Wee (M/24) came for eye examination, with complaints of blurry far vision since after MCO, especially worse during raining. Near vision is sometimes blurry too after long hours on phone. He also has regular headache (not specifically after phone) once a while since many years ago. He is not spectacles wearer. He was told that he could have squint eye during last eye check 3-4 years ago.
Vision without glasses
R: 6/24-
L: 6/7.5-
Retinoscopy
R: -1.00/-0.50×180 (6/7.5-)
L: +0.25/-0.50×90 (6/6)
Examination shows: WD lens Delay Fogging – modified for comfort
R: -1.25/-0.25×180 (6/6) (+1.00 blur lens test 6/15-)
L: PL/-0.25×90 (6/6) (+1.00 blur lens test 6/12-) [L: left dominant eye] L>R
Near: R>L
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
small XP, fast recovery @ Distance
moderate XP, moderate recovery @ 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 10^ Base Down on Right eye
Distance: 6 – 8 – 10 XP (blue part)
Near: >20 XP (blue part)
-1.00 Near: 18 – 20 XP (blue part)
(normal value: 0-1 EP or 0-3 XP @Distance and 0-6 XP @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
+1.50
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-1.50
(normal value: -1.37 to -3.37)
MEM (Accommodation lag – to measure accommodation response seeing near target)
R: +0.75
L: +0.75
(normal value: +0.25 to +0.75)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 1.50
BE: 4 cycle per minit(cpm), difficult with plus lens (1st lens)
R: 10 cycle per minit(cpm), difficult with minus lens(2nd lens)
L: 10 cycle per minit(cpm), difficult with minus lens(2nd lens)
* cannot clear +2.00 flipper
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
8/10cm, 9/12cm, 11/14, 13/17cm, 15/20cm
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)R: 6/24-
Jump convergence: slight laggy hesitant
Examination of Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: -/16/8
Near, Base-In/Divergent, NFV: -/20/16
Distance, Base-Out/Convergent, PFV: -/20/16
Distance, Base-In/Divergent, NFV: 14/18/14
(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]
Examination of Eye Alignment/Posture (Howell Card) by 8^ Base Down on Right eye
-1.00 Distance: 4 – 6 XP (blue part)
-1.50 Distance: 0 – 2 XP (blue part)
-1.50 Near: 2 – 4 XP (blue part)
(normal value: 0-1 EP or 0-3 XP @Distance and 0-6 XP @Near)
EP = Esophoria is misalignment of the eye, eye is deviated inwards
XP = Exophoria is misalignment of the eye, eye is deviated outwards
Power of exercise glasses
R: -1.25/-0.25×180
L: PL/-0.25×90
Add: -1.25
Wee has significant exophoria at far & near with receded NPC. We prescribe exercise glasses and free-space stereogram to train his eyes to converge. Proper visual hygiene is reinforced & we advise on holding phone further away with exercise glasses since he is big & tall.
We will see him in 3-4weeks.