University of Edinburgh
 

Low Vision Aids

by Heather Mason

Low vision aids training record

 

Name Age
Date of birth  
Visual impairment/s  
Date of last LVA assessment  
Visual Acuity  
uncorrected Near R Distance R Binocular
  Near L Distance L  
corrected Near R Distance R Binocular
Field of Vision   normal (Y/N)
  Central Y/N
  Peripheral Y/N
  hemianopia Y/N
Colour Perception Y/N
Light Sensitivity Y/N
Ability to see in the dark Y/N
Contrast sensitivity Y/N
Ability to discern moving objects Y/N

LVA Prescription

Near  
  Distance  
  CCTV  
     

Visual functioning with LVAs

Can read size [ ] N print at [ ] cm

Estimation of speed of reading for near distance is [ ] wpm

Estimation of distance at which objects can be discerned [ ] m

Additional comments, eg; summary of any functional vision test