WONG MAN HONG – 88 Optometry

21/4/2021

Man (M/28) came for eye examination, complaining blurry far vision. His left eye is observed to be bulging out compared to his right eye and he reported the bulging has been there since young.

Vision with own glasses of 6years
R: -3.00/-2.75×180 (6/18-)
L: -6.00/-2.75×175 (blurry, cannot guess 6/120)

Examination shows:
R: -4.25/-2.75×180 (6/6) N5@40cm
L: -16.50/-3.75X175 (6/12+) N5-@40cm

Other assessments show:

Examination of Eye Alignment/Vergence (Cover Test)
Left eye Exotropia @Distance & Near
(normal value: orthophoria/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
Exotropia = constant outwards position of eye
Esotropia = constant inwards position of eye

Man reported that he was seeing fine in his left eye 6years ago. With such huge increment of shortsighted power/myopia over the years, we strongly advise him to go and check his left eye with eye specialist doctor/ophthalmologist, but he is not keen to go at the moment. Having such extreme high power, this significantly increases the risks for vision impairment from pathologic eye conditions including retinal damage, cataract and glaucoma.

He is also advised to avoid adventurous, action-filled recreational activities such as bungee jumping that put higher risk for vision impairment.

We will still advise him to go and see ophthalmologist soonest.

Modified power for comfort of glasses wear
R: -4.25/-2.75×180
L: -7.50/-3.75X175
We plan to let him try to wear contact lens of power 800 in his left eye on top of wearing his spectacles.

*UpdatedA

Man (M/29) came & his old spec that he used for working has broken.. and he does not wear any glasses at work for many weeks already aiyoooooo

Man reported seeing ophthalmologist 5years ago, was told about refractive surgery but he did not proceed due to cost.

Existing glasses power
R: -4.25/-2.75×180 (6/6) N5
L: -7.50/-3.75X175

Subjective Refraction
R: -4.25/-2.75×180 (6/6) N5
L: -15.50/-3.75X175 (6/12+) PHNI, N5-

Other assessments show:

Cover Test
Distance: L Exotropia
(upon cover uncover: pt reported LE moves to his left & up)
Near: L Exotropia
– Left proptosis noted

We fitted him with contact lens -12.00 in left eye.

Vision with contact lens
R:
L: -12.00 (6/30-)
(we will reduce contact lens power the next fit, let over Rx to be about the same in BE)

Over Rx (Residual power after wearing contact lens)
R: -4.25/-2.75×180
L: -1.50/-3.75X175

He reported seeing shadow to the right of each of the testing alphabet.

We tried
Over Rx
R: -4.25/-2.75×180
L: -1.50/-3.75X175 2BI

Man reported no double is seen when he is static/not moving, but he still sees slight shadow upon moving his head or changing gaze.

Initially, Man was skeptical in using contact lens as he heard about stories of contact lens melting in the eye. After having the contact lens on & noticing the big improvement in his vision, we guess this changes his mind.. and he is willing to try wearing contact lens in both eyes.

We will wait for him to come back again, to check on remaining tests.

We will refer him to co-manage with ophthalmologist & orthoptist.

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
ACT: alternating CT

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)

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)

Random Dot 3S – 3D Vision/Stereopsis
12.5″

Worth 4 Dots – Binocular Perception 4 dots