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Want To Wear Contact Lens To Work?

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Joanne (F/42) came for eye examination, vision with existing glasses is fine seeing far & near.

Vision without glasses
R: guess 6/120
L: guess 6/120

Existing glasses of 1+years
R: -3.50/-0.75×10 (6/6)
L: -4.50/-0.75×180 (6/6)
Add: +1.00

Subjective Refraction
R: -4.00 (6/6) (+1.00 blur lens test: 6/9-)
L: -5.00 (6/6) (+1.00 blur lens test: 6/12) L>R
Add: +1.50 R>L

Other assessments show:

Cover Test
Distance: NMD
Near: small XP, fast recovery

Howell Card
Distance: 0 – 2 XP
Near: 6 – 8 XP
-1.00 Near: 2 – 4 XP

NRA
+0.75

PRA
-0.25

NPC
14/22cm, 16/24cm, 18/24cm, 20/24cm, 20/24cm, 20/24cm

AA
R: 46yo, 46yo, 46yo
L: 46yo, 46yo, 46yo

MEM
R: +0.50
L: +0.50

Fusional Reserves
Near, PFV: 6/12/10
Near, NFV: 8/12/10
Distance, PFV: 10/16/14
Distance, NFV: 4/6/4

Vergence Facility
Near: 7cpm (double BO & BI, blink & single)
Distance: 4cpm (double BO & BI, blink & single)

Interpupillary distance, IPD = 7.2cm

Joanne wants to wear contact lens to work.

We prescribe monthly multifocal.
R: -4.00 +1.50 N
L: -5.00 +1.00 D

Glad that her vision with this contact lens is fine @far & near.

Notes

Vision without glasses
6/6 – smallest testing line
6/7.5 – 2nd smallest line
6/9 – 3rd smallest line
6/12 – 4th smallest line
6/15 – 5th
6/18 – 6th
6/21 – 7th
6/24 – 8th

Examination of Eye Alignment
Cover Test, CT @ Distance & Near
– NMD(No Movement Detected) or
– small XP, fast recovery
EP = Esophoria is misalignment of eye, eye is deviated inwards
XP = Exophoria is misalignment of eye, eye is deviated outwards

Examination of Eye Posture
(Howell Card) by 6^ BD OD
Distance:
– 0-3 XP (blue part) or
– 0-1 EP (yellow part)
Near:
– 0-6 XP (blue part)

Accommodation/Focusing analysis – ability to relax
NRA
+1.50 to +2.50

Accommodation/Focusing analysis – ability to focus
PRA
-1.37 to -3.37

Convergence, NPC – ability of eye to maintain a single clear near image (RAF rule)
Break/Recovery – within 10cm or TTN(to the nose)

AA(Amplitude Accommodation) – eye stamina (Dioptre, D) (RAF rule)
6yo – 16.5D | 6cm
9yo – 15.5D | 6.5cm
12yo – 14.5D | 7cm
15yo – 13.5D | 7.5cm
18yo – 12.5D | 8cm
21yo – 11.5D | 9cm
24yo – 10.5D | 10cm
27yo – 9.5D | 11cm
30yo – 8.5D | 12cm

MEM(Monocular Estimation Method) – measure accommodation response seeing near target
+0.25 to +0.75 (with movement)

Accommodation Facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00
Monocular: 6cpm – 16cpm
Binocular: 4cpm – 14cpm
(1 cycle per minute, cpm = 2 words)

Fusional Reserves –
Convergent/Divergent reserve stamina (Prism Bar)
Blur/Break/Recovery
Children 7-12yo
Near, BO PFV: x/15-31/10-22
Near, BI NFV: x/7-17/3-11
Adult
Near, BO PFV: x/10-28/7-21
Near, BI NFV: x/7-19/5-15
Distance, BO PFV: x/4-18/5-9
Distance, BI NFV: x/4-10/2-6

Vergence Facility  – ability to make rapid repetitive vergence changes (Prism Flipper 12BO & 3BI)
Distance: 12-18 cpm
Near: 12-18 cpm)
(1 cycle = 2 times clearing target)