Racheal (F/24) came for eye examination, vision with existing glasses is fine seeing far & near.
Vision with existing glasses of <1year
R: -8.25/-1.50×10 (6/6)
L: -8.00/-1.50×160 (6/6)
Examination shows:
R: -8.25/-1.50×15 (6/6) (+1.00 blur lens test 6/12+1) [R: right dominant eye]
L: -7.25/-2.00×160 (6/6) (+1.50 blur lens test 6/9-)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
small XP, fast recovery @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: 6 – 8 XP (blue part)
-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
XP = Exophoria is misalignment of the eye, eye is deviated outwards
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, TTN
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+1.00
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-1.25
(normal value: -1.37 to -3.37)
MEM (Accommodation lag – to measure accommodation response seeing near target)
R: +0.50
L: +0.75
(normal value: +0.25 to +0.75)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
BE: 10 cycle per minit(cpm), difficult with plus lens (1st lens)
R: 11 cycle per minit(cpm), difficult with plus lens(1st lens)
L: 12 cycle per minit(cpm), difficult with minus lens(2nd lens)
Pt reported needing a bit time to clear plus lenses
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Examination of Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/20/18
Near, Base-In/Divergent, NFV: 10/18/14
(normal value: 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]
Racheal has some exophoria at near.. but it can be compensated – being pulled in & balanced by her fusional reserves PFV. Having 6-8 exophoria, her PFV (Break) needs to have at least twice in order for her to have comfortable near vision (Sheard’s criterion) and she has 20.. thus she has no near complaint.
Racheal wants to try contact lenses.. contact lens wear may make exophoria even more.. in cases like this, we may experience losing focus on near print or having symptom resembling dry eye especially after prolonged near work. Since her PFV is adequate, we will assess her eye posture when she puts on her contact lens.. and we will see how it goes.