Health assessment should include vision questions
Because most home health patients are embarrassed to admit vision problems, it is important to include vision-related questions in a home health assessment, says Priscilla Rogers, PhD, a vision rehabilitation consultant in Mooresburg, TN. She suggests that the following questions be included:
1. Has your vision become worse in the last three months?
_____Yes ____No _____Sometimes
2. Have you experienced any of the following problems?
• Sudden hazy or blurred vision
• Recurrent pain in or around the eyes
• Double vision
• Seeing flashes of light
• Seeing halos around lights
• Unusual sensitivity to light or glare
• Changes in the color of the iris
• Sudden development of persistent floaters in the eye
3. If so, have you seen an eye doctor?
_____Yes ____No _____Unsure
4. What is your diagnosis?
_____ macular degeneration
_____ cataracts
_____ glaucoma
_____ diabetic retinopathy
_____ other
_____ unsure
5. What is the severity of your visual impairment? (Select only one.)
____ No light perception or LP only
____ Other legal blindness
____ Other severe visual impairment
____ Declined to answer or doesn't know
If a vision problem is suspected or if the patient has not seen an eye doctor in several months, Rogers suggests that the following questionnaires, which are designed to more clearly identify the type of vision loss, be used. This questionnaire is to help identify people who may be experiencing a vision problem and who could benefit from seeing an eye care professional, either an optometrist or an ophthalmologist, she says. "People who use glasses or contact lenses should answer the questions in terms of how they see when wearing their glasses or contact lenses," she points out. This does not include the use of magnifiers or any other special low vision devices, she adds.
(Scoring and understanding the results: Scores are indicated next to the answer for each item. After completing the questionnaire, total the number of ones the older person provided. People who score nine or above should be encouraged to seek an eye examination from an optometrist or ophthalmologist.)
1. Do you ever feel that problems with your vision make it difficult for you to do the things you would like to do?
1. Yes 0. No
2. Can you see the large print headlines in the newspaper?
0. Yes 1. No
3. Can you see the regular print in newspapers, magazines or books?
0. Yes 1. No
4. Can you see the numbers and names in a telephone directory?
0. Yes 1. No
5. When you are walking in the street, can you see the "walk" sign and street name signs?
0. Yes 1. No
6. When crossing the street, do cars seem to appear very suddenly?
1. Yes 0. No
7. Does trouble with your vision make it difficult for you to watch TV, play cards, do sewing, or any similar type of activity?
1. Yes 0. No
8. Does trouble with your vision make it difficult for you to see labels on medicine bottles?
1. Yes 0. No
9. Does trouble with your vision make it difficult for you to read prices when you shop?
1. Yes 0. No
10. Does trouble with your vision make it difficult for you to read your own mail?
1. Yes 0. No
11. Does trouble with your vision make it difficult for you to read your own handwriting?
1. Yes 0. No
12. Can you recognize the faces of family or friends when they are across an average size room?
0. Yes 1. No
13. Do you have any particular difficulty seeing in dim light?
1. Yes 0. No
14. Do you tend to sit very close to the television?
1. Yes 0. No
15. Has a doctor ever told you that nothing more can be done for your vision?
1. Yes 0. No
(Source: Arlene R. Gordon Research Institute, Lighthouse International New York, NY, funded in part by a grant from the National Institute on Disability and Rehabilitation Research, U.S. Department of Education, 133A20019.)
If the person scores nine or more on the above instrument, you may want to include these questions in your assessment.
1. Have you seen a low vision specialist, either an optometrist or ophthalmologist who is specially trained to determine if any special optical devices in addition to regular eye glasses can help you to see better so that you can do the things you want to do, such as read, watch television or see objects at a distance?
Yes ______No _____Unsure_____
Examples of these devices include:
• High-powered spectacles
• Hand-held or stand magnifiers for reading or writing
• Telescopes to help you see at a distance, such as see a street sign
• Closed-circuit television systems (CCTV) that magnify print onto a screen up to many times their size
• Portable electronic magnification systems — hand-held cameras to bring the camera to the material to be viewed. These can magnify almost anything within reach, including labels on packages of food and medicine and are similar to regular magnifiers but with much more power.
2. Do you use optical devices to help you see?
Yes _____No____
If yes, please indicate what type(s):
___Magnifiers or high-powered glasses for reading/close work
___Telescopic lens for distance
___Closed-circuit television
___Portable electronic magnifier
___Other
3. Do you use any non-optical aids such as talking or large print watches or clocks, writing aids or large print cards?
Yes____No______
If yes, please explain:
4. Do you have problems getting around your home, yard or neighborhood because of your vision?
Yes_____ No_____ Sometimes______
If so, do you use a white cane or dog guide?
Yes_____ No_______
5. Are there activities or tasks that you don't perform or can't perform as a result of vision loss that are important to you? Please list.
6. Have you been referred to a rehabilitation agency serving people with vision problems?
Yes_____ No_____ Don't know____
7. If so, what services did you receive?
_____Learning new ways to manage in the kitchen and do household tasks
_____Learning how to make my home safe for me to get around and find things
_____Learning to use devices to help with writing, such as signature guides, check writing guides, bold-lined paper
_____Learning to use optical devices such as magnifiers or telescopes
_____Learning how to use a cane to get around my home or neighborhood
8. If not, or if you don't know, are you interested in being referred to such an agency and learning more about how to cope with your vision problems?
Yes_____ No_____ Maybe_____ Need more information_____.
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