27/10/2021
Wil (M/10) came for eye examination, with complaints of blurry far vision since quite some time ago with existing glasses of 2years. His near vision is fine with existing glasses.
Vision with existing glasses (first pair of glasses)
R: -2.00/-0.75×90 (6/45-)
L: -1.75/-0.75×85 (6/45+)
Examination shows:
R: -4.25/-1.00×90 (6/12) PHNI, N5-@30cm
L: -4.00/-0.75×85 (6/12+) PHNI, N5@30cm
BE: 6/9+ (Vision with both eyes: 6/9+)
Add: +1.50 (clearer near vision reported)
Examination of Eye Power (Cyclodamia with +2.00 in both eyes)
R: -4.25/-1.00×90
L: -4.00/-0.75×85
Vision with both eyes 6/9+
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test-no glasses)
NMD @ Distance
small EP, 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: 2 XP (blue part)
+1.00 Near: 4 XP (blue part)
+2.00 Near: 6 – 8 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
6cm, 6cm, 6cm
(normal value: less than 10cm or to the nose, TTN)
Jump Convergence: Right eye deviates out after few rounds
AA (Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 8cm, 8cm, 8cm
L: 8cm, 8cm, 8cm
– target is blurred at far end of RAF rule, only come into focus at midway
(normal value: about 8cm for 10yo)
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+2.25
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-2.25
(normal value: -1.37 to -3.37)
MEM (Accommodation lag – to measure accommodation response seeing near target)
R: PL
L: PL (PL=plano=zero)
(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
R: 2 cycle per minit(cpm), failed minus lens
L: 2 cycle per minit(cpm), failed minus lens
BE: 4 cycle per minit(cpm)
(normal value:
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
[Interpupillary distance, PD: 5.7cm]
Wil has significant increment of short-sightedness/myopia. The trend of myopia progression is noted. His eye stamina, AA seems fine (despite target only comes into focus at close distance) but contradictorily, he has difficulty stimulating focusing by Flipper -2.00 monocularly. And on PRA, he can just make it to clear -2.00 lens binocularly.
When eyes are not seeing optimally(with the right power), eye systems – convergence & accommodation may go haywire as both work together in giving us clear vision. One is deficient, the other will need to work extra hard to support.. until a point when the imbalance has exhausted our reserves stamina.. semua tenaga simpanan sudah kong & kosong…… by then, our eyes will start to give us symptoms like headache, blurry near vision or even blurry far vision too, super tired eyes, feeling of dry, burning, gritty sensation and you name it.
Therefore, it is important to have eye examination should you notice any visual symptoms. Our eyes are too precious to not be seeing with optimum vision. Eyes can see perfectly well, with any type of correction, and that’s absolutely amazing! In event of eye diseases, good vision may not be achieved, and this… we cannot do anything to reverse it.
*UpdatedA
Wil (M/11) came for 5months follow up.
Vision with existing glasses
R: -4.25/-1.00×90 (R>L), N5
L: -4.00/-0.75×85, N5
Add: +1.50 (Near: L>R)
Vision with both eyes 6/6-
Other assessments (with existing glasses) show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
NMD @Near (on alternating CT: upon covering left eye, patient reported target goes left.. when covering right eye, target “no move”)
(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: 2 – 4 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
+1.25
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-2.00
(normal value: -1.37 to -3.37)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.75
L: PL
(normal value: +0.25 to +0.75)
Accommodation Facility – ability to change focus: far to near or near to far (by Flipper +/-2.00)
BE: 8 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 12 cycle per minit(cpm), no difficulty
L: 9 cycle per minit(cpm), difficult with plus lens(1st lens)
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 4/2
Near, Base-In/Divergent, NFV: 18/14
Distance, Base-In/Divergent, NFV: 10/8
Distance, Base-Out/Convergent, PFV: 25/20
(normal value: Blur/Break/Recovery)
Near, PFV: x/15-31/10-22
Near, NFV: x/7-17/3-11
[Scheiman et al – Children 7-12yo Data]
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, TTN, TTN, TTN, TTN
(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: 8 YO, 8 YO, 8 YO
L: 8 YO, 8 YO, 8 YO
(normal value: AA goes according to age; YO=years old)
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 9 cpm
Distance: 2 cpm (difficult Base-Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
3D Vision (Titmus Fly)
20″ (slow)
(normal value: 20″)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 20/16 (we repeated the test)
Interpupillary Distance = 5.6cm