ZQing (F/13) came for eye examination, with complaint of slight blurry far vision with existing glasses of 1+ year. Her near vision is fine, but she reported blurry near vision sometimes in which she will wash her face & it will be fine then. We observe that she has her head tilted up to see far, when we asked.. she said that her vision is better like this. She also will tilt her head left or right to see if it is better. No headache is reported.
Vision without glasses
R: 6/60+1
L: 6/45-1
Vision with existing glasses
R: -3.50/-1.25×175 (6/7.5-, slow guess 6/6-)
L: -3.25/-1.25×160 (6/7.5-, slow guess 6/6-)
Examination shows: (Delay Fogging)
R: -3.75/-1.25×175 (6/6) [+1.00 blur lens test: 6/18] (R: right dominant eye)
L: -3.50/-1.25×160 (6/6) [+1.00 blur lens test: 6/12-] L>R
Adding +0.50 in left eye, R>L but she did not like it
Near: R>L {adding +0.50 in left eye, L>R but she did not like it}
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 her right.. when covering right eye, the target goes to her left)
small EP, fast recovery @Near
(alternating CT: upon covering left eye, patient reported the target goes to her right.. when covering right eye, the target goes to her left)
(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 – 5 EP (yellow part)
Near: 11 – 13 – 15 EP (yellow part)
+1.00 Near: 3 – 5 – 7 EP (yellow 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
Examination of Eye Alignment/Posture (Maddox Rod)
Distance: horizontal white line touches red spotlight but horizontal white line is slanting (patient left is higher, right is lower) & 5 Base-Out (touch then drift apart) [with head tilt to left, horizontal line becomes straight]
Near: same like Distance
(normal value: 0-1 EP (yellow part) or 0-3 XP (blue part) @Distance; and 0-6 XP (blue part) @Near)
Base Out/EP = Esophoria is misalignment of the eye, eye is deviated inwards
Base In/XP = Exophoria is misalignment of the eye, eye is deviated outwards
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+2.75
(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)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +1.25 (vertical reflex seen is a slanting reflex at around 70°)?
L: +1.25 (vertical reflex seen is a slanting reflex at around 70°)?
(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: 6 YO, 6 YO, 6 YO
L: 8 YO, 8 YO, 8 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, TTN
(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 +/-1.00)
BE: 10 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 12 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with right eye]
L: 12 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with left eye]
– patient cannot clear -2.00 & -1.50
(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/6/2
Near, Base-Out/Convergent, PFV: x/12/10
Distance, Base-In/Divergent, NFV: 8/10/8
Distance, Base-Out/Convergent, PFV: 12/30/20
(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 – 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.. upon repeated testing, double with Base-In too)
Distance: 5 cpm (double with Base-Out then it becomes single & double with Base-In too – blink2 eyes then single)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
3D Vision (Random Dot 3S)
20″
16″ (with Add +1.00 BE)
(normal value: 12.5″)
Interpupillary Distance = 6.0cm
ZQing also told us that she sometimes sees double vision when eyes are tired. We refer her for cycloplegic refraction.