Thivyan (M/15) came for eye examination, own glasses of 1 year are broken. He wears his glasses to school and whenever he is on computer/phone only.
Vision without glasses
R: 6/45
L: 6/45+1
Examination shows: (Delay Fogging)
R: -2.75/-0.25×15 (6/6) [+1.00 blur lens test: 6/9-] (scissoring-like retinoscopy reflex => spherical aberration?)
L: -2.75 (6/6) [+1.00 blur lens test: 6/12] (L: left dominant eye)
Add: +1.25
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes to his right.. when covering right eye, the target goes to his left side)
small EP, fast recovery @Near
(alternating CT: upon covering left eye, patient reported the target goes to his right. when covering right eye, the target goes to his left side)
(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
Near: 1 – 3 EP (yellow part)
+1.00 Near: 0 – 1 EP (yellow part)
+1.50 Near: 4 XP (blue part)
(normal value: 0-1 EP (yellow part) or 0-3 XP (blue part) @Distance; and 0-6 XP (blue part) @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
with Add: +0.75
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
with Add: -1.50
(normal value: -1.37 to -3.37)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: 1 vertical thin line seen
L: PL
(normal value: +0.25 to +0.75)
Accommodation Facility – ability to change focus: far to near or near to far (by Flipper +/-2.00)
BE: 12 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 12 cycle per minit(cpm), difficult with minus lens(2nd lens) [right eye sees better than with both eyes]
L: 12 cycle per minit(cpm), difficult with minus lens(2nd lens) [left eye sees better than with both eyes]
(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-In/Divergent, NFV: x/8/6
Near, Base-Out/Convergent, PFV: 12 onwards – break into two & become single back again
Distance, Base-In/Divergent, NFV: 4 onwards – break into two & become single back again
Distance, Base-Out/Convergent, PFV: 2 onwards – break into two & become single back again
(normal value: Blur/Break/Recovery)
Near, PFV: 10-28/7-21
Near, NFV: 7-19/5-15
Distance, PFV: 4-18/5-9
Distance, NFV: 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: 2 cpm (double Base-In.. sometimes double Base-Out too after repeated testing)
Distance: 2 cpm (double Base-Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary Distance = 6.1cm
Initially, Thiv told us that his power is about 300+.. he brought his spec in later to show us:
R: -2.25/-0.25×15
L: missing
Vergence anomaly?