En (F/26) came for eye examination, with complaints of blurry far vision ie. looking at food menu above cashier counter & blurry vision working on laptop. Her vision has been blurry since many years ago, even after spectacles change 3+ years ago. She is a full-time contact lens wearer of -4.25 in both eyes and she wears her glasses at night after lens removal. No headache is reported.
Vision without glasses
R: 6/120
L: 6/120 (L>R)
Vision with existing glasses
R: -4.50/-0.25×155 (6/18-2, 6/15-2, 6/12-)
L: -4.25/-0.75×10 (6/18-2, 6/15-2, 6/12-)
Examination shows:
R: -5.25/-1.50×165 (6/6) (+1.00 blur lens test 6/12) [R: dominant right eye]
L: -4.75/-1.50×5 (6/6) (+1.00 blur lens test 6/12-) L>R
Add: +1.00 or +1.50 (Range of clear vision: less than 10cm to 25cm)
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test)
small EP, fast recovery @ Distance
moderate EP, 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 6^ Base Down on Right eye
Distance: 3 – 5 EP (yellow part)
+1.00 Distance: 3 – 5 EP (yellow part) – blurry
Near: 11 – 13 EP (yellow part)
+1.00 Near: 7 – 9 EP (yellow part)
+2.00 Near: 1 – 3 EP (yellow part)
+2.50 Near: 0 – 1 EP (yellow 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
MEM (Accommodation lag – to measure accommodation response seeing near target)
R: +2.00
L: +2.00
(normal value: +0.25 to +0.75)
Facility (Accommodation facility – ability to change focus: far to near or near to far) Chart held at 20cm by Flipper +/- 2.00
R: 11 cycle per minit(cpm)
L: 11 cycle per minit(cpm), difficult with minus lens
BE: 10 cycle per minit(cpm), difficult with minus lens
(normal value: *chart held at 40cm – blurry
Monocular or R/L: 6cpm to 16cpm
Binocular or BE-both eyes: 4cpm to 14cpm)
*Chart held at 40cm – blurry
Fusional Reserves (Convergent/Divergent reserve stamina) by Prism Bar
Distance, Base-In/Divergent, NFV: 4/10/4
Distance, Base-Out/Convergent, PFV: 4/18/12
Near, Base-In/Divergent, NFV: 10/16/8
Near, Base-Out/Convergent, PFV: 16/30/18
(normal value: Blur/Break/Recovery)
Distance, PFV: x/4-18/5-9
Distance, NFV: x/4-10/2-6
Near, PFV: 16/10-28/7-21
Near, NFV: 13/7-19/5-15
[Scheiman – Adult Data]
Examination of Eye Alignment/Posture (Howell Card) by 6^ Base Down on Right eye
Distance: 3 – 5 EP (yellow part)
1^ BO in both eyes Distance: 3 – 5 EP (yellow part) [1^ BO = 1 prism Base Out]
2^ BO in both eyes Distance: 3 – 5 EP (yellow part)
3^ BO in both eyes Distance: 1 – 3 EP (yellow part)
1^ BI in both eyes Distance: 5 – 7 EP (yellow part) [1^ BI = 1 prism Base In]
(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
3D Vision (Random Dot 3S)
12.5 slow – face repeatedly paced closer & further away from testing book to see
(normal value: 12.5)
En always holds her hp & book at very upclose distance to see clearly since many2 years ago. She will end up going near to screen to see when working on laptop. She reported her vision is blurry like this since long ago, even after she has changed a new spec. As she recalled, her previous glasses was about shortsighted power of -3.50 with no astigmatism in both eyes before she changed into her existing glasses.
We refer her for cycloplegic refraction (to put eye drop to temporarily paralyse eye muscles) & we will see her again soon.