TEOH HOU YIN – 88 Optometry

5/12/2021

HYin (M/7) came for eye examination, mother Rachael reported that he always rubs his eyes after some time looking at tablet or watching TV. He has not worn any glasses before.

Vision without glasses
R: 6/6
L: 6/6- slow

Examination shows:
R: PL (6/6) [+1.00 blur lens test: 6/12] R>L [R: dominant right eye] N5@35cm
L: +0.75/-0.25×165 (6/6) [+1.00 blur lens test: 6/6, blur lens +1.50: 6/9] N6 blur @35cm
Near: Add is not favoured
He prefers to remove correction to see brighter
Vision fluctuation noted

Other assessments show:

Examination of Eye Alignment/Vergence (Cover Test)
small EP fast recovery @Distance
small EP fast recovery @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: 5 EP (yellow part)
Near: 3 EP (yellow part)
+1.00 Near: 0 –> 1 –> 3 EP
+2.00 Near: 2 XP
(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

Retinoscopy & Delay Fogging
R: +0.50
L: +1.25/-0.25×160
BE: 6/6
He does not like the correction & wants to remove it

HYin has longsightedness/hyperopia/plus power in both eyes. His eyes are tensed, in which they reject the hyperopic power that we give. Eye alignment shows some esophoria.. possibly due to eyes exerting focusing to autocorrect the hyperopic power.

We refer HYin for cycloplegic refraction – to put eye drop at eyes specialist clinic to temporarily suspend accommodation/focusing to get the true eye power. We will assess his eye systems after 4-6weeks of full-time wear of cycloplegic power.

……………………………..

Mother previously let us know that no eye prescription was given.

*UpdatedA

HYin (M/8) came back for follow up with complaint of blurry far vision looking at whiteboard as he sits at the back of class. He needs to move to the front in order to copy.. and teacher has advised to go for eye check.

Vision without glasses
R: 6/6-
L: 6/7.5-

Subjective Refraction
R: +0.50 (6/6) (+1.00 blur lens test: 6/7.5-) N5@35cm
L: +1.00/-0.25×160 (6/6) (+1.00 blur lens test: 6/12) N5-@35cm(blurry @near)
Add: +0.75

Other assessments show:

Colour Vision
R-G

3D Vision
60″
25″ (with Add +0.75)

Cover Test
Distance: NMD
(upon ACT: pt reported RE has no movement.. LE sees the target going to his left & up)
Near: NMD
(upon ACT: pt reported RE has no movement.. LE sees the target going to his left)

Howell Card
Distance: 3 EP
Near: 1 – 3 EP
+1.00 Near: 2 XP
-1.00 Near: 3 EP
+2.00 Near: 2 XP
-2.00 Near: 9 EP

NPC
6/8cm, 6/8cm, 6/8cm, 6/8cm, 6/8cm, 6/8cm

AA (with Add +0.75)
R: 15.5D, 15.5D, 14.5D
L: 15.5D, 15.5D, 15.5D

MEM (with Add +0.75)
R: +0.25
L: +0.25

Accommodation Facility (+/- 2.00)
BE: 15 cpm, difficult minus lens
R: 16 cpm, no difficulty with plus/minus (see bigger with plus, see smaller with minus)
L: 17 cpm, difficult plus lens

Fusional Reserves
Near, NFV: x/4/2
Near, PFV: x/2/-4
Distance, NFV: x/4/2
Distance, PFV: x/20/14

Fusional Reserves (with Add +0.75 OU)
Near, NFV: x/6/4
Near, PFV: x/14/12

Fusional Reserves (with Add R:+0.75, L:+1.00)
Near, NFV: x/10/4

Vergence Facility
Near: 12 cpm
Distance: 10 cpm

Interpupillary distance, IPD = 6.0cm

We prescribe glasses for full-time wear. We will see HYin in 2months.

KIV

EP @D & N
PFV & NFV @D & N

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)

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)

Random Dot 3S – 3D Vision
12.5″