Tay Zong Yi – 88 Optometry

ZYi (M/13) came with c/o blurry far vision with his glasses(left at home), near vision is fine. He usually wears his glasses to school only. Father has asked him not to wear his glasses always.

Vision without glasses
R: 6/18-
L: 6/30-

Examination shows:
R: -1.00 (6/6) [+1..00 blur test: 6/9-] [R: right dominant eye] R>L
L: -2.25 (6/6-) [+1.00 blur test: 6/9-]
Near: L>R

Other assessments show:

Cover Test
Distance: NMD (ACT: pt reported RE sees the target going down, LE sees the target going up)
Near: NMD (ACT: pt reported RE sees the target going down, LE sees the target going up)

Howell Card (6BD on OD)
Distance: 1 EP
Near: 2 XP
+1.00 Near: 4 XP
-1.00 Near: 2 XP
+2.00 Near: 8 XP
-2.00 Near: 0

NRA
+1.50 (occlude monocularly: OD clearer, OS clearer)

PRA
-0.75 (occlude monocularly: OD clearer, OS clearer)

NPC
7/10cm, 7/11cm, 7/12cm, 8/13cm, 8/14cm, 9/15cm

AA
R: 14D, 14D, 14D
L: 14D, 14D, 14D

Accommodation Facility (+/- 2.00)
BE: 11 cpm, difficult minus lens
R: 12 cpm, difficult minus lens
L: 14 cpm, difficult minus lens

MEM
R: +0.25
L: PL

Modified
R: -1.00
L: -2.00

Fusional Reserves
Near, NFV: x/10/8
Near, PFV: x/20/18
Distance, NFV: x/6/4
Distance, PFV: x/16/14

Vergence Facility
Near: 10 cpm (slow BO, sometimes slow BI)
Distance: 10 cpm (initially slow BI, sometimes slow BO too.. then fine towards end of test)

Interpupillary distance, IPD = 6.0cm

We reinforce proper visual hygiene.
TCA 4/12

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 Alignment
(Maddox Rod) placed on RE

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)

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/Stereopsis
12.5″

Worth 4 Dots – Binocular Perception
4 dots/lights