YYang (M/19) came for eye examination, with complaint of slight blurry far vision seeing far2 away with existing glasses of 5 years, he has no issue in his daily tasks though. He mentioned about having tired eyes with near work sometimes but near vision is fine.
Vision without glasses
R: cannot see 6/60 (but squeeze eyes can guess 6/60+)
L: cannot see 6/60 (but squeeze eyes can guess 6/60+)
Vision with existing glasses
R: -5.25/-0.75×20 (6/7.5-, 6/6)
L: -4.75/-1.00×170 (6/9-)
Examination shows: (Delay Fogging)
R: -5.25/-0.75×175 (6/6) [+1.00 blur lens test: 6/9]
L: -5.25/-1.00×170 (6/7.5) PH 6/6 (L: left dominant eye) R>L [left eye reported seeing shadow at top upper left of each alphabet]
Add: +0.50
Adding up to +0.75 in right eye, still R>L
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes to his left. when covering right eye, the target goes to his right in bigger movement than the other eye)
NMD @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: 4 – 6 – 8 XP (blue part)
+1.00 Near: 10 – 12 XP (blue part)
-1.00 Near: 2 – 4 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
+1.75
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-1.75
(normal value: -1.37 to -3.37)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +1.00
L: +1.00 dimmer reflex
(normal value: +0.25 to +0.75)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 15 YO, 15 YO, 15 YO
L: 15 YO, 15 YO, 15 YO
(normal value: AA goes according to age; YO=years old)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, TTN, TTN, 10/14cm, 12/16cm (the vertical line is seen split at the bottom with top intact)
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Accommodation Facility – ability to change focus: far to near or near to far (by Flipper +/-2.00)
BE: 9 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 14 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with right eye]
L: 13 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with left eye]
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 10/12/10
Near, Base-In/Divergent, NFV: 18/20/18
Distance, Base-Out/Convergent, PFV: x/14/12 (above 8 break point, double then single)
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]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 6 cpm (double with Base Out at the end of test)
Distance: 12 cpm
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD = 6.6cm
3D Vision (Random Dot 3S)
12.5″
(normal value: 12.5″)
Binocular Perception (Worth 4 Dots)
Distance: 4 dots
Near: 4 dots
(normal value: 4 dots = normal; 3 dots = Right suppression; 2 dots = Left suppression; 5 dots = Double vision)
Examination of Eye Alignment/Posture (Maddox Rod)
Distance: exophoria
Near: exophoria – vertical line is seen at middle, red dot on patient’s right (but see a few shadow of red lights & 1-2 faint vertical white lines)
(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
Amsler Chart (assess integrity of macula)
R: all lines are straight
L: all lines are straight
(normal value: normal-all lines are straight/no crooked/distorted
Colour Vision
R: normal
L: normal
(normal value: normal)