Low Vision Assessment

Transcription

1 Reason for Assessment Diagnosis & relevant history: Does patient wear corrective lenses? Y N If yes, what type? single strength bifocals trifocal Lenses worn for: near vision distance at all times Last eye exam: / / Observations/Chart Review: Difficulty with ADLs Recent Falls Bumps into things Difficulty traveling Leaves food on one side of tray Misjudges placement of chair when sitting Difficulty reading or seeing near objects Intolerant of light/ issues with glare Other: Subjective patient report of deficits: Visual Attention/ROM/Saccades Functional Vision Screen Questionnaire score Score > 9 indicates potential functional problems Check all that apply based on interview: /15 Halos or rings around lights Trouble distinguishing light colors Sees flashes of light Sees curtains over eyes Double vision Impaired WFL Test Area Instructions for testing Visual Attention Processing simultaneous stimuli Ocular ROM/Pursuits smooth/coordinated ataxic loss of target unable Saccadic Eye Movements searches for target on right searches for target on left Ask the patient to fixate on an object located away at midline for 10 seconds Look at my nose, how many fingers am I holding up? Tester proceeds to hold up fingers in various positions and asks for patient to count them while looking at nose. (see reverse) Stand at midline. Move your finger across the field of vision (see graphic on reverse) and observe the ability to track the target (pursuit) and visual alignment/teaming of eyes (eyes moving together) Check the box that describes your observations of movement Saccades is the accuracy of moving eyes between 2 points. Start by holding 2 different colored chips (one in each hand) starting at midline 16 from patient, then moving chips away about 4 toward either side. Ask the patient to look at the blue and then the yellow while stopping at various points in the left and right visual field.(video example of testing on falls resource cd) Comments:

2 Oval represents visual field Arrows represent recommended direction for testing ocular ROM and pursuits Hands represent positions for testing processing of simultaneous stimuli Instructions for testing/scoring acuity using the Snellen Eye Chart: Post the Snellen eye chart and measure a distance of 20 feet. Mark a line on the floor with tape at 20 ft. and ask the patient to stand there. Use a disposable (non-opaque) cup to cover one eye at a time. Acuity is represented as: Distance standing Last row read legibly Example: at 20 feet, you can read the letters on the row marked "40", this means you have visual acuity of 20/40 or better: 1/2 normal. From 10 feet, if the smallest letters you could read were on the "40" line, this would give you an acuity of 10/40: 1/4 normal. (eye exam referral for < 20/40 or disparity > 1 line on eye chart )

3 Visual Field Test one eye at a time by covering opposite eye. Move your finger across the visual field from top to midline, side to midline, inferior side to midline and ask patient to state when they see it. Repeat for other eye. Peripheral visual field < 75 = deficit. <30 of midline vision overlap= deficit. Indicate level of visual awareness as A (aware,) P (partial,) T (totally unaware) Use the grid to plot the total visual field. 1 Right Left Aware Partial Unaware Peripheral Vision Right Superior Left Superior Right Inferior Left Inferior Aware Partial Unaware Central Vision Right Superior Left Superior Right Inferior Left Inferior 2 3 Visual Acuity : / glasses on Visual Perception ( areas of impairment) See guidance for using and scoring Snellen eye chart on reverse of p.1 Moderate Low Vision 20/70-20/160 Legal Blindness 20/200-20/400 Comments: Print Reading: Geriatric Patterns Test Card circle WFL Impaired Moderate Highly Severe (see reverse) Right/Left Discrimination Color Discrimination (reach with right, left) (name chip colors) Comments: Depth Perception (reach for chips w/accurate grasp distance) Body Scheme (points to body parts) Comments: MVPT results summary % discrimination %memory n/a % matching % Gestalt

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5 How is visual/perceptual impairment impacting function? difficulty with self care routine problem with feeding difficulty with mobility Falls/increased risk of falls Difficulty reading/writing Other: Recommended Interventions : Environmental modifications Visual motor exercises Analyze/Educate on appropriate compensatory strategies Large print books Books on tape Feeding evaluation and FMP PT Assessment OT Assessment ST Assessment Optometry/Opthamologist referral Other: Resident/Caregiver training: Effective visual strategies Environmental recommendations Assisting with ADLs Home exercise program Safety and injury prevention Other: Patient response to intervention: