source: WorldVistAEHR/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCVSC1.m@ 619

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1DVBCVSC1 ;ALB ISC/THM-MISC TEXT FOR VISUAL EXAM ; 7/1/91 10:15 AM
2 ;;2.7;AMIE;;Apr 10, 1995
3 ;
4 F I=1:1 S LY=$T(@LX+I) Q:LY["END" D:LY["|TOP|" HD2^DVBCVSCK W:LY'["|TOP|" $P(LY,";;",2),!
5 Q
6 ;
7TXT ;
8 ;;C. Diplopia - (The measurement of muscle function will be performed using a
9 ;; Goldmann Perimeter Chart. The examiner will chart the areas in which
10 ;; diplopia exists. This plotted chart will be made a part of the examination
11 ;; report and the entire report is to be mailed to the regional office.):
12 ;;
13 ;; Yes No (circle one)
14 ;;
15 ;;
16 ;; 1. If diplopia is present, state whether it is constant or intermittent,
17 ;; whether it is present at all distances or only for near or distant vision,
18 ;; and whether it is correctable by use of lenses or prisms.
19 ;;
20 ;; 2. If diplopia is constant and not correctable, indicate which sectors
21 ;; of the visual field are affected and provide the Goldmann perimeter chart
22 ;; showing actual areas of diplopia. Diplopia outside these areas is not
23 ;; considered disabling but can be used in evaluation of the underlying
24 ;; disease or injury.
25 ;;
26 ;; a. Central 20 degrees
27 ;;
28 ;; b. 21 to 30 degrees
29 ;;
30 ;; down
31 ;;
32 ;; right lateral
33 ;;
34 ;; left lateral
35 ;;
36 ;; up
37 ;;
38 ;; c. 31 to 40 degrees
39 ;;
40 ;; down
41 ;;
42 ;; right lateral
43 ;;
44 ;; left lateral
45 ;;
46 ;; up
47 ;;
48 ;;D. Visual field deficit: Yes No (circle one)
49 ;;
50 ;; If Yes, chart fields per the following instructions and provide visual
51 ;; field charts (see attachment).
52 ;;
53 ;; 1. For aphakic eye which cannot be fitted with contact lens or intra-ocular
54 ;; implant, use the IV/4e test object.
55 ;;
56 ;; 2. In all other cases, use the III/4e test object.
57 ;;
58 ;; 3. Visual field charts submitted for evaluation purposes should contain
59 ;; only one field chart with only the III/4e or IV/4e object as above.
60 ;; If the examiner feels that charting with other objects is necessary,
61 ;; for confirmation of test results, they should be reported on a
62 ;; separate chart along with an explanation of the need and the significance
63 ;; of any discrepancies noted.
64 ;;|TOP|
65 ;;
66 ;; 4. All scotomas should be plotted carefully so that the rating board
67 ;; can make appropriate allowances in calculating the extent of the
68 ;; effective visual field in each eye.
69 ;;
70 ;;
71 ;;E. Indicate the presence or absence of disease or damage to the retina
72 ;; cornea, iris, or other part of the eye -- detached retina, glaucoma,
73 ;; cataract, iritis, etc. Describe any episodes of incapaciting pain or
74 ;; other need for bed rest. If keratoconus is present, state whether
75 ;; contact lenses are required or adequate correction is possible by other
76 ;; means. Include any other remarks or comments as deemed appropriate.
77 ;;END
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