Mr Wong (M/61) came for eye examination, with complaint of seeing 1 car with another shadow of the same car when driving since few days ago. When he closes either eye, no shadow is seen. He experienced tenderness in right eye a few days ago. He does welding work and he has not worn any glasses before.
Vision without glasses
R: 6/7.5- slow
L: 6/7.5- slow
Examination shows: (Delay Fogging)
R: PL/-0.25×90 (6/6) [+1.00 blur lens test: 6/12]
L: PL/-0.25×90 (6/6) [+1.00 blur lens test: 6/12]
Add: +1.75
Shadow is seen sometimes.
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
Distance: R hypertropia (or L hypotropia)
(unilateral CT-cover uncover right eye: row of shadow at bottom of each testing row)
(unilateral CT-cover uncover left eye: row of shadow at top of each testing row)
Near: R hypertropia (or L hypotropia)
(alternating CT: upon covering left eye, patient reported the target goes down & to his left. when covering right eye, the target goes up & to his right
(normal value: orthophoria/NMD-No Movement Detected or small XP, fast recovery)
Hypertropia = is misalignment of the eye, eye is deviated upwards
Hypotropia = is misalignment of the eye, eye is deviated downwards
Examination of Eye Alignment/Posture (Maddox Rod)
Distance: R 7 BD, 0.5 BI
Near: R 6 BD, 1 BI
(normal value: 0-1 EP or 0-3 XP @Distance and 0-6 XP @Near)
BO/EP = Base Out/Esophoria is misalignment of the eye, eye is deviated inwards
BI/XP = Base In/Exophoria is misalignment of the eye, eye is deviated outwards
BD/Hypertropia = is misalignment of the eye, eye is deviated upwards
BU/Hypotropia = is misalignment of the eye, eye is deviated downwards
Power given
R: PL/-0.25×90
L: PL/-0.25×90 3BU
Add: +1.75
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
8/14cm, 8/14cm, 8/15cm/ 8/15cm, 8/16cm, 8/16cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/10/8
Near, Base-In/Divergent, NFV: x/8/-1
Distance, Base-Out/Convergent, PFV: x/12/6
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]
Fusional Reserves (Supravergent/Infravergent reserve stamina) by Prism Bar
Near, R Base-Up/Infravergent, IV: 3/2
Near, R Base-Down/Supravergent, SV: 3/2
Distance, R Base-Up/Infravergent, IV: 2/1
Distance, R Base-Down/Supravergent, SV: 5/4
(normal value: 2-4)
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 0 cpm (double with Base Out)
Distance: 0 cpm (double with Base Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Examination of 3D Vision/Stereopsis (Random Dot 3S)
12.5″ (with prism)
12.5″ (no prism)
(normal value: 12.5″)
Examination of Binocular Perception (Worth 4 Dots)
Distance: 2sets of dots seen (1set of 3dots seen at the top & another set of 4dots seen at the bottom)
Near: 4 dots seen
(normal value: 4 dots = normal; 3 dots = Right suppression; 2 dots = Left suppression; 5 dots = Double vision)
Colour Vision
R: normal
L: normal
(normal value: normal)
BHTT Head Tilt Test
R hypertropia
vision is worse on left gaze (patient reports: vision is worse on right/left gaze)
vision is worse on right tilt (patient reports: vision is worse on right/left tilt)
Assessment of Pupil
PERRL, -RAPD
Fluorescein Test
R: -ve
L: -ve
Interpupillary distance, IPD = 6.5cm
Mr Wong said he still sees slight double vision looking at far.
Trial framing
R: PL/-0.25×90
L: PL/-0.25×90 4BU
Add: +1.75
We refer him to see ophthalmologist & orthoptist.