JWen (M/20) came for eye examination, with complaint of slight swollen left upper eyelid . Vision is fine seeing far & near.
Vision without glasses
R: 6/6-
L: 6/6- (better)
Examination shows: (Delay Fogging)
R: PL/-0.50×75 (6/6) (+1.00 blur lens test 6/12) R>L
L: PL (6/6) (+1.00 blur lens test 6/21) [L: left dominant eye]
Near: Add is not favoured (L>R) (adding +0.75 on right eye: R>L)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
NMD @Distance
NMD @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 – 4 XP (blue part)
+1.00 Near: 6 – 8 XP (blue part)
-1.00 Near: 2 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
NRA (Accommodation analysis – ability to relax accommodation) by plus lens
+0.75
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-1.00 (above -0.50 blur then clear)
(normal value: -1.37 to -3.37)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.50
L: PL
(normal value: +0.25 to +0.75)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 20YO, 20YO, 20YO
L: 18YO, 18YO, 18YO
(normal value: AA goes according to age; YO=years old)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, TTN
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
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 plus & minus (blur then clear with plus & minus lens)
R: 8 cycle per minit(cpm), difficult with plus & minus (blur then clear with plus & minus lens)
L: 11 cycle per minit(cpm), difficult with plus lens(1st lens)
– both eyes see better than one eye
(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: 20/18
Near, Base-In/Divergent, NFV: 16/8
Distance, Base-In/Divergent, NFV: 10/6
Distance, Base-Out/Convergent, PFV: 12/10
(normal value: Blur/Break/Recovery)
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
[Scheiman – Adult Data]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 7 cpm
Distance: 6 cpm (difficulty with Base Out – target is seen double initially for first 10 seconds.. later can fuse Base Out )
(normal value: 1 cycle = 2 times clearing target (target becomes clear & single)
Distance: 12-18 cpm
Near: 12-18 cpm)
3D Vision (Random Dot 3S)
12.5″ slow (incorrect 16″)
(normal value: 12.5″)
Interpupillary Distance = 6.5cm
JWen has mild oil gland blockage on left eye.
He has been on near work a lot lately. We emphasise on taking regular break in between near work.