Patient Assessment

Patient History

• Occupational vision demands
• hobbies
• rank vision and functional goals
• history of falls
• familial support (3)
• daily living problems (3)
• ocular pathology in terms of field loss and sensitivity to light and glare (2)

 Thorough Eye Assessment

• Visual acuity (3)
• Refraction (3)
• Near vision (3)
• Contrast sensitivity (2)
• Using prescribed and over the counter assistive devices (e.g., glasses, magnifiers (2,3))
• Establish preferred retinal locus for fixation (AMD) (5)

Ability to Perform Visual Tasks (4)

• reading continuous print
• writing
• using a cell phone
• using a computer
• walking
• navigating steps

Discussion of Patient's Vision Needs (2,3,4)

• paying bills
• maintaining hygiene
• dressing ousekeeping
• shopping
• food preparation
• work
• ambulation
• driving or taking public transportation
• watching television
• reading
• hobbies

Other

• assess for dual losses vision and hearing, preferably hearing before vision
• confirm with patient the results of his / her visual screening (3)

Management and Referral

Discuss patient’s understanding of their condition

• Discuss the future of patient’s condition
• Discuss activities that may be beneficial/detrimental to his/her condition

Patient Goals

• Set attainable goals and help patients understand what they will and will not be able to do (3)
• Establish management solutions based on patients’ needs and goals, with OT if available (eg. adaptive equipment, lifestyle changes that can improve performance)
• Gauge if patient can use assistive device correctly. Refer back to OT if not.

Other *

• Determine appropriateness of a support group (5)
• Assess how the patient is coping.
• Screen for depression.
• Consider social work or Department of Aging referral to assist with transportation needs.

Referral to Low Vision

• Referral from optometrist/ ophthalmologist is preferred but not necessary; possible direct referral from primary care, but this can result in inappropriate referral.**
• Referral to Occupational Therapy
• Referral from optometrist/ ophthalmologist or primary care provider is required for assistance through insurance.

OT= Occupational Therapy

*"Psychosocial adaptation to age-related vision loss encompasses three domains including acceptance of sensory loss, a persons attitude toward rehabilitation and finally, attitude toward social relationship"

**If primary care refers to ophthalmology they can mention low vision to clients if there is a possibility of continued functional impairment. Need to be sure of accurate diagnosis for the vision impairment and sure that surgical, medical and other modalities have been maximized as the patient's general condition allows.