This is Low Vision Case Analysis. A 58/f come to clinic with complain of DOV (OU) since @ 8yrs back , for distance see Tv 2.1x vision 0.3 logmar . For near prismatic glasses 8xN8@15-20cm.

1. PRESENTED BY :-
SHUBHAM KR. KASHYAP
OPTM 3RD YR (STUDENT)

2. LOW VISION – INITIAL ASSESSMENT
Pt. Name :- Nisreen Mokhanawala UMR NO:-
07/018
Date of Birth :- Age/Gender:-
58/F
Date:- 08/09/23
Ocular Diagnosis:- Retinal Telangiectasia
Date of First Diagnosis:- 04/march/23
Duration of Vision loss :- 8yrs

3. PERSONAL HISTORY
Education Occupation Marital
Status
Co-operation
from work place
BBA House Wife married ------------
Are you the
bread –
winner of the
family
Support Depend
ents
Literac
y
status
of
parent
s
Econo
mic
status
of
family
Financia
l
support
provided
by
Yes/No 1. Independe
nt
2. Partially
dependent
3. Totally
dependent
------------ --------- --------- ---------

4. FAMILY HISTORY:
Consanguinity Family history of
visual problems
Family history of
other problems
Details of Family
History
NO NO NO NO
Physical
Disabilit
y
Hearing
Disability
Speech
Disability
Intellectual
Disability
Other Disability
NO NO NO NO NO
Additional Disabilities:

5. PREVIOUS USE OF DEVICES:
Previous Low Vision Care: YES/NO If yes ,specify where and
when:
Current
and last
used
devices:
Duratio
n (hour
per day)
Time
since
purchas
e
(
months)
Present
conditio
n of
device
Satisfactio
n with use
of device
Device
brough
t today
comment
s
Spectacle
s
9 hour 8 yrs ------ --------- -------- -------
Contact
lenses ---------- ----------- ---------- ----------- ----------
-
-----------
Low
vision
devices
1
-------- ----------- -------- ------------- -------- ---------

6. DISTANT VISION TASK:
 Do you have difficulty in any of the following?
1. Recognizing faces ( Yes/No)
2. Watching TV at a distance ( Yes/ No)
3. Reading bus numbers ( Yes/No)
4. Copying a chalk board ( Yes/No)
5. Watching movies in theatre ( Yes/No)
6. Driving or riding a motor vehicle (Yes/No)
7. following computer presentations (Yes/No)
8. sightseeing (Yes/No)
9. Others
INTERMEDIATE VISION TASKS:
Do you use computer use : Yes/No
Preferred font size : purpose of using computers: 1. communication
2. profession 3. Education

7. DO YOU HAVE DIFFICULTY IN ANY OF THE FOLLOWING WHILE USING COMPUTERS?
1. Reading print on the monitor ( × )
2. Glare from the monitor ( √ )
3. Recognizing keyboard letters/symbols ( ×)
4. Others:
Near vision Tasks:
Do you have difficulty while reading any of the following?
1. Textbooks 2. Newspaper 3. Religious books 4. Dictionary 5. price bills
6. medicine labels 7. Others:
Can you manage to read at a closer distance? Yes/No
Is writing a priority? Yes / No
Purpose of writing : 1. Education 2. Occupation 3. Religious 4. Recreation
5. others
Do you have difficulty in writing along a straight line? Yes/ No

8. PREFERENCE OF ILLUMINATION:
 Illumination source: 1.Fluorescent light 2. Natural light 3. other:
 Illumination Quality: 1. Bright light 2. indirect light 3. reduced light 4. Others
LIGHT SENSITIVITY:
Do you have problem with glare in outdoors? Yes /No
Source of Glare: 1. sunlight 2. vehicle lights from opposite direction 4. Other:
MOBILITY HISTORY:
Do you have any difficulty in mobility ? Yes/No
Do have take help from others for your mobility? Yes/No If yes , help from :

9. DESCRIPTION OF PROBLEM:
SI.
No
Specific
problems
Familia
r Unfamilia
r
Day Night
1 Ascending Stairs ----- -------- ------ ------
2 Descending Stairs --------- -------- ------ -------
3 Bumping into Objects ------- ----------- ------- -------
4 Crossing Roads -------- ---------- --------- -------
5 Others
1.
2.
---------- -------- -------- ------
DAILY LIVING SKILLS
Is there a difficulty in performing activities of daily living?
Yes/No

10. DIFFICULTY IN:
I. Grooming: 1.Bathing 2.Using the toilet 3.Dressing 4.Matching Clothes
5.Others
II. Kitchen and Eating skills: 1.Identifying Groceries 2. Measuring Quantity
3.Cutting veg. 4.Others:
III. Housekeeping: 1.Cleaning the house 2.Making the Bed 3.Arranging
Cupboards 4.Others
IV. Miscellaneous: 1.Threading a needle 2.Coin Identification 3. telling time 4.
Others:
BRIEF CURRENT MEDICAL HISTORY
Chief Complaints:
C/O DOV (04) *8YRS BACK,

11. GROSS VISUAL BEHAVIOUR:
Visual Fixation: Ocular preference:
Right/Left/Both/Unknown
DISTANCE VISUAL ACUITY:
Distance Vision Chart Used: Distance of Chart: Logmar. Illumination
for chart:
Unaided Vision: Aided Vision:
LCVA HCVA
Right
Eye
0.9
Left Eye 0.8
Both
Eye
0.6
LCVA HCVA
Right
Eye
Left eye
Both Eye

12. CURRENT DISTANCE PRESCRIPTION:
Sphere Cylinder Axis
Right -0.50 140
Left -0.50 120
Near Add +2.50
6/60 p
6/36
N36
@15-20cm
N24
Near Vision ( Both eyes) :___________at _15-20_____cm, using _______ chart
under______ illumination.
Type of Spectacle:
1. Single Vision 2. Bifocal 3.Progressive
Frame Shape:_________________, Type of Bifocal:________________, Frame
Material:_____________

13. REFRACTION:
Dry Retinoscopy Dry Acceptance
Sph Cyl Axis Sph Cyl Axis Distanc
e Vision
Near
Add
Near
visio
n
Right
Eye
0.0 -0.50 140 0.0 -0.50 140 6/60(p) +2.50 N36
Left
Eye
0.0 -0.50 120 0.0 -0.50 120 6/36 +2.50 N24
Cycloplegic Used:
Atropine/Homatropine/Cyclopentolate/Tropicamide/Others:
Sph Cyl Axis Sph Cyl Axis Distanc
e
Vision
Near
Add
Near
visio
n
Right
Eye
Left
Cycloplegic
Refraction
Cycloplegic Acceptance

14. VISUAL FIELD TESTING:
Humpherys Visual Field(30)
confrontation test 2) Others
Right Left Right Left Right Left
× ×
Humpherys Visual Field(10-
Amslers Chart 2) Others
Right Left Right Left Right Left

15. Colour Vision:D15 Contrast Sensitivity
Right Left Right Left
13/21 13/21 1.35 1.35
BINOCULAR FUNCTION:
Worth 4-dot Test: Stereopsis:
TRIAL OF LOW VISION DEVICES:
Distant vision devices: Magnification Required: 3x preference for:
Right/Left/Both Eyes
Trials:
1. See TV 2.1x
2.
3.

16. PREFERRED DEVICE:
Visual Skills: Fixation:Good/Average/Poor Focusing: Good/Average/Poor
Scanning:Good/Average/Poor Tracking:Good/Average/Poor
Near vision devices: EVP= BCUA/TUA=100/WD preference for: Right/Left/Both
Eyes
Trials:
1. Prismatic glass10x N8@15-20cm
2. Prismatic glass 08x N8@15-20cm
3.Dome magnifier 4x65@15-20cm
Preferred Devices:
Visual Skills: Good/Average/poor Visual Objectives Fulfilled: Yes/No

17. REASONS FOR NON-FULFILLMENT OF VISUAL
OBJECTIVES:
1.Sever Visual Impairment 2. Poor Literary Skills 3.Peripheral field loss
4.Poor Co-Operation 5.Multiple Disabilities 6. Others________________.
Preference of Absorptive lenses:
1.Dark Grey 2. Light Grey 3.Dark yellow 4.Light Brow 5,Others_____.
LOW VISION REHABILITATION PLAN AND MANAGEMENT:
Problem summary:
A 58/f come to clinic with complain of DOV(ou) since @ 8yrs
back, for distance see TV 2.1x vision 0.3 logmar. For near prismatic
glasses 8xN8@15-20cm.
Management plan
Distance – SEE TV 2.1x vision 0.3
For near – prismatic glass 8xN8@15-20cm

18. PRESCRIPTION
Optical Devices Suggested:
Distance Task : SEE TV 2.1x vision 0.3
Near Task : Prismatic glass 8xN8@ 15-20cm.
Non- optical Devices Suggested:
Other Devices Suggested:
Motivated to Use LVDs: Not Applicable /Yes/No
If No, Specify: 1.Cost 2.Cosmetic Blemish 3.Handling
problem 4.Others:

19.  LVDs Purchased: Yes/No Source suggested__________________
Cross Consult to Other Department:
Examiner Name & sign:
Next Appointment:
REVIEW 6/12 MONTH