Age/Race/Gender: 46 Black Male
CC: 46 yo BM c h/o end stage POAG OU presents for initial low vision evaluation; lost to f/u for > 1 yr.
HPI: Patient describes trouble focusing between near and distance VA c current specs. Typically removes specs for near work. Complains of trouble with glare and photophobia and decreased vision outdoors. Depends on cane for mobility outdoors, especially in the afternoon. No flashes, floaters, or ocular pain.
POHx:
1. End stage glaucoma s/p TRAB/MMC OU and iridectomy OD/LPI OS - stable IOPs OU s/p April 2010 TRAB surg
2. Superior operculated retinal holes OD - pt with stable h/o photopsia since 1983
PMHx:
1. GERD
2. tobacco use
SHx: attends associate degree program in electrical engineering; extensive work on circuit boards. School has already provided a mounted, lighted magnifier for desk work.
Entering Visual Acuity cc
OD: -3.25 + 0.50 x020 20/25-2
OS: -3.25 + 1.00 x165 20/20-1
MRx:
OD: -3.00 +0.75 x030 20/25+1
OS: -3.25 +0.50 x135 20/20
Near VA c +1.00 add 20/20 OU
pupils: surgical OD, OS round and reactive 1+, no APD OU by reverse
CVF: severly restricted OD, OS (review of HVF 24-2 2/4/2010) Visual Field restricted to approximately 10 degrees horizontal by 6 degrees vertical in the right eye, 15-20 degrees horizontal by 6 degrees veritcal in the left eye.
EOM: full range of motion OU
Visual goals:
1. Near tasks, reading, studying: circuit boards, textbooks
2. Intermediate goals, computer text and computer glare
3. Problems with indoor/outdoor glare
4. Problems with contrast/lighting outdoors
Device Evaluation:
1. 3X Eschenbach pocket magnifier with LED light over OS with VA: 20/20
2. NoIR filters, pt prefers: light grey
3. Cocoon polarized filters, pt prefers: large, grey
Ocular Tension - TAP @ 8:38 am.
OD: 10
OS: 9
Slit Lamp:
lids: mild MGD OU
conj: ST elevated avascular bleb OU
cornea: scattered PEE OU, +NaFl staining between 3-9 o'clock OU.
tears: TBUT < 3-4 sec OU
A/C: deep and quiet OU
iris: superior iridectomy OD, large superior iridotomy OS
lens: 1+ NS OU
ant. vit: clear OU
Undilated c 90D Volk:
C/D: 0.95 OD, OS
nerve: pale, distinct margins OU
macula: clear, flat OU, +FR OU
vessels: healthy, 2/3 OU
Assessment and Plan in the comments.
Impression/Plan:
ReplyDelete1. Legal blindness by fields secondary to end stage POAG OU s/p TRAB/MMC OU and iridectomy OD/LPI OS
-50% of time spent educating patient on condition, findings, and prognosis
-pt no longer driving; does not qualify based on severly restricted peripheral vision. Utilizes public transportation and cane for travel.
-ordered the following devices to help pt meet his visual goals
1. Grey coccons
2. FT-bifocal with light tint
OD: -3.00 +0.75 x030
OS: -3.25 +0.50 x135
add: +1.00
-Recommend the following devices:
1. Acrobat CCTV given vocational needs. Currently no therapist available for trianing; would recommend blind rehab program asap. Patient very interested today. Copy Vision Services Coordinator to note for intiate admission process.
-continue follow-up with Blind Rehabilitative Services as scheduled.
-Will see in LV clinic if Blind Rehabilitative Center (BRC) if severly backed up.
2. End stage glaucoma s/p TRAB/MMC OU and iridectomy OD/LPI OS
-low, stable IOP today
-HVF 10-2 today
-continue follow-up with EO2/Dr. Junk/glc today
3. h/o superior retinal holes OD
-pt chronically symptomatic with stable photopsia since 1983
-patient being seen by OMD/glc today at conclusion of low vision exam.
Glaucoma specialist plan:
-Does not appear to be change in VF although comparing 24-2 and 10-2. Repeat 10-2 at f/u in 6 mos.
- IOP stable sc gtts s/p Trab OU. Continue current management and f/u 6 mos.
So far in my LV experience, POAG patients really only need glare control with minimal magnification since central VA is typically good. Don't need to have LV experience to order tinted specs!! Try grey, yellow, or amber #1.