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Tired Eyes Upon Prolonged Computer Work With Glasses? *Updated

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10/6/2022

JNi (F/25) came for eye examination, vision with existing glasses of 1/2year is fine seeing far & near but she sometimes has tired eyes upon prolonged computer work. She wears contact lens to attend lecture & she puts on glasses when she is at home. Her previous spec was about 3-4years ago & she was told that her power increased 100+.

Vision without glasses
R: 6/60-1
L: 6/120

Vision with existing glasses
R: -5.25/-0.75×175 (6/6)
L: -5.50/-1.75×165 (6/6)

Power of contact lens (far vision is fine)
R: -5.25/-0.75×20
L: -5.50/-1.75×180

Examination shows: (Binocular Refraction)
R: -5.25/-0.75×5 (6/6) [+1.00 blur lens test: 6/9-] [R: right dominant eye] R>L
L: -5.25/-1.50×170 (6/6) [+1.00 blur lens test: 6/9-]
Near Add is not favoured (L>R)
Lowering astigmatism binocularly is not favoured

Other assessments show:

Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance 
NMD @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: 0
Near: 1 – 3 EP (yellow part)
+1.00 Near: 0 – 2 XP (blue part)
-1.00 Near: 3 – 5 EP (yellow 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
+1.00
(normal value: +1.50 to +2.50)

PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens 
-2.50
(normal value: -1.37 to -3.37)

MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.50
L: +0.25
(normal value: +0.25 to +0.75) 

NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, TTN, TTN, TTN, TTN, TTN
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)

AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 8 YO, 8 YO, 8 YO
L: 8 YO, 8 YO, 8 YO (target is blurry @end of RAF rule, only comes into focus starting @34cm)
(normal value: AA goes according to age; YO=years old) 

Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
BE: 8 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 10 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with right eye)
L: 10 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with left eye)
(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-Out/Convergent, PFV: x/35/25
Near, Base-In/Divergent, NFV: x/25/20
Distance, Base-In/Divergent, NFV: x/14/12
Distance, Base-Out/Convergent, PFV: 12/x/x
(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 et al – Adult Data]

Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 11 cpm
Distance: 12 cpm
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)

Interpupillary distance, IPD = 6.2cm

JNi is esophoric at near.. we tried to relieve with added plus at near but she did not like it & her NRA is low. When we lowered her shortsightedness 025 monocularly/binocularly, she said it is shadowy when seeing far & dimmer when seeing near.

She wants to get contact lens supplies, we will prescribe her contact lens of new power.

*Updated

Contact lens
R: -5.25/-0.75×10 R>L
L: -5.25/-1.25×180 (VA OU 6/6-)
Near: R>L (adding +0.25/+0.50 still R>L)

JNi reported that vision in these contact lenses is slightly blurry @Near & blurry seeing phone, far vision is fine.

*Updated

Contact lens modified
R: -5.25/-0.75×10 R>L
L: -5.25/-1.75×180
Near: R>L (adding up to +0.75, still R>L)

Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 0 (slightly on blue part)
Near: 0 – 2 XP (blue part)

3D Vision (Random Dot 3S)
12.5″

JNi reported near vision in left eye is still slightly blurry.. but near vision is fine with both eyes. Glad to see her near eye posture is normalised in contact lens.