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Penglihatan Jauh Adakalanya Kabur?

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Vicky (M/32) datang untuk pemeriksaan mata, mengadu penglihatan jauh adakalanya kabur.. tengok dekat okay. Beliau bawa lori.

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

Subjective Refraction (Delay Fogging +2.00 OU)
R: PL (6/6) (+1.00 blur lens test: 6/12)
L: PL (6/6) (+1.00 blur lens test: 6/9) L>R
Near: R>L (adding up to +0.75 in OS, still R>L)
Hyperopia/longsightedness is not favoured for far mono & bino.
Near Add +0.25/+0.50 is not favoured

Other assessments show:

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

Howell Card
Distance: 3 EP
Near: 0 (slightly touching yellow)
+1.00 Near: 2 XP
-1.00 Near: 3 EP
+2.00 Near: 2 XP
-2.00 Near: 7 EP

NRA
+0.75

PRA
-0.50

NPC
TTN, TTN, TTN, TTN, TTN

AA
R: 9D, 9D, 8.5D
L: 6.8D, 6.8D, 6.8D

MEM
R: +1.00
L: +1.00

Accommodation Facility (+/- 2.00)
BE: 5cpm, difficult plus lens

Accommodation Facility (+/- 1.00)
R: 6cpm, difficult plus lens
L: 11cpm, difficult minus lens
– BE see better than with RE/LE
– very difficult to clear +/-2.00 & 1.50 monocularl
y

Fusional Reserves
Near, NFV: x/12/10
Near, PFV: 20/40/25
Distance, NFV: x/6/4
Distance, PFV: x/30/25

Vergence Facility
Near: 5 cpm
(double BO – blink, focus it & single)
Distance: 10 cpm

3D Vision (Random Dot 3S)
12.5″

Interpupillary distance, IPD = 6.0cm

+gradient AC/A = 2:1 (low)

Sheard’s criterion met

If not met, KIV
Sheard’s criterion
P = 2/3(EP) – 1/3NFV
= 2/3(3) – 1/3(6)
= 0

Or we can try 1/3 of EP@D

Vicky ada esophoric postur mata @jauh, matanya tegang sikit.

Beliau kurang memandu sekarang.. so setakat ini, kita tekankan proper visual hygiene.. betapa pentingnya untuk kita ambil rehat antara hp/kerja dekat & pegang hp dalam jarak siku kita dengan mata.

Kalau beliau masih nampak penglihatan kabur/berganda semasa memandu, kita semak balik nanti.

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

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)

AA(Amplitude Accommodation) – eye stamina (Dioptre, D) (RAF rule)
6yo – 16.5D | 6cm
9yo – 15.5D | 6.5cm
12yo – 14.5D | 7cm
15yo – 13.5D | 7.5cm
18yo – 12.5D | 8cm
21yo – 11.5D | 9cm
24yo – 10.5D | 10cm
27yo – 9.5D | 11cm
30yo – 8.5D | 12cm

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, PFV: x/15-31/10-22
Near, NFV: x/7-17/3-11
Adult
Near, PFV: x/10-28/7-21
Near, NFV: x/7-19/5-15
Distance, PFV: x/4-18/5-9
Distance, 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)