Sample of summarising data for case studies

In the case studies, the phrase 'no perceptual distortions' indicates that the child replied 'no' when asked whether letters or words ever blur, double, jump around, move, flicker, shimmer, wobble, or change size or shape. If the child responded by reporting any of these symptoms, then they were questioned further.

Ophthalmoscopy is direct ophthalmoscopy unless otherwise stated.

Pupils are routinely assessed for direct, consensual, near, and afferent pupillary defects. When pupil reactions are described as 'normal' then these four features have always been checked.
Cover test recovery is graded as follows:

Cover/uncover test, deviation in prism diopters is estimated from movement, unless otherwise stated
Alt = alternating; R/L=R hyper; SOP=esophoria; XOT=exotropia; etc
If phoria, the recovery is graded as G1 (grade 1; rapid and smooth), G2 (slightly slow/jerky), G3 (definitely slow/jerky but not breaking down), G4 (slow/jerky and breaks down with repeat covering, or recovers only after a blink), G5 (breaks down readily after 1-3 covers).

The patient's usual reading distance (and any commonly used intermediate distances) are recorded on the front of the record and all near vision tests (except Maddox wing) are carried out at this distance. At every visit the OO checks that this is still the patient's habitual reading distance. These measurements are shown in the record under the heading.

'Vision' generally refers to unaided vision and 'visual acuity' to corrected visual acuity.

The cover test target is usually an optotype from the line above the worst monocular VA. If this is worse than about 6/24 then a spotlight is used.

With the Maddox wing test, patients are first asked which horizontal number the arrow points to, and then whether the arrow moves. If it moves, they are asked to describe which numbers it moves between to give an estimate of variability of the horizontal heterophoria (for example, 4Æ XOP ± 2Æ).

The variable prism stereoscope is adjusted at the rate of approx 1Æ per second and uses a near test target comprising a vertical column of numbers (1 3 7 0) of N5 size. If an eye cannot resolve these then an alternative target is used comprising a vertical black line measuring 2cm high by 3mm wide.

NCT readings for each eye on records are always the average of three good readings unless the readings are unusually variable (>3mmHg), in which case more readings are taken and the values are individually quoted.

The International Standards Organisation has suggested describing the prism to eliminate a fixation disparity as the aligning prism; this term is used throughout the Portfolio. Similarly, the aligning sphere is the spherical correction that eliminates a fixation disparity.

Convergence/divergence: this refers to a test of jump convergence (Jennings, 1998), which is used occasionally in these case studies. The patient is asked to alternate fixation between a distance Snellen letter two lines above their worst monocular acuity and a 6/12 letter on a 'budgie stick', which is held at 15cm (or a few cm outside their near point of convergence). A 'normal' response is prompt and smooth convergence and divergence movements. Version movement of both eyes, hesitant or slow convergence, or no movement, are all taken to be abnormal.

MEM retinoscopy: In some records (where accommodative dysfunction is suspected), accommodative lag is measured by retinoscopy using the monocular estimate method (MEM; Cooper, 1987).