DVBCVSC1 ;ALB ISC/THM-MISC TEXT FOR VISUAL EXAM ; 7/1/91 10:15 AM
;;2.7;AMIE;;Apr 10, 1995
;
F I=1:1 S LY=$T(@LX+I) Q:LY["END" D:LY["|TOP|" HD2^DVBCVSCK W:LY'["|TOP|" $P(LY,";;",2),!
Q
;
TXT ;
;;C. Diplopia - (The measurement of muscle function will be performed using a
;; Goldmann Perimeter Chart. The examiner will chart the areas in which
;; diplopia exists. This plotted chart will be made a part of the examination
;; report and the entire report is to be mailed to the regional office.):
;;
;; Yes No (circle one)
;;
;;
;; 1. If diplopia is present, state whether it is constant or intermittent,
;; whether it is present at all distances or only for near or distant vision,
;; and whether it is correctable by use of lenses or prisms.
;;
;; 2. If diplopia is constant and not correctable, indicate which sectors
;; of the visual field are affected and provide the Goldmann perimeter chart
;; showing actual areas of diplopia. Diplopia outside these areas is not
;; considered disabling but can be used in evaluation of the underlying
;; disease or injury.
;;
;; a. Central 20 degrees
;;
;; b. 21 to 30 degrees
;;
;; down
;;
;; right lateral
;;
;; left lateral
;;
;; up
;;
;; c. 31 to 40 degrees
;;
;; down
;;
;; right lateral
;;
;; left lateral
;;
;; up
;;
;;D. Visual field deficit: Yes No (circle one)
;;
;; If Yes, chart fields per the following instructions and provide visual
;; field charts (see attachment).
;;
;; 1. For aphakic eye which cannot be fitted with contact lens or intra-ocular
;; implant, use the IV/4e test object.
;;
;; 2. In all other cases, use the III/4e test object.
;;
;; 3. Visual field charts submitted for evaluation purposes should contain
;; only one field chart with only the III/4e or IV/4e object as above.
;; If the examiner feels that charting with other objects is necessary,
;; for confirmation of test results, they should be reported on a
;; separate chart along with an explanation of the need and the significance
;; of any discrepancies noted.
;;|TOP|
;;
;; 4. All scotomas should be plotted carefully so that the rating board
;; can make appropriate allowances in calculating the extent of the
;; effective visual field in each eye.
;;
;;
;;E. Indicate the presence or absence of disease or damage to the retina
;; cornea, iris, or other part of the eye -- detached retina, glaucoma,
;; cataract, iritis, etc. Describe any episodes of incapaciting pain or
;; other need for bed rest. If keratoconus is present, state whether
;; contact lenses are required or adequate correction is possible by other
;; means. Include any other remarks or comments as deemed appropriate.
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCVSC1 3059 printed Sep 23, 2025@19:25:21 Page 2
DVBCVSC1 ;ALB ISC/THM-MISC TEXT FOR VISUAL EXAM ; 7/1/91 10:15 AM
+1 ;;2.7;AMIE;;Apr 10, 1995
+2 ;
+3 FOR I=1:1
SET LY=$TEXT(@LX+I)
if LY["END"
QUIT
if LY["|TOP|"
DO HD2^DVBCVSCK
if LY'["|TOP|"
WRITE $PIECE(LY,";;",2),!
+4 QUIT
+5 ;
TXT ;
+1 ;;C. Diplopia - (The measurement of muscle function will be performed using a
+2 ;; Goldmann Perimeter Chart. The examiner will chart the areas in which
+3 ;; diplopia exists. This plotted chart will be made a part of the examination
+4 ;; report and the entire report is to be mailed to the regional office.):
+5 ;;
+6 ;; Yes No (circle one)
+7 ;;
+8 ;;
+9 ;; 1. If diplopia is present, state whether it is constant or intermittent,
+10 ;; whether it is present at all distances or only for near or distant vision,
+11 ;; and whether it is correctable by use of lenses or prisms.
+12 ;;
+13 ;; 2. If diplopia is constant and not correctable, indicate which sectors
+14 ;; of the visual field are affected and provide the Goldmann perimeter chart
+15 ;; showing actual areas of diplopia. Diplopia outside these areas is not
+16 ;; considered disabling but can be used in evaluation of the underlying
+17 ;; disease or injury.
+18 ;;
+19 ;; a. Central 20 degrees
+20 ;;
+21 ;; b. 21 to 30 degrees
+22 ;;
+23 ;; down
+24 ;;
+25 ;; right lateral
+26 ;;
+27 ;; left lateral
+28 ;;
+29 ;; up
+30 ;;
+31 ;; c. 31 to 40 degrees
+32 ;;
+33 ;; down
+34 ;;
+35 ;; right lateral
+36 ;;
+37 ;; left lateral
+38 ;;
+39 ;; up
+40 ;;
+41 ;;D. Visual field deficit: Yes No (circle one)
+42 ;;
+43 ;; If Yes, chart fields per the following instructions and provide visual
+44 ;; field charts (see attachment).
+45 ;;
+46 ;; 1. For aphakic eye which cannot be fitted with contact lens or intra-ocular
+47 ;; implant, use the IV/4e test object.
+48 ;;
+49 ;; 2. In all other cases, use the III/4e test object.
+50 ;;
+51 ;; 3. Visual field charts submitted for evaluation purposes should contain
+52 ;; only one field chart with only the III/4e or IV/4e object as above.
+53 ;; If the examiner feels that charting with other objects is necessary,
+54 ;; for confirmation of test results, they should be reported on a
+55 ;; separate chart along with an explanation of the need and the significance
+56 ;; of any discrepancies noted.
+57 ;;|TOP|
+58 ;;
+59 ;; 4. All scotomas should be plotted carefully so that the rating board
+60 ;; can make appropriate allowances in calculating the extent of the
+61 ;; effective visual field in each eye.
+62 ;;
+63 ;;
+64 ;;E. Indicate the presence or absence of disease or damage to the retina
+65 ;; cornea, iris, or other part of the eye -- detached retina, glaucoma,
+66 ;; cataract, iritis, etc. Describe any episodes of incapaciting pain or
+67 ;; other need for bed rest. If keratoconus is present, state whether
+68 ;; contact lenses are required or adequate correction is possible by other
+69 ;; means. Include any other remarks or comments as deemed appropriate.
+70 ;;END
