DVBCWEE1 ;ALB/CMM EYE EXAMINATION WKS TEXT - 1 ; 6 MARCH 1997
;;2.7;AMIE;**12**;Apr 10, 1995
;
;
TXT ;
;;A. Review of Medical Records:
;;
;;B. Medical History (Subjective Complaints):
;;
;; Comment on:
;; 1. Pain.
;; 2. Duration and frequency of periods of incapacitation, and rest
;; requirements.
;; 3. Visual symptoms, including distorted or enlarged image, etc.
;; 4. Current ophthalmologic treatment.
;; 5. For malignant neoplasms, state type of treatment and last date.
;; If treatment is current, describe.
;;
;;C. Physical Examination (Objective Findings):
;;
;; Address each of the following, as applicable, and fully describe
;; current findings:
;; 1. Visual Acuity:
;; a. Examine each eye independently and record the refractive
;; information indicated below.
;; b. Use conventional lenses for correction unless the patient
;; has keratoconus, is well adapted to contact lenses and wishes
;; to wear them, and contact lenses result in best corrected
;; visual acuity.
;; c. Use Snellen's test type or its equivalent.
;; d. Carry out an examination with the pupils dilated unless
;; contraindicated, and record the ophthalmic findings.
;; e. For visual acuity worse than 5/200 in either or both eyes,
;; report the distance in feet/inches (or meters/centimeters)
;; from the face at which the veteran can count fingers/detect
;; hand motion/read the largest line on the chart. If the
;; veteran cannot detect hand motion or count fingers at any
;; distance, state whether he or she has light perception.
;; f. If keratoconus is present, state whether contact lenses
;; are required or adequate correction is possible by other means.
;;
;;
;; NEAR FAR
;;
;; RIGHT EYE UNCORRECTED __________ _________
;;
;; RIGHT EYE CORRECTED __________ _________
;;
;;
;;
;; NEAR FAR
;;
;; LEFT EYE UNCORRECTED __________ _________
;;
;; LEFT EYE CORRECTED __________ _________
;;
;;
;; 2. Diplopia:
;; a. Perform the measurement of muscle function using a
;; Goldmann Perimeter Chart and chart the areas in which diplopia
;; exists. Include the chart as part of the examination report
;; to be sent to the regional office.
;; b. 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.
;; c. If diplopia is constant and not correctable, indicate
;; which sectors of the visual field are affected and provide
;; the Goldmann perimeter chart showing the actual areas of
;; diplopia, according to the format below. Diplopia outside
;; these areas should also be reported even though it is not
;; considered disabling because it may be used in the evaluation
;; of the underlying disease or injury.
;;
;; CENTRAL 20 DEGREES _________
;;
;; 21 TO 30 DEGREES
;; DOWN
;; RIGHT LATERAL _________
;;
;; LEFT LATERAL _________
;;
;; UP
;; RIGHT LATERAL _________
;;
;; LEFT LATERAL _________
;;
;; 31 TO 40 DEGREES
;; DOWN
;; RIGHT LATERAL _________
;;
;; LEFT LATERAL _________
;;
;; UP
;; RIGHT LATERAL _________
;;
;; LEFT LATERAL _________
;;
;;
;; 3. Visual Field Deficit:
;; a. Chart any visual field defect using a Goldmann Perimeter
;; Chart and include the chart as part of the examination report
;; to be sent to the regional office.
;; b. For an aphakic eye which cannot be fitted with contact
;; lenses or intra-ocular implant, use the IV/4e test object.
;; For all other cases, use the III/4e test object.
;; c. If the examiner determines that charting with other test
;; objects is indicated, those test results should be reported
;; on a separate chart. All charts, along with an explanation
;; of the need for using a different test object and an
;; explanation of any discrepancies in results, should be
;; included as part of the examination report.
;; d. All scotomas should be plotted carefully in order to
;; allow measurements to be made for adjustments in the
;; calculation of visual field defects.
;; 4. Details of eye disease or injury (including eyebrows,
;; eyelashes, eyelids) other than loss of visual acuity, diplopia,
;; or visual field defect:
;;
;;D. Diagnostic and Clinical Tests: (Other than for visual acuity,
;;diplopia, and visual fields, as described above.)
;;
;; 1. Include results of all diagnostic and clinical tests
;; conducted in the examination report.
;;
;;E. Diagnosis:
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWEE1 5684 printed Apr 09, 2024@20:53:53 Page 2
DVBCWEE1 ;ALB/CMM EYE EXAMINATION WKS TEXT - 1 ; 6 MARCH 1997
+1 ;;2.7;AMIE;**12**;Apr 10, 1995
+2 ;
+3 ;
TXT ;
+1 ;;A. Review of Medical Records:
+2 ;;
+3 ;;B. Medical History (Subjective Complaints):
+4 ;;
+5 ;; Comment on:
+6 ;; 1. Pain.
+7 ;; 2. Duration and frequency of periods of incapacitation, and rest
+8 ;; requirements.
+9 ;; 3. Visual symptoms, including distorted or enlarged image, etc.
+10 ;; 4. Current ophthalmologic treatment.
+11 ;; 5. For malignant neoplasms, state type of treatment and last date.
+12 ;; If treatment is current, describe.
+13 ;;
+14 ;;C. Physical Examination (Objective Findings):
+15 ;;
+16 ;; Address each of the following, as applicable, and fully describe
+17 ;; current findings:
+18 ;; 1. Visual Acuity:
+19 ;; a. Examine each eye independently and record the refractive
+20 ;; information indicated below.
+21 ;; b. Use conventional lenses for correction unless the patient
+22 ;; has keratoconus, is well adapted to contact lenses and wishes
+23 ;; to wear them, and contact lenses result in best corrected
+24 ;; visual acuity.
+25 ;; c. Use Snellen's test type or its equivalent.
+26 ;; d. Carry out an examination with the pupils dilated unless
+27 ;; contraindicated, and record the ophthalmic findings.
+28 ;; e. For visual acuity worse than 5/200 in either or both eyes,
+29 ;; report the distance in feet/inches (or meters/centimeters)
+30 ;; from the face at which the veteran can count fingers/detect
+31 ;; hand motion/read the largest line on the chart. If the
+32 ;; veteran cannot detect hand motion or count fingers at any
+33 ;; distance, state whether he or she has light perception.
+34 ;; f. If keratoconus is present, state whether contact lenses
+35 ;; are required or adequate correction is possible by other means.
+36 ;;
+37 ;;
+38 ;; NEAR FAR
+39 ;;
+40 ;; RIGHT EYE UNCORRECTED __________ _________
+41 ;;
+42 ;; RIGHT EYE CORRECTED __________ _________
+43 ;;
+44 ;;
+45 ;;
+46 ;; NEAR FAR
+47 ;;
+48 ;; LEFT EYE UNCORRECTED __________ _________
+49 ;;
+50 ;; LEFT EYE CORRECTED __________ _________
+51 ;;
+52 ;;
+53 ;; 2. Diplopia:
+54 ;; a. Perform the measurement of muscle function using a
+55 ;; Goldmann Perimeter Chart and chart the areas in which diplopia
+56 ;; exists. Include the chart as part of the examination report
+57 ;; to be sent to the regional office.
+58 ;; b. If diplopia is present, state whether it is constant or
+59 ;; intermittent, whether it is present at all distances or only
+60 ;; for near or distant vision, and whether it is correctable by
+61 ;; use of lenses or prisms.
+62 ;; c. If diplopia is constant and not correctable, indicate
+63 ;; which sectors of the visual field are affected and provide
+64 ;; the Goldmann perimeter chart showing the actual areas of
+65 ;; diplopia, according to the format below. Diplopia outside
+66 ;; these areas should also be reported even though it is not
+67 ;; considered disabling because it may be used in the evaluation
+68 ;; of the underlying disease or injury.
+69 ;;
+70 ;; CENTRAL 20 DEGREES _________
+71 ;;
+72 ;; 21 TO 30 DEGREES
+73 ;; DOWN
+74 ;; RIGHT LATERAL _________
+75 ;;
+76 ;; LEFT LATERAL _________
+77 ;;
+78 ;; UP
+79 ;; RIGHT LATERAL _________
+80 ;;
+81 ;; LEFT LATERAL _________
+82 ;;
+83 ;; 31 TO 40 DEGREES
+84 ;; DOWN
+85 ;; RIGHT LATERAL _________
+86 ;;
+87 ;; LEFT LATERAL _________
+88 ;;
+89 ;; UP
+90 ;; RIGHT LATERAL _________
+91 ;;
+92 ;; LEFT LATERAL _________
+93 ;;
+94 ;;
+95 ;; 3. Visual Field Deficit:
+96 ;; a. Chart any visual field defect using a Goldmann Perimeter
+97 ;; Chart and include the chart as part of the examination report
+98 ;; to be sent to the regional office.
+99 ;; b. For an aphakic eye which cannot be fitted with contact
+100 ;; lenses or intra-ocular implant, use the IV/4e test object.
+101 ;; For all other cases, use the III/4e test object.
+102 ;; c. If the examiner determines that charting with other test
+103 ;; objects is indicated, those test results should be reported
+104 ;; on a separate chart. All charts, along with an explanation
+105 ;; of the need for using a different test object and an
+106 ;; explanation of any discrepancies in results, should be
+107 ;; included as part of the examination report.
+108 ;; d. All scotomas should be plotted carefully in order to
+109 ;; allow measurements to be made for adjustments in the
+110 ;; calculation of visual field defects.
+111 ;; 4. Details of eye disease or injury (including eyebrows,
+112 ;; eyelashes, eyelids) other than loss of visual acuity, diplopia,
+113 ;; or visual field defect:
+114 ;;
+115 ;;D. Diagnostic and Clinical Tests: (Other than for visual acuity,
+116 ;;diplopia, and visual fields, as described above.)
+117 ;;
+118 ;; 1. Include results of all diagnostic and clinical tests
+119 ;; conducted in the examination report.
+120 ;;
+121 ;;E. Diagnosis:
+122 ;;
+123 ;;Signature: Date:
+124 ;;END
