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