Interpretation of Exam/Progress Notes - PowerPoint Presentation

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Interpretation of Exam/Progress Notes

Interpretation of Exam/Progress Notes

Parts of the

Exam- Patient History

Grade:

Attended Evaluation:

Referred by:

Allergies:

Meds:

History:

Will be filled out at both Initial Exam (Background History) and

at Progress Exams (Current functioning level and progress in school/work, etc)

Near VA OD: 20/

Dist. VA OD:

Habitual Rx OD:

Near VA OS: 20/

Habitual Rx OS:

Dist. VA OS:

Current glasses/contacts prescription

Distance acuity with glasses/contacts

Near acuity with

glasses/contacts

Parts of the Exam- Acuity w/ Correction

It may be helpful to note any current medications since some do have ocular side effects

The Snellen fractions, 20/20, 20/30, etc., are measures of sharpness of sight. They relate only to the ability to identify small letters with high contrast at a specified distance.

Interpretation of Exam/Progress Notes

Parts of the

Exam- Acuity w/o Correction/Cover Test

NVA Unaided OD:

DVA Unaided OD:

DVA Unaided OS:

NVA Unaided OS:

Distance Visual Acuity w/o correction

Near Visual

Acuity w/o correction

DCT:

N

CT:

In the alternating cover test the two eyes are alternately covered with an

occluder

or "cover paddle" while the patient looks at a target which he can see clearly. The test is done while the patient fixates a distant target and again when he fixates a near target. When the

occluder

covers an eye, it is dissociated from its fellow and moves to its phoria position. When the

occluder

is removed, the eye resumes fixation. The examiner looks for the direction and amount of

movement of

the eye when the cover paddle is removed. If the patient is exophoric, his eyes diverge in the phoria position and the eye will move medially when uncovered. If the patient is esophoric, his eyes converge in the phoria position and the eye will move laterally when uncovered. An eye may also be

hyperphoric

(deviated upward) or

hypophric

(deviated downward) with corresponding motions down and up, respectively, of the uncovered eye.

Interpretation of Exam/Progress Notes

Parts of the

Exam- Eye Movements

Saccades:

Pursuits:

Fixation:

Pursuits

Dr.B’s

System for Evaluating Oculomotor Skills- Pursuits

4 smooth and accurate3 one fixation loss2 two fixation losses1 more than two fixation losses or any uncontrolled head movement

Smooth pursuit movements are slow tracking movements of the eyes designed to keep a moving stimulus on the fovea. 

Saccades

Dr. B’s

System for Evaluating Oculomotor Skills- Saccades4 smooth and accurate3 some slight undershooting 2 gross undershooting or overshooting or increased latency (time to initiate movement)1 inability to do task or any uncontrolled head movement

Saccades are rapid, ballistic movements of the eyes that abruptly change the point of fixation. They range in amplitude from the small movements made while reading, for example, to the much larger movements made while gazing around a room. 

Fixation

Dr. B’s System for Evaluating Oculomotor Skills- Fixation

4 smooth and accurate3 one fixation loss2 two fixation losses1 more than two fixation losses

Fixation 

is

the maintaining of the visual gaze on a single location. 

Interpretation of Exam/Progress Notes

Parts of the

Exam- Binocular Function

Stereopsis:

NPC:

Color Vision:

Near Point of Convergence

The

closest point to which the two eyes can follow a target in toward the nose without losing fusion (

diplopia

or suppression). Noted as TTN if no break occurs or noted in inches if there is a break or loss of fusion. Also noted may be discomfort (patient reported) or red face which denotes strain.

Stereopsis

Tests and evaluates stereo depth perception for both gross stereopsis evaluation

using

six geometric forms from random dot

backgrounds Tells us how the two eyes are working together.

Test to detect

Daltonism

C

olor

blindness

of

basic colors:

R

ed

,

Blue

and

Green

A distinction is made between:

protanopes

, who do

not see

red;

deuteranopes

, who do not see green;

tritanopes

, who do not see either blue or yellow.

Maddox Rod Near:

Interpretation of Exam/Progress Notes

Parts of the

Exam- Binocular Function Continued

Maddox Rod

Dist:

W4D D:

Worth 4 Dot

W4D I:

W4D N:

+2.00:

-2.00

:

This is a

test

utilizing red-green color

dissociation. The

patient wears red and green goggles (as a convention red in front of right and green in front of left). The test can be performed separately for distance and near vision. The interpretation of this test is as follows-

A) The patient sees all the four dots.

normal binocular response with no manifest deviation

B

) The patient sees five dots.

uncrossed diplopia with esotropia, red dots appear

to

the

right; crossed

diplopia with exotropia, red dots

appear

to the left of the green dots.

C) The patient sees three green dots, suppression of right eye.

D) The patient sees two red dots, suppression of left eye.

E) This test is performed as various distances near, intermediate and distance to watch for variations. Doctor will typically “start where they are” wher

e the patient is likely to have fusion based on previous testing.

Interpretation of Exam/Progress Notes

Parts of the

Exam-Fusional Facility/ Accommodation

MEM OD:

Fus

Facility CPM:

Fusional Facility-

Cycles per Minute

Acc Facility CPM:

Fails:

MEM OS:

Fails:

Accommodative

Facility-Cycles per Minute

This test is usually done with a nearpoint reading card and a flipper with +/-2.00 lenses. The doctor will measure how many cycles of switching (eg. from plus to minus to plus) that the patient can achieve in 1 minute. 

Examination

of Pupils

Doctor notes pupillary response to light. In most cases you may see the abbreviation PERRLA—pupils equal, round, and reactive to light and accommodation. You may also see notes about AO Pupil which is Alpha Omega Pupil where pupil does not hold constriction in bright light after a few seconds.

Pupils:

Performed at distance with 3D BO/ 12D BI. Patient is instructed to keep a vertical line of 20/30 letters single and clear as base out prism and base in prism is introduced. Similar to the Binocular Prism Rock performed in therapy.

The doctor uses the Retinoscope to perform this test. The

'''monocular estimate method''' is a form of dynamic retinoscopy used to objectively measure accommodative response through a plus lens. Values normally attained when performing MEM are between +0.25 and +0.50 diopters. Look for notes about bright and dim – bright is better than dim.

MEM

Interpretation of Exam/Progress Notes

Parts of the

Exam- Retinoscopy/Refraction

Dist

OD: 20/

Retinoscopy OD:

Subjective Refraction OD:

Dist

OU: 20/

Pupils:

Retinoscopy OS:

Subjective Refraction OS:

Add:

Retinoscopy

Dist

OS: 20/

Near OD: 20/

Near OU: 20/

Near OS: 20/

Distance and Near Acuity

with Rx found during Refraction

Subjective Refraction

This is the lens power determined by doctor to give the best corrected visual acuity.

Interpretation of Exam/Progress Notes

Parts of the

Exam- Phoria/ Vergence Ranges

Distance BO:

Dist. Phoria H:

V:

Near Phoria H:

V:

+1.00

To measure subjectively the relative horizontal or vertical deviation of the eyes, one with respect to the other, when fusion is interrupted

Distance BI:

Near BO:

Near BI:

Vergence Ranges- Noted with blur/break/recovery- Performed in

phoropter

for some patients or with prism bar for patients who have difficulty with in

phoropter testing.

To measure subjectively the relative horizontal or vertical deviation of the eyes, one with respect to the other, when fusion is interrupted

SILO -In this area pay special attention to notes like SI or SO (under BO testing) or LI or LO (under BI testing) - this gives the therapist information as to how the patient perceives space and how reliant they are on visual information-

To measure subjectively the relative horizontal or vertical deviation of the eyes, one with respect to the other, when fusion is interrupted

Measures horizontal or vertical deviation of the eyes, one with respect to the other, when fusion is interrupted. The phoria may be assessed by alternating cover test. The doctor will repeat this test many times to check for repeatability and stability.

Learn more about tropia/phoria testing here:

Interpretation of Exam/Progress Notes

Parts of the

Exam- Accommodative Amps

Accommodative Amps OD:

Vertical Range

Dist:

Vertical Range Near:

Accommodative Amps OS:

The

maximum amount of accommodation that can be stimulated, by reducing plus lens power or by adding minus lenses, in an eye.

Normal amplitude of accommodation can be determined by using the following formula:

18- 1/3 of patient’s age (Morgan’s

Expecteds

)

Or

15- ¼ patient’s age (Hofstetter’s Formula

)

Sometimes on Accommodative Amps you will see a # then a dash and another #. The first number is the first “disruptive” lens or prism power but they are able to recover and got up to the higher level.

Interpretation of Exam/Progress Notes

Parts of the

Exam- NRA, PRA, FCC

FCC:

NRA:

PRA:

T

his

nearpoint test evaluates the amount accommodation can be relaxed while convergence is held constant

.

Normal findings are in the range of +2.00 +/- 0.50>2.50: may indicate latent hyperopia <2.50: poor accommodationMost of our patients are low hyperopes so +2.50 should get “easy” with max around +3.00

This

nearpoint test evaluates the amount of increase that can be made in accommodation while convergence is held constant. Normal findings are -2.25 to -2.75 D in the age range of most of our patients.. Values below -1.50 D may indicate an accommodative insufficiency. Our goal is “superhero” on most tests so that “average” becomes easy.

Fused Crossed Cylinder– this test is

done at nearpoint and evaluate how accommodation functions when a target has no meaningful symbols to read or be recognized (i.e. no cognitive demand).  The crossed cylinder tests measure how much plus can be accepted at near and help the doctor in the determination of a nearpoint prescription.

Interpretation of Exam/Progress Notes

Parts of the

Exam- Assessment

Binocularity:

Motility:

Accommodation:

Visual Acuity:

RE:

OH:

Assessment:

Problems found with eye movements will be noted here.

Problems found with accommodation will be noted here.

Problems found with binocular function/vergence will be noted here.

Problems found with visual acuity will be noted here. If normal may be abbreviated to

wnl

OU

Parts of the Exam- Plan/ Recall

Recall:

Exam/Provider:

Plan:

The most valuable portion of exam notes for a therapist or administrative staff – Details doctors findings and recommendations for patient’s future care. Special care should be taken to follow these instructions in upcoming VT sessions for therapists.

Doctor will note session count for next Progress Visit in case of existing VT patient or specific instructions for perceptual testing and follow-up for new patients