MZhong (M/13) came for 6months follow up, vision with existing glasses of 1+ years is fine seeing far & near.
Vision without glasses
R: 6/24-
L: 6/24-
Vision with existing glasses
R: -1.50/-0.75×175 (6/6)
L: -1.75/-1.00×170 (6/6)
Examination shows:
R: -1.25/-0.75×175 (6/6) (+1.00 blur lens test 6/9) N5@38cm [R: right dominant eye]
L: -1.50/-1.00×170 (6/6) (+1.00 blur lens test 6/9) N5@38cm
Add: +0.50
When we tried to lower shortsighted power 025 in both eyes or monocularly, he did not like it
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @ Distance
small XP, fast then 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: 14 – 16 XP (blue part)
+0.50 Near: 12 – 14 XP (blue part)
+1.00 Near: 10 – 12 XP (blue part)
(normal value: 0-1 EP or 0-3 XP @Distance and 0-6 XP @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
6/9cm, 6/11cm, 7/11cm, 7/11cm, 8/12cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
AA (Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 11cm, 13cm, 14cm
L: 11cm, 11cm, 11cm
(normal value: 7.5cm for 13YO)
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+1.50
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.75
(normal value: -1.37 to -3.37)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
R: 12 cycle per minit(cpm), difficult with minus lens
L: 14 cycle per minit(cpm), difficult with minus lens
BE: 9 cycle per minit(cpm), difficult with plus lens
(normal value:
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Examination of Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 25/30/18
Near, Base-In/Divergent, NFV: 14/20/14
(normal value: Blur/Break/Recovery)
Near, PFV: 16/15-31/10-22
Near, NFV: 13/7-17/3-11
[Scheiman et al, 1989]
[Interpupillary distance, PD: 6.2cm]
When prompted whether or not he sees any blurry near vision with headache, he said no headache but he will start to see blurry screen after a while.. in which he holds it further away.. then it is fine. His convergence is slightly lower & receded with fatigued accommodation/focusing too.
We update his power & prescribe pencil push up test.. we will see him in 1 month.