Vali (F/48) datang untuk pemeriksaan mata, mengadu rasa ngilu & pening bila pakai speknya.
Vision without glasses
R: cannot guess 6/30+
L: cannot guess 6/9
Vision with existing glasses of 8-9months
R: -1.00/-1.00×115 (6/6)
L: -0.50/-0.25×5 (6/6)
Add: +1.75
Examination shows: (Delay Fogging)
R: -1.25/-0.50×115 (6/6) [+1.00 blur lens test: 6/18]
L: -0.50/-0.25×180 (6/6) [+1.00 blur lens test: 6/12] (L: left dominant eye) L>R
Add: +1.75 (L>R)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target looks blurry & further away. when covering right eye, the target looks clearer & bigger)
small XP, fast recovery @Near
(alternating CT: pt reported NMD)
(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 – 2 XP (blue part)
Near: 4 – 6 XP (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
+0.25
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-0.25
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, 6/8cm, 8/10cm, TTTN, 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: 47 YO, 47 YO, 47 YO (target is clear @end of RAF rule) (target is clearer with -0.50DC than -0.25DC)
L: 47 YO, 47 YO, 47 YO (target is clear @end of RAF rule) (target is clearer with -0.25DC)
(normal value: AA goes according to age; YO=years old)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: PL
L: +0.25
(normal value: +0.25 to +0.75)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: 4/25/20
Near, Base-In/Divergent, NFV: 6/8/6
Distance, Base-Out/Convergent, PFV: x/14/12
Distance, Base-In/Divergent, NFV: x/6/4
(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: 6 cpm (double with Base In, blink3 eyes & single.. then double with Base Out also, blink3 eyes & single)
Distance: 0 cpm (double with Base In, blink3 eyes & cannot regain single.. double targets are very far apart)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Amsler Chart (assess integrity of macula)
R: all lines are straight (slightly blurry)
L: all lines are straight
(normal value: lines are straight with equal gaps in between lines & no brown/black patch/spot)
Fluorescein (assess integrity of front surface of eye, cornea)
R: -ve staining
L: -ve staining
All near tests are done with Add.
Interpupillary distance, IPD = 5.8cm
Modified
R: -1.25/-0.25×135
L: -0.50/-0.25×180
Add: +1.75
Kita tanya sama ada Kak Vali ada sakit kepala.. beliau bagitahu yang sakit kepalanya sudah lama sejak dulu2 lagi. Biasanya, beliau akan makan ubat migraine.. adakalanya lepas makan ubat pun masih sakit kepala.