source: FOIAVistA/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCVSC1.m@ 1094

DVBCVSC1 ;ALB ISC/THM-MISC TEXT FOR VISUAL EXAM ; 7/1/91  10:15 AM
 ;;2.7;AMIE;;Apr 10, 1995
 ;
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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