The College of Optometrists

Hi there. Can you help. With regards to NPC on a presbyope in the exams, as the px will not have spex, is it wrong to measure NPC by asking the px to follow the tip of your pen and observe break (and near pupil response), or to follow pentorch light for NPC only? as hyperopic presbyopes have difficulty following the target on the RAF rule. thanks.

No

You are right not to confuse the npc and accom induced convergence. As you say accom is reduced in presbyopia so the task gets hard for them - however, they should still maintain good convergence -which you can happily measure with a pen tip. (And as you say do a valuable test for pupil response at the same time (well done!!). So its fine and shows yr thought process.

well done steve

Thank you both

Do we need to do amp of accom with the presbyope in the exam, just to demonstrate we can perform it? Although we won't gain much infomation from doing it.

No, unless it will help yr understanding of the case.