Low vision cases

Name:- MR No:-_________
Age/Sex:- Date:-__/__/____
Address:-
Occupation:-
History of disorder:-
Chief complain:-
CHIEF VISUAL COMPLAINTS
D/V Yes No Board work Yes No Recognizing Yes No Watching TV Yes No
abnormalities in institute faces

N/V Yes No Writing Yes No Extra Yes No Glare effect Yes No

abnormalities Ability illumination

Colour Yes No Food Yes No Mobility Yes No Currency Yes No

sensation identification problem identification

VISUAL ACUITY ASSESSMENT

DISTANCE VISUAL ACUITY RE LE
By Snellen’s chart (unaided)
By Snellen’s chart (aided)
By logMAR chart (unaided)
By logMAR chart (aided)

NEAR VISUAL ACUITY RE LE

Single letter chart (unaided)
Single letter chart (aided)
Crowded letter chart (unaided)
Crowded letter chart (aided)

OTHER ESSENTIAL TEST RE LE

Contrast sensitivity test
Visual field test (peripheral)
Visual field test (central)
Colour vision test
Glare test