CEn (F/12) came for eye examination, vision with existing glasses of 2years is fine seeing far & near. She is able to copy from whiteboard at school. No headache is reported.
Vision without glasses
R: 6/60-
L: 6/120
Vision with existing glasses
R: -4.00/-0.50×170 (6/6)
L: -4.00/-0.50×165 (6/9-)
Examination shows:
R: -4.00/-0.50×170 (6/6) [+1.00 blur lens test: 6/15] (R: right dominant eye) L>R
L: -4.25/-0.50×170 (6/6) [+1 .00 blur lens test: 6/12-] (adding +0.25 in left eye: R>L but not favoured)
Near: R>L (adding +0.25 in left right: L>R)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target looks bigger & goes to her left.. when covering right eye, the target looks smaller & goes to her right)
NMD @Near
(alternating CT: pt reported NMD)
(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: 0
Near: 0 – 2 XP (blue part)
+1.00 Near: 2 – 4 XP (blue part)
-1.00 Near: 3 – 5 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
-0.75
(normal value: -1.37 to -3.37)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, TTN, TTN, TTN
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 2.00 (binocularly) & +/-1.50 (monocularly)
BE: 8 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 8 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with right eye)
L: 8 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with left eye)
– difficult to clear +/- 2.00 monocularly (Fusional Vergence Dysfunction would have normal monocular accommodation facility?)
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: +0.75
L: +0.75
(normal value: +0.25 to +0.75)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 12 YO, 12 YO, 12 YO (target is blurry @end of RAF rule, only comes into focus @30cm) (target is better is -0.50DC than -0.25DC)
L: 10 YO, 10 YO, 10 YO (target is blurry @end of RAF rule, only comes into focus @25cm)
(normal value: AA goes according to age; YO=years old)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-Out/Convergent, PFV: x/8/6
Near, Base-In/Divergent, NFV: x/6/4
Distance, Base-In/Divergent, NFV: x/10/8
Distance, Base-Out/Convergent, PFV: 12/25/20
(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: 1 cpm (double with Base In.. sometimes double Base Out, blink2 eyes then single)
Distance: 3 cpm (double with Base Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD = 6.3cm
We ask CEn .. after seeing near, when she looks back at far.. whether or not her far vision is blurry for a short while before becoming clear.. and she said yes. Her near vision is fine when she changes from seeing far to near.
We prescribe +/- 1.00 flipper eye exercise & we will see her in 6weeks.. KIV prism flipper eye exercise.