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Short-Sightedness Increases 200? *UpdatedABC

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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]

*UpdatedA

27/3/2022

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

*UpdatedAB

5/6/2022

Wil came for follow up.

Existing glasses
R: -5.00 (6/6-) R>L
L: -4.75 (6/6-)
Add: +0.75 (L>R)

Other assessments show:

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

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

NRA 
+2.50

PRA 
-1.75

NPC
TTN, TTN, TTN, TTN, TTN

AA
R: 16D, 16D, 16D (blur @end of RAF rule, clear @35cm)
L: 16.5D, 16.5D, 16.5D (blur @end of RAF rule, clear @35cm)

Accommodation Facility (+/- 2.00) 
BE: 7 cpm, difficult minus lens
R: 8 cpm, no difficulty
L: 6 cpm, no difficulty

MEM
R: PL
L: PL

Fusional Reserves
Near, PFV: x/25/20 (above 6 break point, double then single)
Near, NFV: x/18/16
Distance, NFV: x/14/12
Distance, PFV: x/30/25

Vergence Facility
Near: 7 cpm (initially slow BO, then slow BI also)
Distance: 13 cpm

Random Dot 3S
12.5″

*UpdatedABC

Wil came for follow up.

Existing glasses
R: -5.00 (6/7.5-)
L: -4.75 (6/7.5-)
Add: +0.75
VA OU 6/6

Other assessments show:

Cover Test
Distance: NMD
(ACT: pt reported that RE sees target is bigger, LE sees target is smaller)
Near: NMD

Howell Card
Distance: 0 – 1 EP
Near: 0 – 2 XP
+1.00 Near: 4 – 6 XP
-1.00 Near: 0 – 2 XP
+2.00 Near: 8 – 10 XP
-2.00 Near: 2 XP

NRA 
+1.50
(on +1.50 OU: cover either eye monocularly – OD blur)

PRA 
-3.25

NPC
TTN, TTN, TTN, TTN, TTN

AA
R: 15D, 15D, 15D
L: 16D, 16D, 16D (blur @end of RAF rule, clear @35cm)

Accommodation Facility (+/- 2.00) 
BE: 9 cpm, difficult plus lens
R: 7 cpm, difficult minus lens
L: 5 cpm, difficult plus lens

MEM
R: +0.50
L: PL

Fusional Reserves
Near, PFV: x/25/20 (above 6 break point, double then single)
Near, NFV: x/18/16
Distance, NFV: x/14/12
Distance, PFV: x/30/25

Vergence Facility
Near: 14 cpm
Distance: 14 cpm

We reinforce visual hygiene with Wil:

  1. taking regular break in between seeing near
  2. good posture
  3. enough lighting

Wil has been diligent in his follow ups. He is the one who reminds his father to bring him over for follow up. Awww

I am truly guilty.. i appreciate & thanks Wil for reminding aunty❤️

I love to see all children coming back for follow ups, please do not hesitate to drop us messages to schedule for follow ups.

Can all of you remind aunty?😆🥰

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 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 
12.5″