History taking of low vision
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This document contains information about conducting a low vision assessment, including sections on collecting demographic data, chief complaints, medical and ocular history, visual functioning, goals, and potential low vision devices. It also includes 4 case studies: an 89-year-old with macular degeneration who needs help reading small print, a graduate student who needs magnification for lab work, an aphakic patient with distance and near vision difficulties, and a teacher with retinitis pigmentosa. The case studies demonstrate evaluating patients' needs, calculating required optical powers, testing devices, and selecting appropriate low vision aids.
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History taking of low vision
- 1. Optom. Sagar Kalamkar ( M. Optom 1st year ) Bharti Vidyapeeth ( Deemed University ) Medical college School of optometry
- 2. Date of Assessment Patient Name Age / Gender Address Contact No. Demographic Data
- 3. Frequency Onset Location Duration Associate complaint Recurrence Quality ( mild moderate or sever ) Chief Complaint
- 4. General History Medical History Visual History Social History Formal history
- 5. Allergies Education Financial Status:- Sufficient/Non Sufficient Work / Hobbies Primary goals / Secondary goals Concern about Mobility / Distance vision Depth perception : Difficulties Yes / No Concern about near vision Illumination Use of glasses Yes / No Previous low vision care : Yes / no Source of low vision device : Prescribe / Self purchesed Currently being used : Yes / Not General History
- 6. When was your last physical check- up How did doctor says about your health What is your opinion about your health Do you have any allergies ( list ) Do you or any family members have a problems facing any disease Medical History
- 7. Self Family Heart Kidneys Liver Lungs Skin condition Hypertension Neurologic disease Diabetes Stroke Depression Traumatic head injury Other
- 8. How long ago you first know you have a vision problem When was your last eye examination Have you ever had treatment or surgery for your eye Are you taking eye medication Have you ever had a low vision evaluation What your doctor told you was the cause of your vision problem ? Explain your problem Do you wear glasses now? Do they help? How well do you see now? Family history Visual History
- 9. Psychological History :- • What is your living situation • Are you able to take care of yourself • Are you have any rehabilitation training • Do you use assistive device • Who helps your transportation • Where do you get support ( family, friends ) • How do you feel about your vision loss Social History
- 10. Mobility History:- • Can you see well enough to get around outdoors • Do you drive • Do you have mobility aid ? E.g. Cane or guide dog • Do you have glasses or optical devices that help you get around • Do you have difficulties getting around indoors • Do you tend to trip over low object, such as curbs or steps • Do you tend to bump into object • Do you bump one side of your body more than the other
- 11. Distance vision History:- At what with what Distance device • Are you able to see a) Billboard b) Labels c) Faces • Do you attend the movie • Do you watch TV what is your screen size • Do you have problems Recognizing colour
- 12. Activities of Daily Living :- Because of your vision loss, do you have difficulty Doing your house work Seeing to cook Stove dials Seeing the flame on the stove Seeing the food on your plate Seeing the number pad on the telephone Seeing to groom yourself
- 13. Near Vision History :- what what distance device 1. Do you read print 2. Can you read a. Newspaper Headlines b. Large Print c. Textbook d. Magazine e. Telephone Book 3. How much reading do you do now 4. Which print size do you mostly use 5. What kind of light do you use for reading 6. Did you read more before your vision loss 7. Do you want to read more than you presently do
- 14. Illumination :- 1. Are you comfortable when it is bright and sunny or overcast and cloudy weather 2. Do you were sunglasses 3. Do you use a hat (visor) 4. Are you bothered by glare 5. Do you extra light to improve your vision
- 15. Work, School, and Hobbies :- 1. Are you involve in any following activities now or before your vision loss a. sewing b. crocheting c. playing cards d. playing musical instrument e. Bowling f. bicycling g. typing computers h. miner repairs i. Others 2. do you have any particular difficulties at school or at the house because of your vision 3. How do you spend your day 4. What are your major activities
- 16. Goal is to utilized the patient potential vision Problems, expectation of the patient Managing the cases upto 80% Patients visual requirments, visual demands Informs about patient primary and secondary goals Mental status of the patients towards prescribed or prescribing devices Proper plan for treatment Helpful for future refrence, documentation Functional approch to the patient ( choice of test to be done ) Significance of History taking
- 17. If your vision can be improved with optical devices, are there special task that you would like to be able to do ?
- 18. Case • Visual acuity • Refraction • Torch light • Slit lamp Examination • Tonometry • Glare test (BAT) • Visual Field • Colour Vision Screening • Keratometry • Internal evaluation (Dilated/undilated) • Low vision devices
- 19. Case 1 A patient is an 89 years old with a history of macular degeneration . She was wishes to read newspaper, magazines, and her mails, all of which are approximately 1 M print. Case Studies
- 20. Case study :- • BCVA 20/200 • NVA Tested at 33cm with a +3.00D add (can read 4M ) • Start with +12.00D trail spectacle add allows the patient to read 1M print at 8.3 cm with reading lamp • Further we increasing the add but does not improve performance
- 21. Formula : h . d = H’ . D’ h- Spectacle correction d- reading distance D’- Spectacle correction need H’- working distance need h×d=H’×D’ +3.00D×4M=1M×D’ D’=+3.00D×4M D’=12 1M
- 22. You show the patient other option +12.00D illumined hand held magnifiers works well Patient complaining difficulty maintaining focus after a few minutes of reading Looking for a illuminated stand magnifiers with a transvers magnification 4X and minimum add of at least +3.00D Gives the stand magnifiers, they provide a stable base prolonged reading task She prefers, because it has a built in light and is better for reading newspaper
- 23. She is slightly dissatisfied with the working distance of 4 cm from the lens
- 24. Recommend the +12.00D illuminated hand held magnifier for portability and short-term reading task Such as reading prise tag, mails, and scanning Also be recommend the 4X illuminated stand for longer reading tasks
- 25. Case 2 Patient 2 is a 27 year old male with a history of congenital cataracts. He is aphakic and wears a contact lens correction. He is a graduate chemistry program and is seeking help for two problems. 1- he must read the marking on pipettes held under the laboratory. 2- fine – prints precautions on the chemical jar labels. The pipettes have marking of approx 1.5M The jar labels have print of approx 0.5M are held in 67cm
- 26. Case study BCVA= 20/160 (CLs +12.00D ) Refraction= no changes in contact lens correction ADD +2.50D at 40cm patients read-3.2M and 4M Continuous text Formula- h×d=H’×D’ for pipette marking a number identification task is equal to +5.30D For label text a reading task is +20.00D
- 27. The patient demand od reading the pipette at 67 cm Also a require a system that will leave hand free head borne telescope – 3x or 4x A trail with 4x telescope patient perform the task satisfactory
- 28. Important clinical making process in action 1. Determine the patient need 2. Calculate the power needed to meet each objective 3. Refine the power you actual testing 4. Select appropriate powered devices 5. Guide the patient in the selection of the device
- 29. Case 3 A patient 48 years old with a history of traumatic cataract because of blunt trauma in right eye, now he is aphakic. He is a working in industry suffering from distance or near vision difficulties. The patient visual acuity is Distance near RE LE RE LE BCVA 6/60 6/18 N18 N18
- 30. Case 4 A patient 45 year old patient with a history of retinitis pigmentosa . He is a school teacher and suffering from vision problems. C/O- BE diminution of vision ( For distance and near )
- 31. Case study V/A- R/E 4/60 L/E 4/60 NV BE N36 BCVA- R/E 6/60 Nv- N36 L/E 6/36 Nv- N24 Glass power RE LE -2.50DS/-1.25DC × 10˚ 0.00DS/+1.00DC × 10˚ No significant improvement with glasses Advice LVA LVA Trail:- For distance- spectacle mounted telescope 2X 6/12 For near - Spectacle magnifier 8D N8
- 32. Reference: The art and practice of low vision ( Paul B. Freeman and Randall T. Jose) Essential of low vision practice ( Richard L. Brilliant, O.D, F.A.A.O.)