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Slight Blurry Far Vision?

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XinYi (F/19) came for eye examination, with complaint of slight blurry far vision with existing glasses.. seeing near is fine. She wears contact lens to college & during outings. Vision with contact lens is good.

Vision without glasses
R: cannot guess 6/120
L: cannot guess 6/120

Existing glasses of 1+years
R: -5.50/-0.50×175
L: -5.00/-0.50×175

Contact lens
R: -6.00
L: -5.50

Subjective Refraction (Delay Fogging +2.00 OU)
R: -6.00 (6/6) (+1.00 blur lens test: 6/12)
L: -5.75 (6/6) (+1.00 blur lens test: 6/12) L>R
Adding +0.25 in LE, R>L but she did not like it
Near: R>L (adding +0.50 in OS, L>R)

Other assessments show:

Cover Test
Distance: NMD
(alternating CT: pt reported RE sees target to be smaller, LE sees target to be bigger)
Near: small EP, fast recovery

Howell Card
Distance: 0 – 2 XP
Near: 4 XP
+1.00 Near: 8 XP
-1.00 Near: 2 XP
+2.00 Near: 10 – 12 XP
-2.00 Near: 0

NRA
+2.75

PRA
-2.25

NPC
TTN, TTN, TTN, TTN, TTN

AA
R: 15.5D, 15.5D, 13.5D
L: 15.5D, 15.5D, 15.5D

MEM
R: +1.00
L: +1.00

Accommodation Facility (+/- 2.00)
BE: 11cpm, difficult minus lens
R: 11cpm, difficult minus lens
L: 11cpm, difficult plus lens
– RE/LE sees better than with BE

Fusional Reserves
Near, PFV: x/30/25
Near, NFV: x/20/16
Distance, PFV: x/30/20
Distance, NFV: x/10/8

Vergence Facility
Near: 7 cpm
(double BO – blink & single)
Distance: 7 cpm
(double BO & BI – blink & single)

Fluorescein
R: very mild staining
L: very mild staining

Slit Lamp
R: mild limbal redness
L: mild limbal redness

Interpupillary distance, IPD = 6.3cm

+gradient AC/A = 4:1 (normal)
-gradient AC/A = 2:1

We prescribe monthly disposable contact lens.

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

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, PFV: x/15-31/10-22
Near, NFV: x/7-17/3-11
Adult
Near, PFV: x/10-28/7-21
Near, NFV: x/7-19/5-15
Distance, PFV: x/4-18/5-9
Distance, 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)