Loft optometry ;Your Eyes In Good Hands.

25/08/2026

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Loft Optometry : Location Update
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I would like to share an update regarding our current office location for patients seeking clinical optometry services.
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Over the past two months, I have been fine-tuning our workflow with our returning patients. I'm now fully prepared and operational.
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My practice has relocated from the previous Watcharapol location to my home office situated along Liap Khlong Prapa Road (Chaeng Watthana – Song Prapha).
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This move was originally planned for nearly a decade with ideas to build next door, but when the timing called for a change, we made the transition into this current space and made the absolute best of it.
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First and foremost, a heartfelt thank you to all returning patients who visited while things were still being set up. The unanimous feedback has been "Why didn't you move sooner? This is so much more convenient for both travel and parking!"
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How to Find Us
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if you Coming from Chaeng Watthana Rd.

Before reaching the Muang Thong Thani entrance (Khlong Prapa gate), you will see the Motown Brio village. Look slightly up, and you will spot our [Loft Optometry] – [Rodenstock] signs prominently displayed.
You can park directly in front of the house (the corner unit adjacent to the perimeter wall). The clinic is in the front zone of the property—no need to drive past the security guardhouse.
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2. if you Coming from Song Prapha Rd.

Drive slightly past St. Francis Xavier School. As you approach the Muang Thong junction, look up to spot our [Loft Optometry] – [Rodenstock] signs. Continue just past the junction and turn right directly into Motown Brio.

3.Coming from Upcountry / Out of Town: Take the expressway exit into Muang Thong Thani, then head toward the Khlong Prapa exit gate. Right before exiting, look up to your right to see our signage. Turn right onto the main road, and then make an immediate right into the village.
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Clinic Hours (Unchanged)

Tuesday – Sunday: Examination hours from 10:00 AM – 6:00 PM (Closed Mondays)
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Accessibility & Traffic Considerations
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Stairs Access: Our clinical examination office is located on the 2nd floor. This may present accessibility challenges for patients unable to climb stairs. We are actively planning an elevator installation in the near future once resources allow.
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Evening Traffic (3:00 PM – 4:30 PM): This coincides with school dismissal at St. Francis Xavier School. If scheduling an afternoon appointment, we highly recommend arriving before 2:30 PM. Otherwise, a 2–3 km stretch along the canal road may take over 30 minutes.

Alternatively, aim to arrive after 4:30 PM (please check Google Maps for real-time traffic conditions).
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Clinical Instrument Update

my clinical optometry equipment is fully calibrated and ready. We have also enhanced our diagnostic suite with the new Reichert Phoropter and the latest-generation DNEye Scan 3. These instruments significantly enhance clinical investigation across both anterior and posterior segments—including high-resolution retinal imaging, dry eye assessment, and comprehensive ocular biometrics required for tailoring Rodenstock Impression B.I.G. EXACT Sensitive lenses.
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Thank you to all our page followers and patients for your continuous trust and support. Once everything is fully settled, expect more frequent case studies and clinical updates.
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Warm regards,
Dr. Loft
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LOFT OPTOMETRY
111/56 Motown Brio Village, Liap Khlong Prapa Rd. (Chaeng Watthana – Song Prapha), Ban Mai, Pak Kret, Nonthaburi 11120
Mobile: 090-553-6554
Line ID: loftoptometry
Website: www.loftoptometry.com
Google Maps: https://maps.app.goo.gl/T4Cj9JNQGouCS1o38

20/03/2025

topic : Why Does Myopia Decrease in Elderly Patients?
By Dr. Loft, O.D.
Introduction

Over the past 10 years, several cases have been observed where "myopia decreases with age." This case study is an example of a patient I have been taking care of since early 2019 until now (2025). The patient's distance vision myopia has decreased by more than 1.00D, while the addition power has remained relatively stable. Many patients exhibit similar trends, prompting me to revisit textbooks and research the factors that contribute to this phenomenon. Today, I will share my findings.
Patient Background

This patient female aged 57 ( in 2019), initially wore single-vision lenses, which provided clear distance vision but caused difficulty reading. Based on a friend's recommendation, the patient opted for progressive lenses from a well-known optical store in Social media (by ads) .
However, after the first use, they experienced discomfort in the left eye, including pain radiating from the inner eye to the cheek and an abnormal strain on the left eye. The store advised the patient to adapt for one more week.
After a week, the pain persisted, leading the store to adjust the prescription by reducing distance vision power by one step (0.25D). The pain lessened but did not completely resolve. The patient continued experiencing discomfort and frequent blinking and was advised to adapt for another two weeks.
While waiting, the patient researched online and came across Loft Optometry : Your Eyes in Good Hands. page, eventually reaching out to me via inbox for a professional analysis. This led to a comprehensive eye exam.
Preliminary Eye Exam (2019)

Patient's Habitual Prescription (After Previous Adjustments)

OD: -4.50 VA 20/20

OS: -4.50 VA 20/25

Addition: +2.50
New Refraction Findings

Retinoscopy

OD: -4.00-0.50x30 VA 20/20

OS: -3.25-0.50x180 VA 20/20

Final Prescription (BVA)

OD: -3.75 -0.62 x 65 VA 20/15+2

OS: -3.00 -0.62 x 5 VA 20/15+2

Functional Tests at 6 m

Horizontal Phoria. : 6 BI Exophoria

Vertical Phoria : 1 BD OD (Right Hyperphoria)

Functional Test at 40 cm

BCC: +2.00 D

NRA/PRA: +0.75/-0.75 (rely on BCC)


1.Compound myopic astigmatism

2.Convergence insufficiency

3.Right hyperphoria

4.Presbyopia


1.Full Prescription

OD: -3.75 -0.62 x 65

OS: -3.00 -0.62 x 5

2. Prism Correction

3. 3 BI prism to reduce latent exophoria

4. 1 pd prism to correct right hyperphoria

Progressive Additional Lens

Add +2.00D
I'm prescribe this Rx and ask her to claim the shop she bought for new lens with new Rx and Following these changes, the left eye pain disappeared, and vision improved at all distances. However, near and intermediate vision was still suboptimal. Upon reevaluation, I suspected an issue with the progressive lens design (a brand I did not trust : well known brand from ads but not innovation) . The patient agreed to switch to a higher-quality lens (Rodenstock Multigressiv MyView 1.6), which resolved all issues.
Follow-Ups

April 24, 2021 (Two Years Later)

The patient returned for prescription sunglasses. A new eye exam showed:

Refraction

OD: -3.75 -0.50x43 VA 20/20

OS: -2.75 -1.00x170 VA 20/20
Plan

1.)Full Rx with Add +2.25

2.)0.5 BD OD / 0.5 BU OS prism

3.)BI prism removed due to normalized horizontal phoria
February 25, 2025 (Four Years Later)

The patient reported clear distance vision but increasing difficulty reading, an uncommon issue in individuals over 55 unless distance vision power has decreased.

New Refraction Findings

OD: -3.00 -0.50x60 VA 20/20

OS: -2.12 -0.37x130 VA 20/20
Plan

Full Rx
OD -3.00 -0.50x60 VA 20/20

OS. -2.12 -0.37x130 VA 20/20

Add +2.25D

0.5 BD OD / 0.5 BU OS prism



Full Correction and Binocular Function

With full correction, binocular function normalized over time. Initially, the patient exhibited significant exophoria (6 BI), but after wearing the prescribed correction, it reduced to 1 BI, indicating that proper accommodation balance helped the eyes stabilize. However, vertical phoria remained unchanged, as hyperphoria is unrelated to accommodation.
Changes with Age

The patient’s myopia decreased significantly:

OD: From -4.00DS (2019) to -3.00DS (2025)

OS: From -2.75DS (2019) to -2.12DS (2025)

This prompts the question: Why does myopia decrease with age?
Affecting Myopia Reduction

Corneal Curvature: Usually stable after the mid-20s

Axial Length: Lengthening in childhood increases myopia, but remains stable in adulthood

Crystalline Lens Changes: Continuous fiber accumulation makes the lens denser and less flexible

Aging lenses absorb UV rays and gradually become opaque, leading to cataract formation. Cataracts can shift refraction in two directions:

: Increased farsightedness

: Increased nearsightedness (or decreased farsightedness)
Types of Cataracts Affecting Refraction



Occurs in the central lens, causing a denser protein core, increasing lens refractive index, leading to a myopic shift (increased nearsightedness).



Occurs in the outer layers, often appearing as spoke-like opacities. These cataracts can cause hyperopic shifts, affecting near vision first.


This case demonstrates how aging, cataract formation, and lens hardening contribute to myopia reduction in elderly patients. Understanding these changes helps optometrists provide accurate prescriptions and improve patient outcomes.

For patients experiencing unexpected myopia reduction, regular eye exams are essential to monitor cataract progression and ensure optimal vision correction.

thanks for your following

dr.loft ,O.D

reading in original thai version : https://www.loftoptometry.com/whatnew/view/211

17/03/2025

"The Clarity Market" – Thailand’s Vision Bazaar
By Dr.Loft ,O.D.

Initially, this article wasn’t meant to have this title. It began with a simple question: What does "clarity" truly mean to Thai people? If 100 people say they see clearly, do all 100 of them perceive the world the same way? What does “clear” even mean?

Everywhere we look, we see a world obsessed with clarity—ultra-clear TVs, high-definition movies, crystal-clear cameras, and sharp smartphone screens. Technology keeps evolving: HD, 4K, 5K, 8K, Retina Display—all designed to provide the clearest possible vision.

In the world of eyeglasses, the demand for clarity is just as strong. Opticians measure vision for clarity, patients want clear glasses, and lens companies market their lenses as the sharpest available. But ironically, when it comes time to prescribe glasses, many professionals say:
👉 “Don’t make the prescription too sharp, or it will cause headaches.”

If clarity truly caused headaches, then wouldn’t an 8K display be more painful to watch than a 5K, 4K, or HD screen? Would an old CRT television with weak signals and lots of noise be easier on the eyes? Clearly, this is not the case.

So, what exactly do we mean by “clear”? If clarity supposedly leads to discomfort, what are we actually measuring? Do we truly understand what "clarity" should look like?

The Business of Selling Clarity

Before we chase after "clarity" in the marketplace, we should first ask ourselves: What does true clarity look like? True clarity should be comfortable, effortless, and free from headaches. But how do we define correct clarity?

In clinical optometry, which is the global standard for vision care, clarity is not just about seeing sharp images—it’s about correct vision that is comfortable and functional. If a prescription is truly accurate, it should not cause discomfort. There must be a point where clarity is both correct and comfortable.

Yet, clarity has become a multi-billion-dollar industry, with businesses competing to sell it. And when clarity becomes a product to be marketed, advertising tactics take over. This leads to exaggerated marketing gimmicks—grand promises like:
✔ The clearest vision!
✔ The sharpest details!
✔ The most advanced technology!

We hear endless superlatives even though we know there is no such thing as the absolute “sharpest” or “best” vision. These marketing phrases exist to sell products, not to ensure correct vision.

But how many people truly understand what real clarity is? What kind of clarity prevents headaches instead of causing them?

This article aims to help both consumers and eye care professionals recognize what true clarity should be. If you ever need to "shop for clarity," you’ll be equipped with the knowledge to make the right choice. And if you're in the business of selling clarity, this might encourage you to think beyond marketing gimmicks and instead focus on clinical accuracy—so that clarity is not just a sales pitch but a true visual solution.

Raising Professional Standards in Thai Eye Care
This article is written with the hope that the optical industry in Thailand can align with a global standard of vision care. There are no official regulations in Thailand—anyone with enough money can open an optical shop, regardless of whether they have professional optometry training. This situation makes Thailand’s vision care industry look underdeveloped, operating without laws, regulations, or accountability.

One of the biggest myths that needs to be erased from Thai optometry is:

👉 “Don’t prescribe too much clarity, or the patient will get headaches.”

This statement is completely false. The issue is not about too much clarity—it is about prescribing the correct clarity. When vision is corrected properly, it should be clear, comfortable, and headache-free.

So, if you want to know what correct clarity looks like, keep reading.

Lastly, I wish you all good health and safety. Let’s overcome COVID-19 together and step into a future with better vision care for all.

Dr. Loft
Loft Optometry : Your Eyes in Good Hands.
📍 578 Wacharapol Rd., Bangkhen, Bangkok
📞 090-553-6554 | 📩 Line: loftoptometry | 🌐 www.loftoptometry.com

คลินิกทัศนมาตรที่ใช้มาตรฐานสูงสุดในการแก้ไขปัญหาการมองเห็น

16/03/2025

Case Study
Topic: The Management of Pre-Presbyopic Mixed Hyperopic Astigmatism with Plus Lens SV
By: Dr. Loft, O.D.

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Case History

A 45-year-old male patient presented for an eye exam, reporting that his current progressive glasses are becoming blurry for near vision, while distance vision remains clear.

Six years ago (08/06/2019), at the age of 39, he visited the clinic complaining of mild distance blur, while still being able to read at near without glasses. He had no complaints of headaches or double vision, was in good health, and worked on a computer all day.

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Initial Examination (2019)
Preliminary Eye Exam
PD:36/36
Visual Acuity (Unaided):
OD: 20/20
OS: 20/40
Alternating Cover Test (CT): Ortho / EP’

Retinoscopy Findings
OD: +0.75 -0.50 × 90 (VA 20/20)
OS: 0.00 -0.50 × 90 (VA 20/20)

Monocular Subjective Refraction
OD:+0.75 (VA 20/20)
OS: -0.25 -0.50 × 90 (VA 20/20)

Best-Corrected Visual Acuity (BVA) on Phoropter
OD: +1.00 (VA 20/20)
OS: +0.50 -0.50 × 95 (VA 20/20)
OU: VA 20/15

Binocular Function at Distance (6m)
Horizontal Phoria: 5 BI (exophoria)
BI Vergence : X / 8 / 3
BO Vergence : 6 / >20 / -
Vertical Phoria: Ortho

Binocular Function at Near (40cm)
Horizontal Phoria : 8 BI (exophoria)
BI Vergence : 18 / 30 / 24
BO Vergence: 12 / 18 / 12
BCC:+0.50
NRA:+2.25

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Assessment (2019)
1. Simple hyperopia OD and mixed hyperopic astigmatism OS
2. Convergence insufficiency

Management Plan (2019)
1. Full prescription: Single vision lenses (Rodenstock Parfait 1.6)
OD: +1.00
OS:+0.50 -0.50 × 95
2. No additional treatment required

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Current Examination (12/02/2025)
Refraction Findings
Retinoscopy
OD: +1.00 -0.75 × 90 (VA 20/20)
OS: +0.75 -0.75 × 90 (VA 20/20)

Monocular Subjective Refraction
OD: +1.00 -0.62 × 97 (VA 20/20)
OS: 0.00 -1.00 × 110 (VA 20/20)

Best-Corrected Visual Acuity (BVA) on Phoropter
OD: +1.25 -0.62 × 97 (VA 20/20)
OS: +0.25 -1.00 × 110 (VA 20/20)
OU: VA 20/15

Best-Corrected Visual Acuity (BCVA) with Trial Frame
OD: +1.00 -0.62 × 100
OS: 0.00 -0.87 × 100

Binocular Function at Distance (6m)
Horizontal Phoria: 2 BI (mild exophoria, within normal limits)
Vertical Phoria: Ortho

Binocular Function at Near (40cm)
BCC: +1.00
NRA: +2.25 (relies on BVA)
PRA: -0.75 (relies on BVA)

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Assessment (2025)
1. Compound hyperopic astigmatism OD and simple hyperopic astigmatism OS
2.Presbyopia
3.Normal binocular function

Management Plan (2025)
1. Full prescription:
OD:+1.00 -0.62 × 100
OS: 0.00 -0.87 × 100
2. Progressive additional lenses
Add: +1.25 (Rodenstock Progressive B.I.G. Norm 1.6)
3. No additional treatment required

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Discussion

Over the past six years, the patient’s distance prescription has not significantly changed. However, presbyopia has developed, which is a natural decline in the eye’s ability to accommodate due to reduced lens flexibility.

For this case, since the addition power is only +1.25D, single vision lenses with a mild plus addition could have been prescribed. However, Rodenstock's pricing structure makes progressive lenses more cost-effective than single vision lenses with an add, leading to the decision to prescribe Rodenstock Progressive B.I.G. Norm 1.6 with an add power of +1.25D.

Regarding the frame, the patient's Lindberg Spiritis still in good condition and only requires minor part replacements (e.g., rubber components). This makes it a worthwhile long-term investment, as Lindberg frames are durable, resistant to color fading (except for shiny rose gold PU60 , which may fade), and offer ongoing availability of spare parts.

One interesting observation in this case is that fully correcting the patient’s vision helped reduce his exophoria from 5 BI to 2 BI , which is within the normal range. This supports the principle that proper full correction—without unnecessary adjustments—can help restore normal binocular vision function.

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Conclusion

This case was relatively straightforward. Thank you for following along, and I’ll see you in the next case study!

Best regards,
Dr. Loft, O.D.

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Products Used
Lenses:Rodenstock PGR B.I.G. Norm 1.6 All L
Frame: Lindberg Spirit 5569
Size: 55 #16
Bridge:Flat M
Temple:155mm
Color: Deep Blue (20)

Contact Information
Loft Optometry
Address: 578 Wacharapol Rd., Tharang, Bangkhen, Bangkok 10220
📞 090-553-6554
Line ID: loftoptometry
Website: www.loftoptometry.com

16/03/2025

Preview Case
by Dr.Loft,O.D



Yatita, a 42-year-old female patient, came in for a routine eye check-up. She has clear distance vision without glasses but experiences strain and tension in her eyes when reading, making near work increasingly difficult.

She has never worn glasses before.

She experiences daily headaches, which become more intense in the afternoon or after prolonged computer use. However, due to her work, she cannot avoid using a computer, spending 4–6 hours in front of a screen daily.

She is in good health, undergoes annual medical check-ups, and does not take any regular medications.


Visual Acuity (Unaided)
OD: 20/20
OS: 20/20

Refraction
Retinoscopy
OD: +0.50 -0.50 x 180, VA 20/20
OS: +0.25 , VA 20/20

Monocular Subjective Refraction
OD: +0.50 -0.12 x 180, VA 20/20
OS: -0.25 , VA 20/20

Best Vision Acuity (BVA) on Trial Frame
OD: +0.50 -0.12 x 180, VA 20/20
OS: +0.12 , VA 20/20

Best Corrected Visual Acuity (BCVA) on Trial Frame
OD: +0.50 -0.12 x 180, VA 20/20
OS: +0.12 , VA 20/20

Binocular Function at 6m Distance:
Horizontal Phoria: Ortho
Vertical Phoria: Ortho

Functional Testing at 40cm (Near Vision)
BCC: +1.00
NRA: +2.25 (relative to BVA)
PRA: -1.00 (relative to BVA)


1. Simple Hyperopia (OD & OS)
2. Pre-Presbyopia
3. Normal Binocular Function


1. Full Prescription:
OD: +0.50 -0.12 x 180
OS: +0.12
2. Plus Add Single Vision Lens:
RX_Add +1.1 (Rodenstock Cosmolit B.I.G. Norm 1.6 P+1.1)
3. N/A



At first glance, the refractive error seems minimal, but this seemingly small issue causes daily headaches for the patient. Given that her distance vision is already clear, there’s a high chance that she might opt for glasses with no prescription and blue-light filtering, or worse, continue relying on painkillers for relief.

The next question is:
Why does such a minor refractive error cause daily headaches?

The exam results indicate that the headaches are not due to binocular vision dysfunction, as her phoria results are Ortho. This leaves fatigue of the accommodative system (accommodative insufficiency) as the likely cause. This condition marks the early stages of pre-presbyopia, where the eye struggles to maintain focus for extended near tasks—such as prolonged computer use. Over time, the resulting stress on the accommodative system leads to headaches.

A Common Dilemma: Should We Correct a Minor Refractive Error?

If the patient can already see clearly at a distance, and one eye has slight hyperopia (+0.50D) while the other has nearly zero error (0.00D), should we prescribe 0.00D for both eyes instead?

Many optometrists follow the principle:

"If it ain’t broke, don’t fix it!"
This mindset is ingrained in many professionals, discouraging them from prescribing full correction even when needed.

However, human vision is “binocular” our eyes function as a system, much like the front wheels of a car turning together. If one part of the system is off-balance, the entire function is compromised, leading to discomfort and strain. Just as car wheels require proper alignment for smooth driving, our eyes need balanced vision for optimal comfort.

To achieve this balance, we must ensure that both eyes focus together (correcting any astigmatism) and that their focal points are equidistant from the retina. This equalizes the accommodative response, preventing "fluctuations in accommodation” a condition where the eyes struggle to find a stable focus, causing ongoing strain and headaches.

Many practitioners mistakenly believe that “binocular balancing” means prescribing the same lens power for both eyes. This is incorrect. The goal is to “equalize accommodative effort”, not necessarily to make both prescriptions identical. The concept of Aniseikonia (differences in image size between eyes) is often cited as a reason to avoid full correction, but in practice, the effects are usually minor compared to the benefits of full correction.



Upon wearing the new glasses, the patient initially felt slightly unusual due to the progressive structure of the Plus-Addition +1.1D lenses. However, she immediately noticed that her distance vision felt more relaxed. Although she could see clearly without glasses, wearing them provided added clarity and reduced strain.

For near work, she no longer needed to strain her eyes. The only adoption issue was peripheral aberration , which is expected when adapting to progressive lenses for the first time. However, after discussing with her for 30 minutes, her discomfort significantly reduced. Based on this, I estimate that she will fully adapt to the lenses within two days.

This case highlights the importance of full correction—even for small refractive errors—when considering the overall function of the binocular visual system.

Product Used
Lens:Rodenstock Cosmolit B.I.G. Norm Plus +1.1
Frame Lindberg Spirit 2528 (Color: P10/P10)

For more information on Plus Add Single Vision Lenses, visit:
https://www.loftoptometry.com/whatnew/view/64

Loft Optometry
578 Wacharapol Rd, Tharang, Bangkhen, BKK 10220
📞 Mobile: 090-553-655
📱 Line ID: loftoptometry

14/01/2025

No symptom complain , does not mean no problem."

Case Study� : The Treatment of Compound Hyperopic Astigmatism and Diplopia Caused by Hypertropia + Esophoria with Prism Single Vision + Add Plus Lens.�

By Dr. Loft O.D.

Introduction

Before diving into the details, let me wish everyone a belated Happy New Year! May the divine bless everyone with happiness, good health, and strength for the year ahead and beyond. Buddha Bless.

For this inaugural case study of 2025, I would like to share a case I found quite interesting. The patient presented with what appeared to be a minor issue—there were no obvious complaints, and the patient did not even realize there was a problem.

However, upon further investigation, we discovered multiple issues, including the suppression mechanism of visual system, which led to the patient unknowingly using one eye for most of their life.

mention to suppression , The suppression mechanism is an adaptive response by the brain that "turns off" or ignores the input from one eye when it detects that the images being sent by both eyes do not align or match. This mechanism helps to prevent the perception of double vision, which could be confusing and disorienting

This case also highlights the importance of checking for problems even when the patient feels no discomfort, as many people simply adapt to these issues over time. The patient, now 37 years old, learned for the first time how the world real depth looks when viewed with both eyes.

Case History

A 37-year-old male came in for a routine eye check (just curious about getting his vision checked). He reported being able to see clearly at a distance, but having difficulty reading. His current glasses were made to correct his hyperopia, and he had been using them for over a year. He did not experience headaches or diplopia, and his distance vision remained clear. He could still read better with glasses than without them, but overall, he did not perceive any major problems (the reason the patient was not aware of diplopia was because his brain had suppressed the signal from one eye as above describe).

Surgery History

When inquiring about past surgeries, the patient mentioned having had eye muscle surgery as a child (he could not remember which eye was operated on or the exact nature of the surgery). He also underwent another eye muscle surgery 5 years ago, specifically on his left eye, to improve cosmetic appearance. Post-surgery, he did not experience headaches or diplopia, but he also could not perceive depth, which was something he had never been able to do.

Mention above : Despite not being able to combine images from both eyes, the patient never saw double because his brain learned to suppress one eye's signal, creating the experience of monocular vision. As a result, he had never experienced true binocular depth perception, only flat vision. After corrective surgery, his cosmetic appearance improved (his eyes no longer appeared crossed), but he still could not achieve proper binocular fusion.

Health Information

Health: No major health issues or chronic conditions; not on regular medication.

Social: Normal daily activities such as driving, using the computer, and using a smartphone.

Preliminary Examination
Visual Acuity (VA):
OD: 20/20
OS: 20/25-1
OU: Unable to combine separate images seen from each eye (vertical diplopia), but when not focusing on the separation, he perceived images one at a time from each eye.

Habitual Rx (Current Glasses Prescription):
OD: +1.00, VA 20/20
OS: +1.25, VA 20/20
OU: Same issue with image fusion as with unaided vision.

Cover Test (Strabismus Evaluation):
+Esophoria (esotropia when eyes are at rest)
+Right Hyperphoria (right eye hypertropia)

Refraction
Retinoscopy:
OD: +1.75 -0.75 x 40, VA 20/20
OS: +3.50 -1.75 x 175, VA 20/20

Monocular Subjective Refraction:
OD: +2.25 -0.62 x 57, VA 20/20
OS: +3.00 -1.00 x 150, VA 20/20
After subjective refraction, the patient still had issues with binocular fusion, which led us to address binocular function before finalizing the prescription.

Functional Tests @ 6m
Associated Phoria Method:
Horizontal Phoria: Esophoria (3 BO)
Hyperphoria: 6 BDOD (right hypertropia)
Maddox Rod Test: Diplopia (fusion with 6 BDOD prism)

Prism Prescription:�

The patient could fuse images with a prism of 3 BO and 6 BDOD. After applying these prisms, we proceeded with binocular fogging and unfogging procedures, which ultimately led to a BCVA of 20/15 OU with improved binocular function.

Functional Tests @ Near (40 cm)
NRA (Near Point Retinoscopy): +2.25 (aligned with BVA)
BCC (Binocular Cross Cylinder): +1.00 D

Assessment
1.Compound hyperopic astigmatism in both eyes.
2.Right hypertropia (right eye deviation).
3.Esophoria (latent esotropia).
4.Accommodative insufficiency.

Plan
1.Full prescription for refractive correction:
OD: +2.25 -0.62 x 57
OS: +3.00 -1.00 x 150

2.Prism correction:
3 BDOD
3 BUOS

3.Additional prism correction for near vision:
1.5 BOOD
1.5 BOOS

4.Plus add lens:
Impression B.I.G. Exact Mono Plus +1.1D (by Rodenstock)
Frame: Lindberg Thintanium 5806, Color 10/10, K-26, Temple Length 140

Discussion

Power of Routine refers to the habitual tasks we perform regularly. While the steps may seem straightforward, having a structured approach helps us to detect abnormalities and find solutions quickly.

In this case, the patient didn't think he had a problem, but through routine checking, we were able to identify underlying issues. Routine checks aren't just for symptomatic patients—they can reveal hidden problems that patients have adapted to over time.
Refraction & Binocular Function�I in this case, even though the patient's visual acuity was close to normal for distance, binocular fusion issues were detected. Binocular function was essential to solving the problem, and we had to adjust our usual procedures to address these issues. For example, we first corrected the patient's diplopia with prisms, and once fusion was achieved, we completed the refraction for a final BCVA of 20/15.

Importance of binocular testing �,Some practitioners may skip binocular testing, assuming that visual acuity is sufficient. However, this case highlights the importance of binocular function, especially when patients present with symptoms like diplopia or suppressed eye signals. By taking the time to assess and correct binocular issues, we can significantly improve the patient's quality of vision and life.

Conclusion

This case demonstrates the importance of thorough and routine examinations, especially when symptoms aren't immediately apparent. The patient experienced visual issues due to suppression and was unaware of the diplopia caused by his strabismus. With careful refraction, prism correction, and addressing the accommodative and binocular functions, we were able to provide him with a corrected prescription that improved his visual experience, allowing him to experience depth for the first time.

Optometrist Job ,Not Just restore vision but enhance visual system . So if you do just refraction but not other system ,you're not doctor but just spectacle seller.

hope you enjoy case and thank for your reading.

Dr.Loft ,O.D.

study more case : www.loftoptometry.com

page in Thai version : www.facebook.com/loftoptometry

contact : Loft Optometry ; 578 Wacharapol Rd, Tharang ,Bangkhen BKK 10220

mobile : 090 553 6554

lineID : loftoptometry

maps : https://maps.app.goo.gl/wdTy88ar5omZvczU9