6/1/2022
Niesha (F/19) came for eye examination, vision with existing glasses is fine seeing far & near. She reported feeling sleepy after using phone, especially after long hours. She wears -1.25 & -3.25 daily contact lenses occasionally and she always wears her glasses.
Vision without glasses
R: 6/9-
L: 6/120
Vision with existing Single Vision glasses of 1+year
R: -1.25/-0.50×20 (6/6)
L: -2.75/-0.25×165 (6/6)
Examination shows:
R: -0.75/-0.50×30 (6/6) (+1.00 blur lens test 6/9) [R: right dominant eye]
L: -2.50/-0.25×165 (6/6) (+1.00 blur lens test 6/9-)
We tried to lower -0.25 shortsightedness/myopia in right eye, but she did not like it
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
NMD @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 – 1 EP (yellow part)
Near: (blue part) 2 XP – 0 – 1 EP (yellow part) (arrow paced between blue & yellow, after blink to blue side)
+1.00 Near: 2 – 4 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 (yellow part)
XP = Exophoria is misalignment of the eye, eye is deviated outwards (blue part)
MEM (Accommodation lag – to measure accommodation response seeing near target)
R: +1.25
L: +1.25
(normal value: +0.25 to +0.75)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 1.50
BE: 12 cycle per minit(cpm), difficult with minus lens (2nd lens)
R: 11 cycle per minit(cpm), difficult with minus lens(2nd lens)
L: 12 cycle per minit(cpm), difficult with minus lens(2nd lens)
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 23 YO, 23 YO, 23 YO
L: 23 YO, 23 YO, 23 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
6/8cm, 6/8cm, 6/8cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
The contact lenses Niesha is wearing (-1.25 & -3.25) is slightly on the higher side. When we wear higher shortsigntedness/myopia, we are exhausting our focusing hence getting tired eyes on near work easily. We know that she has tired eyes from her findings of low PRA, difficult with minus lenses on accommodation facility & MEM higher than +0.75. Her eye stamina, AA is fatigued or slightly reduced too. Her eye posture at near is slightly esophoric.. and it can be relieved with added plus lens at near. We update her contact lens prescription and we will assess her AA & near posture again.
*Updated
Monthly disposable (1st trial)
R: -0.75 (6/12)
L: -2.50 (6/9-)
Add: +1.00 D
Over Refraction
R: -0.75
L: -0.50 Near: +0.50
Monthly disposable (2nd trial)
R: -1.50 (6/6)
L: -3.00 (6/7.5) BE 6/6
Add: +1.50 D
Range of Clear Vision, ROCV can go very upclose <10cm
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 1 EP (yellow part)
Near: 3 – 5 EP (yellow 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
Daily disposable (1st trial)
R: -0.75 (6/9+)
L: -2.50 (6/9)
Add: Low
Range of Clear Vision, ROCV: 20cm –
Over Refraction
R: -0.25
L: -0.25 BE 6/6
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0 – 1 EP (yellow part) – slightly on yellow, but mostly on 0
Near: 3 – 5 EP (yellow 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
Despite wearing added plus at near, her esophoria is still not relieved.. and she keeps wanting higher shortsightedness/myopia.
When we look at near posture in her existing glasses:
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye (own glasses)
Near: 7 – 9 EP (yellow 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
Her near posture when she does not wear glasses:
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye (not wearing glasses)
Near: 4 – 6 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
Niesha may be having some Convergence Excess causing her significant esophoria.. we refer for cycloplegic refraction to put eye drop at eyes specialist clinic to temporarily relax her eye muscles.