Ms Fung (F/31) came for eye examination, with complaint of tired eyes with near work with existing glasses of 2+ years. She shared that she did not always wear her glasses of power about 200 5 years ago.. and with time, she needs to have her glasses full time now.
Vision without glasses
R: 6/60+1
L: 6/60-2
Vision with existing glasses
R: -3.25/-0.50×70 (6/6)
L: -4.00/-0.50×125 (6/6)
Examination shows: (Delay Fogging)
R: -3.00/-0.50×90 (6/6) [+1.00 blur lens test: 6/9] (R: right dominant eye) R>L
L: -3.75/-0.50×125 (6/6) [+1.00 blur lens test: 6/12]
Add: +0.50 R>L [L: -3.75/-0.25×125 L>R, but not favoured for far vision)
We tried to reduce astigmatism, she did not like it.
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 middle.. when covering right eye, the target goes to her right side)
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: 4 – 6 XP (blue part)
+1.00 Near: 6 – 8 EP (blue part)
-1.00 Near: 0 – 2 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
+1.25
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-1.75
(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)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 25 YO, 25 YO, 25 YO
L: 25 YO, 25 YO, 25 YO
(normal value: AA goes according to age; YO=years old)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
6/8cm, 6/8cm, 8/10cm, 8/10cm, 8/10cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Accommodation Facility – ability to change focus: far to near or near to far (by Flipper +/-2.00)
BE: 6 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 5 cycle per minit(cpm), difficult with minus lens(2nd lens) [both eyes see better than with right eye]
L: 5 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: 10/x/x
Near, Base-In/Divergent, NFV: x/14/12
Distance, Base-In/Divergent, NFV: 8/16/10
Distance, Base-Out/Convergent, PFV: 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 – Adult Data]
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 9 cpm
Distance: 2 cpm (initially double with Base-Out.. upon repeated testing, double with Base-In)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary Distance = 5.8cm