Sandra (F/47) came for eye examination, complaining about the hassle of needing to remove & put on her reading glasses repeatedly while she is at work. Colleague sometimes will be at the door of her office in which she needs to remove her glasses to talk to her colleague. She will put on her glasses to continue working.. and at other times, she needs to walk away from her workplace & she will remove her glasses again.
Vision without glasses
R: 6/12
L: 6/12
Power of reading glasses made recently
R: +2.75
L: +2.75
Examination shows: (Delay Fogging)
R: +0.75 (6/6) [+1.00 blur lens test: 6/7.5-] (R: right dominant eye) R>L
L: +0.75 (6/6) [+1.00 blur lens test: 6/7.5-] [central black patch is seen on retinoscopy)
Add: +1.75 (R>L)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target looks bigger.. when covering right eye, the target looks smaller)
small XP, fast recovery @Near
(alternating CT: pt reported NMD)
(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: 4 – 6 XP (blue part)
-1.00 Near: 2 XP (blue 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
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+0.50
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.25
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
18/24cm, 18/24cm, 18/24cm, 20/28cm, 20/28cm, 20/28cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 47 YO, 47 YO, 47 YO (target is clear @end of RAF rule)
L: 47 YO, 47 YO, 47 YO (target is clear @end of RAF rule)
(normal value: AA goes according to age; YO=years old)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.75
L: +0.75
(normal value: +0.25 to +0.75)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/6/4
Near, Base-In/Divergent, NFV: x/14/10
Distance, Base-In/Divergent, NFV: 4/10/8
Distance, Base-Out/Convergent, PFV: 4/14/10
(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: 0 cpm (double with Base In)
Distance: 3 cpm (double with Base Out, blink3 eyes & single.. then double with Base In, blink3 eyes & single)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Fluorescein (assess integrity of front surface of eye, cornea)
R: -ve staining
L: -ve staining
Slit Lamp microscope
R: mild cataract
L: mild cataract L>R
All near tests are done with Add.
Interpupillary distance, IPD = 5.8cm
We prescribe a pair of multifocal glasses for Sandra so that she can walk around in office without needing to remove her reading glasses for convenience.