low vision assessment Flashcards
name 3 things that you observe about a patient in your lv clinic
- postural abnormalities
- mobility
- appearance
what is the most important part of a low vision assessment
history taking
how is a lv history taking different to a pcc history taking
more follow up questions are asked and more time is spent on it
list 9 things you will ask about in history taking of your lv assessment
- the duration of condition and onset
- stability of condition and differences between the eyes
- patients knowledge of the condition and prognosis
- ongoing hospital monitoring and or treatment
- registration status
- education and or employment
- present aids and spectacles
- general health and medications
- reason for making the appointment
why will you ask the patient about their knowledge of the condition and prognosis, during history taking
as the patient needs to understand the eye condition to know how to deal with it and they will know if the condition will deteriorate so they can adjust to it well
why will you need to know if a lv patient is on any ongoing hospital monitoring and or treatment
to know if you should prescribe glasses or not
and you dont want to dilate the patient unless they’re having a new symptom, because if they’re at the hospital then they are getting dilated already, but if they’re not then you must dilate
why will you want to know about a patients registration status during history taking
to know if they’re SI or SSI
and you want to know if they have access to any benefits e.g. social services
if not you may need to follow up with them or refer them to be registered
why will you want to know about a patients education status during history taking
if its a child, you want to know if they’re in an ordinary or a specialist school
why will you want to know about a patients employment status during history taking
incase you need to tell them about the access to work scheme
if they’re employed they can use lv aids at work
why will you want to know about present aids and spectacles during history taking
to know if the aids/spectacles have been working in order to avoid wasting your patients time
why will you want to know about a patients general health and medications during history taking
to know which aid to give e.g. patient may have arthritis or Parkinson’s therefore they cannot hold a magnifier and you will want to give glasses instead etc
why will you want to know about a patients reason for making the appointment during history taking
you don’t want to assume that the px made the appointment themselves
sometimes they don’t know why they have made the appointment, as in the UK, the patient will be referred by the ophthalmologist and they don’t know why they came to the clinic
why do you want to ask about distance vision to your lv patient during history taking
- difficulty seeing: faces, buildings, cars, street signs, road signals, bus numbers and steps
- vision fluctuates or not
- eccentric viewing status
- problems with glare: wears tinted glasses
- vision better outdoors/indoors
which type of eye conditions will a lv px have if they have difficulty seeing faces
AMD or stargart’s / any macula problem
why would you want to know if a patients distance vision fluctuates or not during history taking
because you want to be aware, incase you give the wrong lv aid or glasses
why would you want to know about a patients eccentric viewing status during history taking
because if they dont use this technique, then you can give advice on how to use it for e.g. AMD or stargart’s patient management
why would you want to know if vision is better outdoor or indoor during history taking
as this can cause a fluctuation in vision and this can impact on what LVA you give to the px
what do you want to know about a patients mobility in the lv clinic
does the patient walk alone, or accompanied in new/familiar environments
give an example of a px who will have problems with mobility in unfamiliar environments
px who’s had a stroke and got a hemianopia
list 4 things you want to ask about a patients home situations during history taking
- if the patient lives alone or with family
- if they have difficulty getting around the house
- if they have difficulty watching tv
- if they have difficulties with colours
why would you want to ask a lv patient is they live alone or with family in your history taking
- if lives alone, they may need additional help e.g. with reading letters etc
- if lives with family, you know that support is easier for them
what 3 things will you ask your lv px during history taking about reading, close work and hobbies
- do they have difficulties seeing books, newspapers, headlines, large print, own writing
- is vision better in dim light or bright light
- do they have difficulties with hobbies such as sewing, bingo etc
why would you want to ask your lv px about their reading during history taking
it is one of the main problems a lv px faces, especially the elderly as they tend to stay at home and read
why would you want to ask your lv px about their hobbies during history taking
to know how to best help the px
whats a good idea to do at the end of history taking
make a list of the patients priorities in order to know what help the patients wants
then summarise your findings to the patient and offer help by asking the patient
what is the next thing to do in your lv assessment after history taking
measure visual acuity
record visual acuity ____________ then ___________ ______ and ___________ aid
record visual acuity monocularly then binocularly with and without aid
where is it best to start testing va’s
a close distances and then modify
what must you never resort to when measuring va’s and why
contain fingers
because if the px can read 6/60 at 1m then they can definitely see counting fingers at 1m, so don’t resort to it
give an example of how precisely va should be recorded
3/60 instead of
if a lv patient does not have a previous va history, how must you start
start at 3 metres as this is a positive start and the patient is most likely to read
when measuring near vision on your lv px, what 2 things must you do/record
- distance at which near vision assessment was made
- measure reading speed if possible
why must you measure the distance at which near vision assessment was made
because for example, N40 at 40cm can be different to N40 at 20cm
so must record working distance