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Assessing patients with low vision

If you do not have sufficient expertise to assess a patient with low vision, you should refer the patient to someone who has. This may be an optometrist, or a dispensing optician based in a low vision service, or the local social services department.
You should assess the patient's:
  1. history, symptoms and needs. Some patients may have a personal care plan or low vision passport that would assist in this assessment
  2. visual acuity, including use of distance and near logMAR charts. If these are not available you may be able to use conventional charts to achieve meaningful results
You may need to assess:
  1. contrast sensitivity
  2. glare function
  3. central visual function using, for example, Amsler charts and appropriate colour vision tests
  4. visual field. You should:
    • repeat field assessments, where necessary and possible, to obtain a meaningful result, and
    • be aware of the limitations of static screening equipment particularly in cases of severe sight loss. If you do not have access to a conventional kinetic test, such as Goldmann, you should use confrontation type tests and Amsler charts for central vision to give practical advice to the patient
  5. binocular and accommodative status, where appropriate, for example in phakic children with low vision
  6. visual hallucination status (Charles Bonnet Syndrome).
When you have completed the appropriate assessments you must advise the patient your findings in a way they can understand.45, 46, 47 This may include using large print, sending as an audio file, Braille, or in an easy read format.
You should pass on relevant information to the low vision team or other appropriate parties, with an explanation of the results.
See section on Consent.