Mr Ho (M/37) came for eye examination, vision with existing glasses of more than 6-7years is okay seeing far & he complains of seeing blurry on small prints on his drawing since 1-2years ago. Previously, he used to print his drawing in large paper.. he minimises & prints on smaller page now in which he finds that he no longer can see the small prints. He is tall, we observe that he will hold his phone at a further distance thanks to his long arms.
Vision without glasses
R: 6/45-
L: 6/60-
Vision with existing glasses
R: -2.75/-0.75×5 (6/6-)
L: -4.25/-0.25×75 (6/6-)
Examination shows:
R: -2.75/-0.50×40 (6/6) (+1.00 blur lens test 6/9)
L: -4.00/-0.50×75 (6/6) (+1.00 blur lens test 6/9-) [L: dominant left eye] L>R
Add: +1.00
We tried to lower shortsighted power 025 in right eye, but he did not like it
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
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: 2 – 4 XP (blue part)
+1.00 Near: 4 – 6 XP (blue part)
(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
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
9cm, 9cm, 9cm
(normal value: less than 10cm or to the nose, TTN)
AA (Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: AA of 42 – 44 YO (20cm to 22cm)
L: AA of 40 YO (18cm)
(normal value: AA goes according to your age, can see up to 15cm before blur reported for 37YO)
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
-0.50
(normal value: -1.37 to -3.37)
MEM (Accommodation lag – to measure accommodation response seeing near target)
R: +1.25 (dim reflex)
L: +1.00 (bright reflex)
(normal value: +0.25 to +0.75)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 1.00
R: 1 cycle per minit(cpm), difficult with minus lens
L: 2 cycle per minit(cpm), difficult with minus lens
BE: 3 cycle per minit(cpm), difficult with plus lens
(normal value: *below normative data is not applicable for adult above 30
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Mr Ho seems to have lower eye stamina/AA. We prescribe added plus lenses to support his near vision. After he wears his new glasses for a few months, we will see him to review his AA to see whether or not it is regulated/normalised.
Should accommodation insufficiency still persist, we can work on vision therapy in strengthening his AA. Also, AA will be expected to reduce when we hit the age of 40.
We will see him in 3 months.