QZee (F/14) a non-spectacles wearer, came for eye examination with complaint of tired eyes after hours of computer/phone. When she looks back in the distance/far away, it takes a while before regaining clear vision.
Vision without glasses
R: 6/6-1
L: 6/6
Examination shows: (Delay Fogging)
R: PL/-0.50×180 (6/6) [+1.00 blur lens test: 6/9-2] (R: right dominant eye)
L: +0.25/-0.50×5 (6/6) [+1.00 blur lens test: 6/9-] L>R
Add: +0.50 L>R
She shared that vision is dimmer, she likes it brighter.
Modified
R: PL/-0.25×180
L: PL-0.25×5
Add: +0.75
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target is smaller & dimmer.. when covering right eye, the target is brighter & bigger)
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: 0
Near: 0 – 1 EP (yellow part) top arrow stops at 1 yellow
+1.00 Near: 0 – 2 XP (blue 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
+1.50
(normal value: +1.50 to +2.50)
PRA (Accommodation analysis – ability to stimulate accommodation) by minus lens
-2.50 (> -1.00 = words are blurred then clear)
(normal value: -1.37 to -3.37)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: PL
L: PL
(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: 8 YO, 8 YO, 8 YO (her head retreats backwards when target gets closer)
L: 8 YO, 8 YO, 8 YO (her head retreats backwards when target gets closer)
(normal value: AA goes according to age; YO=years old)
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)
Accommodation Facility – ability to change focus: far to near or near to far (by Flipper +/-2.00)
BE: 12 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 13 cycle per minit(cpm), difficult with plus lens(1st lens) [both eyes see better than with right eye]
L: 13 cycle per minit(cpm), difficult with plus lens(1st lens) [both eyes see better than with left eye]
– patient reported seeing [bigger but blurrier with plus lens] & [smaller but clearer with minus lens]
(normal value: 1 cycle = 2 words read
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Near, Base-In/Divergent, NFV: x/8/4
Near, Base-Out/Convergent, PFV: x/12/10
Distance, Base-In/Divergent, NFV: x/8/6
Distance, Base-Out/Convergent, PFV: x/25/20 (above 12, target is seen double then become single back)
(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 – Adult Data]
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar (with Add +0.75)
Near, Base-In/Divergent, NFV: x/12/8
Near, Base-Out/Convergent, PFV: x/25/20
Vergence Facility – ability to make rapid repetitive vergence changes (by Prism Flipper of 12Base Out & 3Base In)
Near: 17 cpm
Distance: 11 cpm (difficult Base-Out)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary Distance = 6.0cm