Teoh Jin Wei – 88 Optometry

5/12/2021

JWei (M/15) came for eye examination, with complaints of having tired eyes looking at screen easily & sometimes blurry near vision upon prolonged near work. Vision with existing glasses of 2 years is fine seeing far.

Vision without glasses
R: 6/30-
L: 6/24-

Vision with existing glasses
R: -5.50 (6/7.5-)
L: -5.25/-0.50×160 (6/7.5-)

Examination shows:
R: -5.00/-1.25×180 (6/6) [+1.00 blur lens test: 6/7.5]
L: -4.50/-1.00×160 (6/6) [+1.00 blur lens test: 6/7.5] L>R [L: dominant left eye]
We tried giving him -0.25 lower shortsightedness in both eyes or monocularly but he did not like it as compared to his existing glasses

Other assessments show:

Cover Test
Distance: small XP, fast recovery
Near: small XP, fast to moderate recovery

Howell Card
Distance: 6 XP (2 XP – after close eyes for longer time)
Near: 20 XP
+1.00 Near: beyond & out of blue scale
+1.00 Near: 16 XP (after blink2)

NRA
+2.00

PRA
-0.50

Accommodation Facility +/- 2.00
R: 6 cpm, difficult minus lens
L: 9 cpm, difficult minus lens
BE: 8 cpm, difficult minus lens

*UpdatedA

JWei (M/16) came for follow up.. vision with existing glasses made with us 11months ago is fine seeing far & near. He is able to see whiteboard at school.

Vision without glasses
R: 6/45- slow (when focused)
L: 6/30 slow (when focused)

Vision with existing glasses
R: -5.00/-1.25×180 (6/6-)
L: -4.50/-1.00×160 (6/6-)

Other assessments show:

Cover Test
Distance: small XP, fast recovery
Near: moderate XP, moderate recovery (prolonged ACT: large XP, slow recovery)

Howell Card
Distance: 6 XP
Near: 18 – 20 XP
+1.00 Near: 18 – 20 XP
-1.00 Near: 20 XP
+2.00 Near: 20 XP
-2.00 Near: 16 – 18 XP

NRA
+0.75
(mono occlusion: OD clear, OS blur)

PRA
-0.75

NPC
10/16cm, 10/16cm, 10/16cm, 10/16cm, 10/16cm, 10/16cm

AA
R: 15.5D, 15.5D, 15.5D (blink clears blurriness in btween for a few times) (blur @end of RAF rule, clear @30cm)
L: 15.5D, 15.5D, 15.5D (blink clears blurriness in btween for a few times)

Accommodation Facility (+/- 2.00)
BE: 11 cpm, difficult minus lens
R: 9 cpm, difficult minus lens
L: 12 cpm, difficult minus lens

MEM
R: vy3 dim
L: vy3 dim

Modified
R: -4.50/-1.75×180
L: -4.50/-1.25×160
New DC is favoured @N
(Pt prefers habitual seeing far)

Fusional Reserves
Near, PFV: x/8/-4
Near, NFV: x/18/16
Distance, PFV: x/6/4
Distance, NFV: x/12/6

Vergence Facility
Near: 0 cpm (double BO)
Distance: 0 cpm (double BO)

Interpupillary distance, IPD = 6.7cm

We ask whether or not his near vision will be blurry sometimes, he said yes.. especially when his eyes are tired. We also ask if his far vision is affected too, he said that his far vision is fine.

Separate pair for near
R: -4.25/-1.75×180
L: -3.75/-1.25×160

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