5 – 7 EP

NRA
+2.50

PRA
-1.50

NPC
LE deviates @8cm x5

AA
R: 15.5D, 14.5D, 13.5D
L: 15.5D, 15.5D, 15.5D

Accommodation Facility (+/- 2.00)
BE: 13 cpm, difficult minus lens
R: 13 cpm, difficult minus lens
L: 15 cpm, difficult minus lens

MEM
R: +1.25
L: +0.75

Modified
R: -2.25/-0.75×170
L: -4.75/-0.75×180

Fusional Reserves
Near, PFV: x/25/20
Near, NFV: x/14/10 (above break pt 6, double then single.. then keep wanting to double)
Distance, PFV: x/20/18
Distance, NFV: x/8/6

Vergence Facility
Near: 8 cpm (slow BO & BI sometimes)
Distance: 8 cpm (slow BO & BI sometimes)

Interpupillary distance, IPD = 5.7cm

Assessing Control of IXT
Subjective
Clinic Control
Distance: score 0 (good control)
Near: score 0 (good control)
Objective
Binocular VA
Distance: 6/6

AHP Head Posture
very mild face turn to left

CHee will continue with Dot card eye exercise.

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/lights