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Starbursts Glaring?

Ms Loo (F/56) came for eye examination, with complaint of starbursts glaring seeing light source since last 1-2years ago. She feels that her right eye is strain when doing near work.. and she will remove glasses to see near. She also shared that pushing her glasses higher on her nose, her eyes feel more comfortable.

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

Existing Glasses of 3+ years
R: -3.00/-0.25×115 (6/6)    
L: -3.00/-1.00×75 (6/6)
Add: +2.25

Subjective Refraction
R: -2.25/-0.50×85 (6/6) (+1.00 blur test: 6/7.5-)
L: -2.50/-1.00×75 (6/6) (+1.00 blur test: 6/7.5-)
Add: +2.25 (good rocv)

Other assessments show:

Cover Test
Distance: NMD
Near: small XP, fast recovery

Maddox Rod
Distance: 2 Base In
(on vertical deviation, when focused long enough, horizontal line will go missing intermittently, and sometimes horizontal line will be above the red spotlight)
Near: 8 Base In

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

Worth 4 Dots
Distance: 4 dots
Near: 4 dots

10/14cm, 10/14cm, 10/14cm, 10/14cm, 10/14cm, 10/14cm

Fusional Reserves
Near, PFV: x/x/x
Near, NFV: x/14/10
Distance, NFV: x/10/8
Distance, PFV: x/20/18

Vergence Facility
Near: 14 cpm 
Distance: 16 cpm 

We repeated
Fusional Reserves
Near, PFV: x/30/25

Interpupillary distance, IPD = 6.3cm

Pupil Reflex

Colour Vision
R: normal
L: normal

Amsler Grid
R: normal
L: a few grids look wider inferiorly

Slit Lamp
R: cataract
L: cataract

R: -ve staining
L: -ve staining


Ms Loo reported seeing shadow when seeing a target during monocular testing (in both eyes).. if the shadow or glaring is persistently troublesome to her, she can visit eye specialist doctor/ophthalmologist.

NO eye drop/glasses can reverse cataract.. only by cataract surgery, you will regain clear vision.


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 Alignment
(Maddox Rod) placed on RE

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