Wong Wei Heng – 88 Optometry

WHeng (M/23) came for eye examination, vision is fine seeing far & near.. but sometimes he sees blurry vision.

Vision without glasses
R: cannot guess 6/60
L: 6/45

Own glasses >5years (lenses were refitted to new frame)
R: -4.50/-0.50×175 (6/6)
L: -3.50/-1.50×10 (6/12) (same power on phoropter 6/6)

Subjective Refraction (Delay Fogging +2.00 OU)
R: -4.00/-0.50×10 (6/6) (+1.00 blur test: 6/12+)
L: -3.25/-1.50×165 (6/6) (+1.00 blur test: 6/12+)
Add: +0.75

Other assessments show:

Cover Test
Distance: NMD
(alternating CT: pt reported RE sees target going down & to his left.. LE sees target going up & to his right)
Near: NMD

Howell Card (OD 6^BD)
Distance: 0 – 2 XP

Howell Card (OS 6^BU)
Near: 12 – 14 XP

Howell Card (OD 8^BD)
Near: 16 XP
+2.00 Near: 16 – 18 XP
+1.00 Near: 16 – 18 XP

Howell Card (OD 10^BD)
-2.00 Near: 8 XP
-1.00 Near: 10 XP

Maddox Rod
Distance: 2 BI
Near: 16 BI, OS 1BU

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

NPC (with Add +0.75)
8/12cm, 10/14cm, 14/20cm, 10/14cm, 8/12cm

AA
R: 10.5D, 9.5D, 8.5D
L: 8.5D, 7.5D, 7D (blurry @end of RAF rule, clear @30cm)

MEM
R: +1.00
L: +1.00

Accommodation Facility (+/- 2.00)
BE: 9cpm, difficult minus lens
R: 10cpm, difficult minus lens
(RE sees better than with BE)
L: 10cpm, difficult minus lens
(BE see better than with LE)

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

Fusional Reserves (with Add +0.75)
Near, PFV: x/14/12

Vergence Facility
Near: 0 cpm
(double BO, double did not go closer with blink)
Distance: 0 cpm
(initially double BI.. with repeated flips – double BO, double did not go closer with blink)

Fluorescein
R: -ve
L: -ve

Interpupillary distance, IPD = 7.1cm

Pseudo CI?

We update WHeng’s prescription & prescribe added plus at near.

His work & studies require him to be on computer most of the time, we emphasise on taking regular break.

KIV vision therapy,VT to normalise & equalise accommodation in BE.

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 | (Maddox Rod)
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, PFV: x/15-31/10-22
Near, NFV: x/7-17/3-11
Adult
Near, PFV: x/10-28/7-21
Near, NFV: x/7-19/5-15
Distance, PFV: x/4-18/5-9
Distance, 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)