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Routine: DVBCVSC1

DVBCVSC1.m

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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