146 lines
6.6 KiB
Mathematica
146 lines
6.6 KiB
Mathematica
DVBCWEE4 ;ALB/RLC EYE EXAMINATION WKS TEXT - 1 ; 12 FEB 2007
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;;2.7;AMIE;**121**;Apr 10, 1995;Build 9
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TXT ;
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;;Narrative: An eye examination must be conducted by a licensed optometrist
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;;or ophthalmologist. Examinations for the evaluation of visual fields or
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;;muscle function will be conducted only when there is a medical indication.
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;;
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;;A. Review of Medical Records:
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;;
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;;B. Medical History (Subjective Complaints):
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;;
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;; Comment on:
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;;
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;; 1. General eye symptoms, pain, redness, swelling, discharge, watering, etc.
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;; 2. Duration and frequency of periods of incapacitation, and rest
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;; requirements.
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;; 3. Visual symptoms, including distorted or enlarged image, etc.
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;; 4. Current ophthalmologic treatment, side effects.
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;; 5. For neoplasms, state date of diagnosis, benign or malignant, type
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;; of treatment and last date of treatment.
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;; 6. History of hospitalizations or surgery, dates and location if known,
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;; reason or type of surgery.
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;; 7. For trauma, type and date.
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;; 8. For congestive or inflammatory glaucoma, duration and frequency of
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;; attacks.
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;;
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;;C. Physical Examination (Objective Findings):
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;;
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;; Address each of the following, as applicable, and fully describe
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;; current findings:
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;;
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;; 1. Visual Acuity:
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;;
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;; a. Examine each eye independently and record the refractive
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;; information indicated below.
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;; b. Use conventional lenses for correction unless the patient
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;; has keratoconus, is well adapted to contact lenses and wishes
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;; to wear them, and contact lenses result in best corrected
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;; visual acuity.
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;; c. Use Snellen's test type or its equivalent for distance and revised
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;; Jaegar Standard or its equivalent for near.
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;; d. Carry out an examination with the pupils dilated unless
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;; contraindicated, and record the ophthalmic findings.
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;; e. For visual acuity worse than 5/200 in either or both eyes,
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;; report the distance in feet/inches (or meters/centimeters)
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;; from the face at which the veteran can count fingers/detect
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;; hand motion/read the largest line on the chart. If the
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;; veteran cannot detect hand motion or count fingers at any
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;; distance, state whether he or she has light perception.
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;; f. If keratoconus is present, state whether contact lenses
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;; are required or adequate correction is possible by other means.
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;;TOF
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;; Right Eye FAR NEAR
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;;
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;; RIGHT EYE UNCORRECTED __________ _________
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;;
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;; RIGHT EYE CORRECTED __________ _________
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;;
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;;
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;;
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;; Left Eye FAR NEAR
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;;
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;; LEFT EYE UNCORRECTED __________ _________
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;;
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;; LEFT EYE CORRECTED __________ _________
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;;
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;;
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;; 2. Diplopia:
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;;
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;; a. Perform the measurement of muscle function using a
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;; Goldmann Perimeter Chart and chart the areas in which diplopia
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;; exists. Include the chart as part of the examination report
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;; to be sent to the regional office.
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;; b. If diplopia is present, state whether it is constant or
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;; intermittent, whether it is present at all distances or only
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;; for near or distant vision, and whether it is correctable by
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;; use of lenses or prisms.
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;; c. If diplopia is constant and not correctable, indicate which
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;; of the sectors of the visual field are affected and provide the
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;; Goldmann perimeter chart showing the actual areas of diplopia,
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;; according to the format below. Diplopia outside these areas
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;; should also be reported even though it is not considered disabling
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;; because it may be used in the evaluation of the underlying disease
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;; or injury.
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;;
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;; Diplopia | Amount
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;;
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;; Central 20 Degrees| | |
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;; 21 TO 30 Degrees | | |
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;; | DOWN | |
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;; | | Right Lateral |
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;; | | Left Lateral |
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;; | UP | |
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;; | | Right Lateral |
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;; | | Left Lateral |
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;; 31 TO 40 Degrees | | |
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;; | DOWN | |
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;; | | Right Lateral |
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;; | | Left Lateral |
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;; | UP | |
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;; | | Right Lateral |
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;; | | Left Lateral |
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;;
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;;TOF
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;; 3. Visual Field Deficit:
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;;
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;; a. Chart any visual field defect using a Goldmann Perimeter
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;; Chart and include the chart as part of the examination report
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;; to be sent to the regional office.
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;; b. For an aphakic eye which cannot be fitted with contact
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;; lenses or intra-ocular implant, use the IV/4e test object.
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;; For all other cases, use the III/4e test object.
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;; c. If the examiner determines that charting with other test
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;; objects is indicated, those test results should be reported
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;; on a separate chart. All charts, along with an explanation
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;; of the need for using a different test object and an
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;; explanation of any discrepancies in results, should be
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;; included as part of the examination report.
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;; d. All scotomas should be plotted carefully in order to
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;; allow measurements to be made for adjustments in the
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;; calculation of visual field defects.
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;;
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;; 4. Details of eye disease or injury (including eyebrows,
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;; eyelashes, eyelids, lacrimal duct) other than loss of visual acuity,
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;; diplopia, or visual field defect.
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;; 5. Enucleation. Is prosthesis possible?
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;; 6. Record results of any other examination findings including tonometry,
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;; funduscopic, slit lamp.
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;;
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;;D. Diagnostic and Clinical Tests: (Other than for visual acuity,
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;; diplopia, and visual fields, as described above.)
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;;
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;; 1. Include results of all diagnostic and clinical tests
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;; conducted in the examination report.
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;;
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;;E. Diagnosis:
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;;
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;; 1. For nystagmus, provide type.
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;;
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;;
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;;
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;;Signature: Date:
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;;END
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