Mr Wong (M/49) came for eye examination, with complaint of slight blurry near vision with existing glasses of 4-5years in which he needs to hang his glasses lower on nose to see near a bit better.
Vision without glasses
R: 6/15-
L: 6/18-
Vision with existing glasses
R: -0.50/-4.00×180 (6/7.5-)
L: -0.75/-4.00×180 (6/12+)
Examination shows: (Delay Fogging)
R: PL/-4.00×180 (6/7.5+) PH 6/7.5+ (R: right dominant eye) R>L
L: PL/-4.00×180 (6/7.5+) PH 6/7.5+
Add: +1.50 (N5@40cm) R>L
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes down.. when covering right eye, the target goes up)
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: 1 EP (yellow part)
Near: 2 – 4 XP (blue part)
No Add Near: 0 – 1 EP (yellow 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
+0.75
(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)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
15/21cm 15/21cm, 15/21cm, 16/22cm, 16/22cm, 16/22cm
no doubling is reported (patient reported that vertical line moves to her left side at end of RAF rule)
(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: 16/20/18
Near, Base-In/Divergent, NFV: 8/12/10
Distance, Base-In/Divergent, NFV: 4/6/4
Distance, Base-Out/Convergent, PFV: 8/16/14
(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: 12 cpm
Distance: 5 cpm (double with Base In, blink then can see single back slowly)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
AHP Head Posture
slight chin up
Prescribe
R: PL/-4.00×180
L: PL/-4.00×180
Add: +1.75
All near tests are done with Add.
Interpupillary distance, IPD = 6.8cm