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Seeing Double Vision On Laptop/Phone Since 3-4 Days Ago?

Harith (M/31) came for eye examination, with complaint of seeing double vision looking at laptop and phone or when he changes fixation since 3-4days ago.. no double is seen after taking a break.. but the double comes back after a while again. He likes to read and he uses his laptop about 9 hours every day. No double is seen when he closes either eye. No eye pain is reported but he feels that his eyes are warm. No recent trauma is reported.

Vision without glasses
R: 6/30-
L: 6/45+ (better)

Existing Glasses
R: -3.00/-1.00×140 (6/6)    
L: -2.25/-1.50×160 (6/6)

Subjective Refraction
R: -2.50/-1.00×160 (6/6) (+1.00 blur test: 6/9+)
L: -2.25/-1.25×175 (6/6) (+1.00 blur test: 6/9-)

Other assessments show:

Cover Test
Distance: NMD
(upon cover-uncover, he reported his right eye seeing alphabets surrounding the target to jiggle up & down, but target did not move)
Near: small EP, fast recovery

Maddox Rod
Distance: 2 Base In, R 2 Base Down
Near: R 1 Base Down

Howell Card
Distance: 0 – 2 XP
Near: 0 – 2 XP

Worth 4 Dots
Distance: 4 dots
Distance: 6 dots (initial moment: he saw extra 2 red dots below the original red dot before normalised the next moment)
Near: 4 dots

double reported @Right gaze
(biggest diplopia @dextrodepression)

Random Dots 3S

Slit Lamp
R: conjunctival/limbal congestion
L: conjunctival/limbal congestion

R: -ve staining
L: -ve staining

Pupil Reflex

Colour Vision
R: normal
L: normal

Amsler Grid
R: normal
L: normal

We refer Harith to see eye doctor/ophthalmologist and orthoptist.


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 Posture
(Howell Card) by 6^ BD OD
– 0-3 XP (blue part) or
– 0-1 EP (yellow part)
– 0-6 XP (blue part)

Accommodation/Focusing analysis – ability to relax
+1.50 to +2.50

Accommodation/Focusing analysis – ability to focus
-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)
Children 7-12yo
Near, BO/PFV: x/15-31/10-22
Near, BI/NFV: x/7-17/3-11
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 

Worth 4 Dots – Binocular Perception 4 dots