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Remove Glasses To See Near?

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Mr Ng HK (M/62) came for eye examination, with complaint of tired eyes with near work & he removes glasses to see near. He also sometimes sees blurry near vision, and he takes a break every now & then when he sees blurry near vision again.

Vision without glasses
R: 6/60-
L: 6/60- (better)

Existing glasses of 3years (far vision is shadowy)
R: -4.50/-0.50×90 (6/6-)
L: -4.50/-0.50×90 (6/7.5-)
Add: +2.75

Subjective Refraction
R: -4.50/-0.25×5 (6/6-) (+1.00 blur test: 6/18- 6/15- 6/12-)
L: -4.00 (6/6) (+1.00 blur test: 6/12)
Add: +2.25

Other assessments show:

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

Howell Card
Distance: 1 EP
Near: 2 – 4 XP (closer to 4 XP)
-1.00 Near: 2 – 4 XP (closer to 2 XP)

NRA
+0.25

PRA
-0.25

NPC
8/12cm, 8/12cm, 14/20cm, 14/20cm, 20/30cm, 26/34cm

Fusional Reserves
Near, PFV: x/30/16
Near, NFV: x/16/14
Distance, NFV: x/6/4
Distance, PFV: x/12/10

Vergence Facility
Near: 1 cpm (double BO)
Distance: 7 cpm (slow BI) 

Interpupillary distance, IPD = 6.5cm

Slit Lamp
R: mild cataract
L: mild cataract

Fluorescein
R: -ve staining
L: -ve staining

Amsler Grid
R: normal
L: normal (light 1-2 lines distorted)

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
ACT: alternating CT

Examination of Eye Alignment
(Maddox Rod) placed on RE

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

Random Dot 3S – 3D Vision/Stereopsis 
12.5″

Worth 4 Dots – Binocular Perception 4 dots