78 lines
2.9 KiB
Mathematica
78 lines
2.9 KiB
Mathematica
DVBCVSC1 ;ALB ISC/THM-MISC TEXT FOR VISUAL EXAM ; 7/1/91 10:15 AM
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;;2.7;AMIE;;Apr 10, 1995
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;
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F I=1:1 S LY=$T(@LX+I) Q:LY["END" D:LY["|TOP|" HD2^DVBCVSCK W:LY'["|TOP|" $P(LY,";;",2),!
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Q
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;
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TXT ;
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;;C. Diplopia - (The measurement of muscle function will be performed using a
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;; Goldmann Perimeter Chart. The examiner will chart the areas in which
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;; diplopia exists. This plotted chart will be made a part of the examination
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;; report and the entire report is to be mailed to the regional office.):
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;;
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;; Yes No (circle one)
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;;
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;;
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;; 1. If diplopia is present, state whether it is constant or intermittent,
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;; whether it is present at all distances or only for near or distant vision,
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;; and whether it is correctable by use of lenses or prisms.
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;;
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;; 2. If diplopia is constant and not correctable, indicate which sectors
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;; of the visual field are affected and provide the Goldmann perimeter chart
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;; showing actual areas of diplopia. Diplopia outside these areas is not
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;; considered disabling but can be used in evaluation of the underlying
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;; disease or injury.
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;;
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;; a. Central 20 degrees
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;;
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;; b. 21 to 30 degrees
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;;
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;; down
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;;
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;; right lateral
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;;
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;; left lateral
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;;
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;; up
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;;
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;; c. 31 to 40 degrees
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;;
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;; down
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;;
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;; right lateral
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;;
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;; left lateral
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;;
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;; up
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;;
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;;D. Visual field deficit: Yes No (circle one)
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;;
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;; If Yes, chart fields per the following instructions and provide visual
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;; field charts (see attachment).
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;;
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;; 1. For aphakic eye which cannot be fitted with contact lens or intra-ocular
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;; implant, use the IV/4e test object.
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;;
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;; 2. In all other cases, use the III/4e test object.
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;;
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;; 3. Visual field charts submitted for evaluation purposes should contain
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;; only one field chart with only the III/4e or IV/4e object as above.
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;; If the examiner feels that charting with other objects is necessary,
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;; for confirmation of test results, they should be reported on a
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;; separate chart along with an explanation of the need and the significance
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;; of any discrepancies noted.
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;;|TOP|
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;;
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;; 4. All scotomas should be plotted carefully so that the rating board
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;; can make appropriate allowances in calculating the extent of the
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;; effective visual field in each eye.
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;;
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;;
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;;E. Indicate the presence or absence of disease or damage to the retina
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;; cornea, iris, or other part of the eye -- detached retina, glaucoma,
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;; cataract, iritis, etc. Describe any episodes of incapaciting pain or
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;; other need for bed rest. If keratoconus is present, state whether
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;; contact lenses are required or adequate correction is possible by other
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;; means. Include any other remarks or comments as deemed appropriate.
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;;END
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