SAW SEAH LEONG – 88 Optometry

Mr Saw (M/53) came for eye examination, with complaint of slight blurry far vision in Right eye & slight blurry near vision in Left eye with existing glasses of more than 10years.

Vision without glasses
R: guess 6/120
L: 6/60-

Existing glasses
R: -5.25/-2.50×30 (6/18-)
L: -3.50/-2.25×150 (6/6)
Add: +1.25

Subjective Refraction
R: -6.75/-1.75×30 (6/6-) [+1.00 blur lens test: 6/15-]
L: -4.00/-1.50×150 (6/6) [+1.00 blur lens test: 6/15-] L>R
Add: +1.75 (L>R) NRA
– lower DC is not favoured @near

Other assessments show:

Cover Test
Distance: NMD
(upon ACT: pt reported LE sees bigger, RE sees smaller)
Near: small XP, fast recovery

Howell Card
Distance: 0 – 1 EP
Near: 2 – 4 XP
-1.00 Near: 1 – 3 EP

NRA
+1.00

PRA
-0.25

NPC
6/8cm, 6/8cm, 6/8cm, 6/8cm, 6/8cm, 6/8cm

AA
R: +0.25 to see end of RAF rule better
L: clear @end of RAF rule

MEM
R: PL
L: +0.25

Modified
R: -6.25/-1.75×30
L: -4.00/-1.50×150
Add: +1.75

Fusional Reserves
Near, PFV: x/x/x
Near, NFV: 8/10/8
Distance, NFV: x/8/6
Distance, PFV: x/20/18

Vergence Facility
Near: 12 cpm
Distance: 8 cpm (slow BO)

We repeated
Fusional Reserves
Near, PFV: x/x/x

Interpupillary distance, IPD = 6.8cm

Near tests are done with Add.

Slit Lamp
R: very mild cataract
L: very mild cataract

Fluorescein
R: -ve staining
L: -ve staining

Amsler Grid
R: normal
L: normal

Worth 4 Dots
R: 4 lights
L: 4 lights

We prescribe multifocal/progressive.

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)

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/lights