Yuva (M/29) datang untuk pemeriksaan mata, mengadu penglihatan jauh2 kabur. Beliau buka spek untuk tengok hp bila kat rumah. Bila tak pakai spek tengok hp, mata senang berair.
Vision without glasses
R: 6/60-1
L: 6/60-2
Vision with existing glasses of 3 years
R: -5.75/-0.75×115 (6/9)
L: -6.75/-0.25×55 (6/6- slow)
Examination shows: (Delay Fogging)
R: -6.25 (6/6) [+1.00 blur lens test: 6/12]
L: -6.50 (6/6) [+1.00 blur lens test: 6/9-] [L: left dominant eye] L>R
Add: +0.50
Other assessments show:
Examination of Eye Alignment/Vergence (Cover Test, CT)
NMD @Distance
(alternating CT: upon covering left eye, patient reported the target goes to his left.. when covering right eye, the target goes to his right)
small XP, fast recovery @Near (exophoric movement is more in left eye than in right eye)
(alternating CT: upon covering left eye, patient reported the target goes to his left.. when covering right eye, the target goes to his right)
(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: 2 XP (blue part)
Near: 8 – 10 XP (blue part)
+1.00 Near: 12 – 14 XP (blue part)
-1.00 Near: 6 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
-1.25
(normal value: -1.37 to -3.37)
MEM – Monocular Estimation Method (Accommodation lag – to measure accommodation response seeing near target)
R: scissors reflex
L: +0.50
(normal value: +0.25 to +0.75)
NPC (Convergence – ability of eye to maintain a single clear near image) by RAF rule
TTN, TTN, TTN, TTN, TTN, TTN
(normal value: Break/Recovery in less than 10cm or to the nose, TTN)
AA (Amplitude Accommodation/Focusing – eye stamina/ability of eye to focus & sustain seeing near clearly) by RAF rule
R: 30 YO, 32 YO, 34 YO (target is blurry @end of RAF rule, only comes into focus starting @32cm)
L: 30 YO, 32 YO, 32 YO (target is blurry @end of RAF rule, only comes into focus starting @36cm)
(normal value: AA goes according to age; YO=years old)
Facility (Accommodation facility – ability to change focus: far to near or near to far) by Flipper +/- 1.00
BE: 14 cycle per minit(cpm), difficult with minus lens(2nd lens)
R: 9 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with right eye)
L: 9 cycle per minit(cpm), difficult with minus lens(2nd lens) (both eyes see better than with left eye)
– cannot clear -2.00 & -1.50 binocularly
(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-Out/Convergent, PFV: 10/20/18
Near, Base-In/Divergent, NFV: 16/18/16
Distance, Base-Out/Convergent, PFV: 10/25/20
Distance, Base-In/Divergent, NFV: 8/10/8
(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: 2 cpm (double Base Out)
Distance: 4 cpm (double Base Out.. blink3 eyes to make it single)
(normal value: 1 cycle = 2 times clearing target
Distance: 12-18 cpm
Near: 12-18 cpm)
Interpupillary distance, IPD = 6.0cm