Mr PKumar (M/34) came for eye examination, with complaint of slight blurry far vision & tired eyes with computer work. He spends long hours using computer, and he feels burning sensation/pedih mata with headache sometimes.
Vision without glasses
R: 6/45
L: 6/45-
Vision with existing glasses of 2years
R: -4.25/-1.00×100 (6/6)
L: -4.75/-1.75×100 (6/9-3, 6/7.5-)
Examination shows: (Delay Fogging)
R: -4.00/-1.00×100 (6/6) [+1.00 blur lens test: 6/9+] (R: right dominant eye) R>L (adding up to +0.75 in right eye, still R>L)
L: -4.50/-1.25×100 (6/6-)
Add: +1.00 R>L
Pupil very small, cannot assess retinoscopy reflex
We tried to reduce short-sightedness in both eyes, but he did not like it
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
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: 1 – 3 EP (yellow part)
Near: 1 – 3 EP (yellow part)
+1.00 Near: 0 – 2 XP (blue part)
-1.00 Near: 0
(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 (with Add)
+0.75
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens (with Add)
-1.75
(normal value: -1.37 to -3.37)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 25 YO, 25 YO, 25 YO
L: 18 YO, 18 YO, 18 YO (target is blurry when it is furthest away, comes into focus almost mid RAF rule)
(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
8/10cm, TTN, 14/18cm, 7/9cm, 12/14cm, 7/9cm
(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: 8 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 10 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with right eye]
L: 9 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-In/Divergent, NFV: x/18/10
Near, Base-Out/Convergent, PFV: x/18/16
Distance, Base-In/Divergent, NFV: x/8/6
Distance, Base-Out/Convergent, PFV: x/20/18
(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: 4 cpm (double then single with Base Out)
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″)
Worth 4 Dots
Distance: normal
Near: normal
(normal value: 4 dots = normal; 3 dots = Right suppression; 2 dots = Left suppression; 5 dots = Double vision)
Fluorescein (to assess the integrity of the front surface of eye, cornea)
R: -ve staining
L: -ve staining
Slit Lamp Examination
R: conjunctiva injection (bahagian putih mata ada merah)
L: conjunctiva injection (bahagian putih mata ada merah)