by Edward J. Huggett, Jr., O.D., P.A.
Chief of Low Vision Services
St. Luke’s Cataract and Laser Institute
Tarpon Springs, Florida
A low vision examination is quite different from a typical eye examination. Rather than looking for visual dysfunction and ways to treat it, a low vision doctor tries to learn what vision you have to work with. As a low vision optometrist, I want enough information so that I can, as closely as possible, understand and visualize what you see.
I know you have questions about your eyes, your vision, and what will happen in the future, but I have questions, too! Some of them might seem unrelated to the examination, but there are definite reasons for them. Here are some questions a low vision doctor will often have. Your doctor or therapist will greatly appreciate it if you will show up with this filled out as completely as possible when you meet for the first time.
__________________________________________________________
General Questions
• Who is your referring doctor? ____________________________
• Who is your primary care doctor? _________________________
• Have you had previous low vision care?
( ) Yes
( ) No
• Have you had any changes in vision since your last eye exam?
( ) Yes
( ) No
• Has your vision changed in the past month?
( ) Yes
( ) No
• Has your vision changed since your last exam?
( ) Yes
( ) No
• Do you have a hearing loss?
( ) Yes
( ) No
• Do you have a hearing aid?
( ) Yes
( ) No
• What is your living situation?
( ) Alone
( ) With a spouse
( ) With a family member
( ) Retirement home
( ) Nursing home
( ) Full/part time aide
• What is your employment status?
( ) Full time
( ) Part time
( ) Retired
( ) Unemployed
( ) On leave
( ) Seeking employment
( ) Homemaker
• If you are employed, is your job in jeopardy because of your
vision?
( ) Yes
( ) No
( ) N/A
• If you are employed, have you considered retiring or resigning because of your vision?
( ) Yes
( ) No
( ) N/A
• Do you have other limitations such as difficulty walking,
tremors hand or arm weakness?
Yes. (Describe: _____________________________________)
• Have you seen things that are not there?
( ) Yes
( ) No
TASK ANALYSIS
Traveling
• Do you go out alone?
( ) Yes
( ) Sometimes
( ) Never
• Do you want to go out alone?
( ) Yes
( ) No
• Do you use a cane/dog as an aid to navigation?
( ) Yes
( ) No
• Have you had O&M instruction?
( ) Yes
( ) No
• Check if you have difficulty:
( ) Traveling locally alone
( ) Traveling far alone
( ) Seeing traffic lights/street signs
( ) Crossing streets
( ) Seeing to drive a car
( ) Distance Viewing
( ) Check if you have difficulty:
( ) Getting around people/objects
( ) Seeing curbs and steps
( ) Walking without tripping
( ) Seeing faces
( ) Seeing TV. How far do you sit from the TV? ________
( ) Seeing at the theater
( ) Daily Living Activities
( ) Check if you have difficulty:
( ) Doing your housework
( ) Seeing to cook
( ) Seeing the stove dials
( ) Seeing flame on your stove
( ) Seeing the food on your plate
( ) Seeing/using the phone
( ) Seeing to groom yourself
( ) Near Tasks
• How long since you have read without any magnifier or help?
_________________________________________
• Check if you have difficulty:
( ) Reading headlines
( ) Reading regular print books
( ) Reading newsprint/small print
( ) Seeing prices or labels
( ) Reading your mail or bills
( ) Reading hand written material
( ) Writing/signing your name
( ) Seeing colors
( ) Seeing to sew/knit /crochet
( ) Seeing playing cards
( ) Seeing your meds/labels
( ) Seeing to fill a syringe (diabetics)
What social activities do you have?
_________________________________________
Lighting Considerations
• Check if you have problems:
( ) Tolerating the sun
( ) Glare Problems Indoors
( ) Glare from Computer
( ) On cloudy/rainy days
( ) Going from bright to dim light
( ) Seeing in dim light
• Do you wear sunglasses?
( ) Yes
( ) No
• If you wear sunglasses, are they effective?
( ) Yes
( ) No
• Does bright light help you?
( ) Yes
( ) No
Job Related Tasks
Check if you have problems:
( ) Using a computer
( ) Has your computer been modified for large print or speech
( ) Using tools/equipment
( ) Reading instruments/indicators
( ) Traveling to work site
( ) Seeing distant presentations
__________________________________
Certainly, these are not all of the questions your doctor may ask, but this will at least help you to start thinking about your vision so you can be an effective partner in your care. As a doctor, I would rather have too much information than not enough. Low vision examination and rehabilitation is not an event: it is a process. It is a process that takes time and the efforts of you, your family, your friends, your doctors and your vision rehabilitation specialist.
Remember, as a low vision doctor, one of my biggest thrills is helping you to see something you haven’t been able to see. We all have the same goals. Let’s work together to help you!
