S. No

Tests

1^st Visit (After 2 months)

2^nd Visit (After 6 months)

3^rd Visit (After 9 months)

1

History taking

Poor concentration at distance

Improved fixation and concentration while watching television & at school noted by the parent and teacher

Improved hand-writing and reading speed noted by the parent

2

Best Corrected Visual acuity (Cardiff acuity)

OU: 0.3 LogMAR

OD: 0.3 LogMAR

OS: 0.0 LogMAR

OD: 0.2 LogMAR

OS: 0.0 LogMAR

3

Manifest refraction

Cycloplegic Refraction

OU: +1.00 DS/-0.50 DC × 180

OU: +1.50 DS/-0.50 DC × 180

OU: +1.50 DS/-1.50 DC × 170

OU: +2.00DS/ -1.50 DC × 170

OU: +1.50 DS/-1.50 DC × 170

OU: +2.00DS/ -1.50 DC × 170

4

Anterior segment

Horizontal pendular nystagmus with chin down position

Regressed Horizontal pendular nystagmus

Regressed Horizontal pendular nystagmus

5

Posterior segment

Within normal limit

Within normal limit

Within normal limit

6

Fixation

< 5 seconds

8-10 seconds

> 10-15 seconds

7

Eye movement (NSUCO method)

Poor ability and accuracy (Score: 4)

Good ability and accuracy, Head and body movement present (Score: 10)

Good ability and accuracy with limited head movement and no body movement (Score: 18)

8

Cover test

Couldn’t perform

2-3 prism Esophoria at distance and near

2-3 prism Esophoria at distance and near

9

Stereopsis with Titmus fly test

Couldn’t perform

800 seconds of arc

400 seconds of arc

10

Worth four dot test

Couldn’t perform

Fusion at all distances

Fusion at all distances

11

MEM

High

High

High

12

Amplitude of accommodation with Push up method

Couldn’t perform

Reduced

Reduced

13

TVPS

Couldn’t perform

Couldn’t perform

Not age appropriate

14

Bilateral integration with Standing Snow-Angel test

Couldn’t perform

Couldn’t perform

Motor Overflow present

15

Piaget left-right concept

Couldn’t perform

Couldn’t perform

Age-appropriate

16

Diagnosis

Poor fixation and eye movements

Improved fixation, saccades and pursuits. Need to work on accommodation and stereopsis

Improved stereopsis, Reduced accommodation and visual perception

17

Management

In-office vision therapy along with home therapy for m/o & b/o fixation, eye movement and eye-hand co-ordination.

In-office vision therapy along with home therapy for further improvement in eye movements, accommodation and stereopsis

In-office vision therapy along with home therapy for improvement in phoria status, accommodation, vergence and visual perception