Lian jie (F/53) came for eye examination, with complaint of sometimes blurry near vision with existing reading glasses of few years(she did not bring.. & she said her “lou fah” power is 100 with some “san gong” 175 or 075). She uses her glasses to see phone only.. she can still manage to read newspaper without glasses.
Vision without glasses
R: 6/12+
L: 6/6
Subjective Refraction
R: PL/-1.00×80 (6/6) (+1.00 blur lens test: 6/7.5-)
L: PL (6/6) (+1.00 blur lens test: 6/7.5-)
Add: +1.50 (N5@40cm)
No long-sightedness is accepted @far.
Other assessments show:
Cover Test
Distance: NMD
(ACT: pt reported RE sees target further away & smaller, LE sees nearer & bigger)
Near: NMD
Howell Card
Distance: 0
Near: 4 – 6 XP
-1.00 Near: 4 – 6 XP
NRA
+0.75
PRA
-0.50
NPC
6/10cm, 6/10cm, RE deviates @8cm
MEM
R: dim
L: dim
Fusional Reserves
Near, PFV: x/x/x
Near, NFV: 4/10/8 (above break pt 4, double then single)
Distance, NFV: x/8/6
Distance, PFV: x/20/18
Vergence Facility
Near: 4 cpm (after 4cpm, double BO)
Distance: 7 cpm (slow BO)
Interpupillary distance, IPD = 6.5cm
Slit Lamp
R: mild cataract
L: mild cataract
Fluorescein
R: -ve staining
L: -ve staining
Amsler Grid
R: some crooked lines, some grids are bigger & some are smaller
L: normal
Modified reading power
R: +1.50/-0.50×80
L: +1.50
Lower DC is favoured @Near
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 Alignment
(Maddox Rod) placed on RE
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)
AA(Amplitude Accommodation) – eye stamina (Dioptre, D) (RAF rule)
6yo – 16.5D | 6cm
9yo – 15.5D | 6.5cm
12yo – 14.5D | 7cm
15yo – 13.5D | 7.5cm
18yo – 12.5D | 8cm
21yo – 11.5D | 9cm
24yo – 10.5D | 10cm
27yo – 9.5D | 11cm
30yo – 8.5D | 12cm
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/lights