DVBCWEE6 ;ALB/RLC EYE EXAMINATION WKS TEXT - 1 ; 12 FEB 2007
;;2.7;AMIE;**138**;Apr 10, 1995;Build 6
;
;
TXT ;
;;Narrative: An eye examination must be conducted by a licensed optometrist
;;or ophthalmologist. Examinations for the evaluation of visual fields or
;;muscle function will be conducted only when there is a medical indication
;;of disease or injury that may be associated with visual field defect or
;;impaired muscle function. Unless medically contraindicated, the fundus must
;;be examined with the claimant's pupils dilated. The examiner must identify
;;the disease, injury, or other pathologic process responsible for any visual
;;impairment found.
;;
;;
;;A. Review of Medical Records:
;;
;;B. Medical History (Subjective Complaints):
;;
;; Comment on:
;;
;; 1. General eye symptoms, pain, redness, swelling, discharge, watering, etc.
;; 2. Visual symptoms, including distorted or enlarged image, glare,
;; blurring, haloes, floaters, photophobia, etc.
;; 3. Current ophthalmologic treatment, side effects. State whether
;; continuous medication is required.
;; 4. For neoplasms, state date of diagnosis, exact diagnosis, whether
;; benign or malignant, types and dates of treatment, and date of last
;; treatment.
;; 5. History of hospitalization or surgery, dates and location if known,
;; reason or type of surgery.
;; 6. For trauma, type of injury, cause, eye injured, and date.
;; 7. Report any incapacitating episodes due to eye diseases such as
;; angle-closure glaucoma, choroidopathy (including uveitis, iritis,
;; cyclitis, and choroiditis), keratopathy, scleritis, retinopathy or
;; maculopathy, intraocular hemorrhage, detachment of retina, or unhealed
;; eye injury. List each incapacitating episode, if any, during the past
;; 12-month period, its duration in days, and the cause of the episode
;; of incapacitation. Note: An incapacitating episode is a period of
;; acute symptoms severe enough to require bed rest and treatment by a
;; physician or other healthcare provider.
;;
;;C. Physical Examination (Objective Findings):
;;
;; Address each of the following, as applicable, and fully describe
;; current findings:
;;
;; 1. Visual Acuity:
;; a. Examination of visual acuity must include the central
;; uncorrected and its equivalent corrected visual acuity for distance
;; and near vision using Snellen's test type or its equivalent.
;; Evaluate central visual acuity on the basis of corrected distance
;; vision with central fixation, even if a central scotoma is present.
;; Examine each eye independently and record the refractive information
;; indicated below.
;; b. Use Snellen's test type or its equivalent for distance and revised
;; Jaegar Standard or its equivalent for near.
;; c. Provided that he or she customarily wears contact lenses, determine
;; the visual acuity of any individual affected by a corneal disorder
;; that results in severe irregular astigmatism (including keratoconus)
;; that can be improved more by contact lenses than by eyeglass lenses,
;; as corrected by contact lenses.
;; d. 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.
;; e. Does the lens required to correct distance vision in the poorer eye
;; differ by more than three diopters from the lens required to correct
;; distance vision in the better eye? If so, explain the reason for
;; the difference.
;; f. Is there a difference equal to two or more scheduled steps or lines
;; of visual acuity between near and distance corrected vision for
;; either eye, with the near vision being worse? If so, include at
;; least two recordings of near and distance corrected vision and an
;; explanation of the reason for the difference.
;;
;; Right Eye FAR NEAR
;;
;; RIGHT EYE Uncorrected __________ _________
;;
;; RIGHT EYE CORRECTED __________ _________
;;
;;
;;
;; Left Eye FAR NEAR
;;
;; LEFT EYE Uncorrected __________ _________
;;
;; LEFT EYE CORRECTED __________ _________
;;
;;
;; 2. Muscle function examination:
;; a. Use a Goldmann perimeter chart that identifies the four major
;; quadrants (upward, downward, left and right lateral) and the
;; central field (20 degrees or less) and chart the areas of diplopia.
;; Include the plotted chart with the examination report. Indicate on
;; the chart whether or not diplopia is present in the following areas:
;;
;; Central 20 degrees
;; 21 to 30 degrees
;; Down
;; Left lateral
;; Right lateral
;; Up
;; 31 to 40 degrees
;; Down
;; Left lateral
;; Right lateral
;; Up
;;
;; b. State whether diplopia occurs occasionally or more than
;; occasionally.
;; c. State whether or not diplopia is correctable with spectacles.
;;
;; NOTE: Procedure for using Goldmann perimeter to assess diplopia field.
;; 1) Both eyes are open and the device is centered between the eyes.
;; 2) The patient's attention is directed towards a III/4e target while both
;; eyes are open and fixating on the target.
;; 3) The patient maintains attention to the target while it is moved. Areas
;; of diplopia are identified on the VF paper.
;;
;; 3. Visual Field Examination:
;; a. Use either Goldmann kinetic perimetry or automated perimetry using
;; Humphrey Model 750, Octopus Model 101, or later versions of these
;; perimetric devices with simulated kinetic Goldmann testing
;; capability.
;; b. For phakic (normal) individuals, as well as for pseudophakic or
;; aphakic individuals who are well adapted to intraocular lens implant
;; or contact lens correction, visual field examinations must be
;; conducted using a standard target size and luminance, which is
;; Goldmann's equivalent III/4e.
;; c. For aphakic individuals not well adapted to contact lens correction
;; or pseudophakic individuals not well adapted to intraocular lens
;; implant, visual field examinations must be conducted using Goldmann's
;; equivalent IV/4e.
;; d. In all cases, record the results on a standard Goldmann chart, and
;; include the Goldmann chart with the examination report. Chart at
;; least 16 meridians 22 1/2 degrees apart for each eye and indicate
;; the Goldmann equivalent used.
;; e. If additional testing is necessary to evaluate visual fields,
;; conduct the additional testing using either a tangent screen or a
;; 30-degree threshold visual field with the Goldmann III stimulus size.
;; Include the tracing of either the tangent screen or of the 30-degree
;; threshold visual field with the Goldmann III stimulus size in the
;; examination report.
;; f. Plot all scotomas carefully in order to allow measurements to be made
;; for adjustments in the calculation of visual field defects.
;;
;; 4. Provide details of eye disease or injury (including eyebrows,
;; eyelashes, eyelids, lacrimal duct) other than loss of visual acuity,
;; diplopia, or visual field defect.
;; 5. If there is enucleation, can a prosthesis be worn?
;; 6. If nystagmus is present, state whether it is the central type.
;; 7. Has a lens been removed? If so, state whether an intraocular lens
;; replacement (implant) is present.
;; 8. If chronic conjunctivitis is present, is it active (with objective
;; findings, such as red, thick conjunctivae, mucous secretion, etc.) or
;; inactive?
;; 9. Report results of tonometry.
;; 10. Report results of slit lamp biomicroscopic examination.
;; 11. For ocular funduscopic retinal examination, report any abnormality of
;; optic nerve, vessels, macula, etc.
;; 12. Report any other abnormalities noted.
;;
;;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:
;;
;; 1. Describe the effects of the condition(s) on the veteran's usual
;; occupation and daily activities.
;;
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWEE6 9645 printed Dec 13, 2024@01:50:44 Page 2
DVBCWEE6 ;ALB/RLC EYE EXAMINATION WKS TEXT - 1 ; 12 FEB 2007
+1 ;;2.7;AMIE;**138**;Apr 10, 1995;Build 6
+2 ;
+3 ;
TXT ;
+1 ;;Narrative: An eye examination must be conducted by a licensed optometrist
+2 ;;or ophthalmologist. Examinations for the evaluation of visual fields or
+3 ;;muscle function will be conducted only when there is a medical indication
+4 ;;of disease or injury that may be associated with visual field defect or
+5 ;;impaired muscle function. Unless medically contraindicated, the fundus must
+6 ;;be examined with the claimant's pupils dilated. The examiner must identify
+7 ;;the disease, injury, or other pathologic process responsible for any visual
+8 ;;impairment found.
+9 ;;
+10 ;;
+11 ;;A. Review of Medical Records:
+12 ;;
+13 ;;B. Medical History (Subjective Complaints):
+14 ;;
+15 ;; Comment on:
+16 ;;
+17 ;; 1. General eye symptoms, pain, redness, swelling, discharge, watering, etc.
+18 ;; 2. Visual symptoms, including distorted or enlarged image, glare,
+19 ;; blurring, haloes, floaters, photophobia, etc.
+20 ;; 3. Current ophthalmologic treatment, side effects. State whether
+21 ;; continuous medication is required.
+22 ;; 4. For neoplasms, state date of diagnosis, exact diagnosis, whether
+23 ;; benign or malignant, types and dates of treatment, and date of last
+24 ;; treatment.
+25 ;; 5. History of hospitalization or surgery, dates and location if known,
+26 ;; reason or type of surgery.
+27 ;; 6. For trauma, type of injury, cause, eye injured, and date.
+28 ;; 7. Report any incapacitating episodes due to eye diseases such as
+29 ;; angle-closure glaucoma, choroidopathy (including uveitis, iritis,
+30 ;; cyclitis, and choroiditis), keratopathy, scleritis, retinopathy or
+31 ;; maculopathy, intraocular hemorrhage, detachment of retina, or unhealed
+32 ;; eye injury. List each incapacitating episode, if any, during the past
+33 ;; 12-month period, its duration in days, and the cause of the episode
+34 ;; of incapacitation. Note: An incapacitating episode is a period of
+35 ;; acute symptoms severe enough to require bed rest and treatment by a
+36 ;; physician or other healthcare provider.
+37 ;;
+38 ;;C. Physical Examination (Objective Findings):
+39 ;;
+40 ;; Address each of the following, as applicable, and fully describe
+41 ;; current findings:
+42 ;;
+43 ;; 1. Visual Acuity:
+44 ;; a. Examination of visual acuity must include the central
+45 ;; uncorrected and its equivalent corrected visual acuity for distance
+46 ;; and near vision using Snellen's test type or its equivalent.
+47 ;; Evaluate central visual acuity on the basis of corrected distance
+48 ;; vision with central fixation, even if a central scotoma is present.
+49 ;; Examine each eye independently and record the refractive information
+50 ;; indicated below.
+51 ;; b. Use Snellen's test type or its equivalent for distance and revised
+52 ;; Jaegar Standard or its equivalent for near.
+53 ;; c. Provided that he or she customarily wears contact lenses, determine
+54 ;; the visual acuity of any individual affected by a corneal disorder
+55 ;; that results in severe irregular astigmatism (including keratoconus)
+56 ;; that can be improved more by contact lenses than by eyeglass lenses,
+57 ;; as corrected by contact lenses.
+58 ;; d. For visual acuity worse than 5/200 in either or both eyes, report
+59 ;; the distance in feet/inches (or meters/centimeters) from the face at
+60 ;; which the veteran can count fingers/detect hand motion/read the
+61 ;; largest line on the chart. If the veteran cannot detect hand
+62 ;; motion or count fingers at any distance, state whether he or she has
+63 ;; light perception.
+64 ;; e. Does the lens required to correct distance vision in the poorer eye
+65 ;; differ by more than three diopters from the lens required to correct
+66 ;; distance vision in the better eye? If so, explain the reason for
+67 ;; the difference.
+68 ;; f. Is there a difference equal to two or more scheduled steps or lines
+69 ;; of visual acuity between near and distance corrected vision for
+70 ;; either eye, with the near vision being worse? If so, include at
+71 ;; least two recordings of near and distance corrected vision and an
+72 ;; explanation of the reason for the difference.
+73 ;;
+74 ;; Right Eye FAR NEAR
+75 ;;
+76 ;; RIGHT EYE Uncorrected __________ _________
+77 ;;
+78 ;; RIGHT EYE CORRECTED __________ _________
+79 ;;
+80 ;;
+81 ;;
+82 ;; Left Eye FAR NEAR
+83 ;;
+84 ;; LEFT EYE Uncorrected __________ _________
+85 ;;
+86 ;; LEFT EYE CORRECTED __________ _________
+87 ;;
+88 ;;
+89 ;; 2. Muscle function examination:
+90 ;; a. Use a Goldmann perimeter chart that identifies the four major
+91 ;; quadrants (upward, downward, left and right lateral) and the
+92 ;; central field (20 degrees or less) and chart the areas of diplopia.
+93 ;; Include the plotted chart with the examination report. Indicate on
+94 ;; the chart whether or not diplopia is present in the following areas:
+95 ;;
+96 ;; Central 20 degrees
+97 ;; 21 to 30 degrees
+98 ;; Down
+99 ;; Left lateral
+100 ;; Right lateral
+101 ;; Up
+102 ;; 31 to 40 degrees
+103 ;; Down
+104 ;; Left lateral
+105 ;; Right lateral
+106 ;; Up
+107 ;;
+108 ;; b. State whether diplopia occurs occasionally or more than
+109 ;; occasionally.
+110 ;; c. State whether or not diplopia is correctable with spectacles.
+111 ;;
+112 ;; NOTE: Procedure for using Goldmann perimeter to assess diplopia field.
+113 ;; 1) Both eyes are open and the device is centered between the eyes.
+114 ;; 2) The patient's attention is directed towards a III/4e target while both
+115 ;; eyes are open and fixating on the target.
+116 ;; 3) The patient maintains attention to the target while it is moved. Areas
+117 ;; of diplopia are identified on the VF paper.
+118 ;;
+119 ;; 3. Visual Field Examination:
+120 ;; a. Use either Goldmann kinetic perimetry or automated perimetry using
+121 ;; Humphrey Model 750, Octopus Model 101, or later versions of these
+122 ;; perimetric devices with simulated kinetic Goldmann testing
+123 ;; capability.
+124 ;; b. For phakic (normal) individuals, as well as for pseudophakic or
+125 ;; aphakic individuals who are well adapted to intraocular lens implant
+126 ;; or contact lens correction, visual field examinations must be
+127 ;; conducted using a standard target size and luminance, which is
+128 ;; Goldmann's equivalent III/4e.
+129 ;; c. For aphakic individuals not well adapted to contact lens correction
+130 ;; or pseudophakic individuals not well adapted to intraocular lens
+131 ;; implant, visual field examinations must be conducted using Goldmann's
+132 ;; equivalent IV/4e.
+133 ;; d. In all cases, record the results on a standard Goldmann chart, and
+134 ;; include the Goldmann chart with the examination report. Chart at
+135 ;; least 16 meridians 22 1/2 degrees apart for each eye and indicate
+136 ;; the Goldmann equivalent used.
+137 ;; e. If additional testing is necessary to evaluate visual fields,
+138 ;; conduct the additional testing using either a tangent screen or a
+139 ;; 30-degree threshold visual field with the Goldmann III stimulus size.
+140 ;; Include the tracing of either the tangent screen or of the 30-degree
+141 ;; threshold visual field with the Goldmann III stimulus size in the
+142 ;; examination report.
+143 ;; f. Plot all scotomas carefully in order to allow measurements to be made
+144 ;; for adjustments in the calculation of visual field defects.
+145 ;;
+146 ;; 4. Provide details of eye disease or injury (including eyebrows,
+147 ;; eyelashes, eyelids, lacrimal duct) other than loss of visual acuity,
+148 ;; diplopia, or visual field defect.
+149 ;; 5. If there is enucleation, can a prosthesis be worn?
+150 ;; 6. If nystagmus is present, state whether it is the central type.
+151 ;; 7. Has a lens been removed? If so, state whether an intraocular lens
+152 ;; replacement (implant) is present.
+153 ;; 8. If chronic conjunctivitis is present, is it active (with objective
+154 ;; findings, such as red, thick conjunctivae, mucous secretion, etc.) or
+155 ;; inactive?
+156 ;; 9. Report results of tonometry.
+157 ;; 10. Report results of slit lamp biomicroscopic examination.
+158 ;; 11. For ocular funduscopic retinal examination, report any abnormality of
+159 ;; optic nerve, vessels, macula, etc.
+160 ;; 12. Report any other abnormalities noted.
+161 ;;
+162 ;;D. Diagnostic and Clinical Tests: (Other than for visual acuity,
+163 ;; diplopia, and visual fields, as described above.)
+164 ;; 1. Include results of all diagnostic and clinical tests conducted in the
+165 ;; examination report.
+166 ;;
+167 ;;E. Diagnosis:
+168 ;;
+169 ;; 1. Describe the effects of the condition(s) on the veteran's usual
+170 ;; occupation and daily activities.
+171 ;;
+172 ;;
+173 ;;
+174 ;;Signature: Date:
+175 ;;END
