source: FOIAVistA/tag/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCWEE1.m@ 628

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