CONTACTS
SUBJECTS
Vision Presbyopia Cannot Read Small Text Books Magazines Text Blurry
0803 -
0803 - ..
0804 - Summary/Objective
0805 -
080501 - Follow up ref SDS 40 0000. ref SDS 38 0000.
080502 -
080503 -
080504 -
080505 -
080506 -
080507 - [On 190114 1050 James ordered glasses; should be delivered
080508 - in about 10 days. ref SDS 45 RS5F
080510 - ..
080511 - [On 190131 1051 letter to Doctor Szu notifies glasses
080512 - ordered on 190111, have not been received. ref SDS 47 XG48
080514 - ..
080515 - [On 190207 1340 received glasses from Korrect Optical.
080516 - ref SDS 48 RS5F
080517 -
080518 -
080519 -
080520 -
080521 -
080523 - ..
0806 -
0807 -
0808 - Background
0809 -
080901 - On 171201 1300 visited Audiology and Balance for treatment scheduled
080902 - with Doctor Wiseman at the end of the meeting last week on 171121
080903 - 0800. ref SDS 21 9X3J Met with Bethany Wiseman, MD...
080905 - ..
080906 - On 171207 1833 sent letter to Bethany reporting BPPV dizziness
080907 - symptoms were resolved. ref SDS 23 GG5I
080909 - ..
080910 - On 180514 0829 letter requests VA Audiology and Balance Department
080911 - examination and treatment for initial symptoms of dizziness
080912 - recurrance. ref SDS 25 038J Bethany responded saying the VA can
080913 - provide treatment anyday this week. ref SDS 25 X65O Notified would
080914 - appear for treatment this morning at 0830. ref SDS 25 4F5F
080916 - ..
080917 - On 180516, meeting with Bethany. She performed Dix Hallpike maneuver
080918 - and diagnosed BPPV. Symptoms did not include common spinning
080919 - sensation. There is a "floating", wobbly, and "disorientation"
080920 - feeling that precedes the "spinning room" sensation. ref SDS 27 GT6K
080921 - Bethany explained recurrence of mild BPPV symptoms is common because,
080922 - after a patient suffers BPPV, then relapse occurs more easily.
080923 - ref SDS 27 TR6N The doctor performed Epley and other treatment
080924 - maneuvers. ref SDS 27 R54O On the last attempt, the patient rolls
080925 - onto the stomach with both arms bent under the chest to support the
080926 - upper body. In this position with the head extended over the end of
080927 - the examination table, Bethany shook the head up and down several
080928 - times very quickly. ref SDS 27 AE7H This line of care was effective
080929 - during treatment on 160707 0900. ref SDS 6 414G Bethany said to let
080930 - her know if symptoms return. ref SDS 27 QN9G
080932 - ..
080933 - On 180517 1713 favorable report to Doctor Wiseman saying BPPV symptoms
080934 - seem fully resolved. ref SDS 28 005U
080936 - ..
080937 - On 180707 0852 report BPPV recurred - little wobbly - for past week,
080938 - and on 180707 recurred strongly. ref SDS 29 RS5F Letter to Bethany at
080939 - VAMCSF Audiology and Balance requests examination for BPPV recurrence
080940 - and treatment. ref SDS 29 U13F
080942 - ..
080943 - On 180712 1526 letter from Bethany at VAMCSF proposes meeting on
080944 - Wednesday morning early for examination BPPV. ref SDS 30 RS5F
080946 - ..
080947 - On 180716 0835 letter to Bethany saying will stop by office on 180718
080948 - 0800 for BPPV examination, if she has time. Mention hiking Half Dome.
080949 - ref SDS 31 RS5F
080951 - ..
080952 - On 180718 0809 letter to VAMCSF notified Doctor Wiseman that could not
080953 - meet this morning to examine recurrance BPPV because of construction
080954 - repairs underway on home. Suggested re-schedule to 180725 early
080955 - morning. ref SDS 32 RS5F Received letter from the doctor agreeing to
080956 - meet on 180725 0800. ref SDS 32 CD9L
080958 - ..
080959 - On 180919 0800 meeting with Doctor Wiseman in Audiology & Balance
080960 - Department at VAMCSF. ref SDS 36 RS5F Bethany performed Dix Halpike
080961 - maneuver and reported seeing horizontal eye movement, indicating
080962 - recurrence of BPPV. She did several Epley maneuvers and also a new
080963 - maneuver. Bethay ended treatment by shaking head up and down
080964 - vigorously. Seemed better after this line of care. ref SDS 36 VL6O
080966 - ..
080967 - On, 181031 0740 Doctor Wiseman performed Dix Halpike maneuver. She
080968 - reported seeing no evidence of eye movements that signal BPPV
080969 - occurring. ref SDS 38 RS5F She also scheduled meeting to review
080970 - vision issues on 181204 1000. ref SDS 38 0S6I
080972 - ..
080973 - During the meeting on 181031, Bethany said she did not get the letter
080974 - explaining how to sign up for permits to hike Half Dome next year,
080975 - which was submitted on 181019 1043. ref SDS 37 E36F
080977 - ..
080978 - On 181204 1000 meeting at Audiology and Balance with Melissa Velasco,
080979 - AUD and Clinical Audioologist, and with Melisa Tektas, Resident, and
080980 - with Ashley Richards, Student; they performed extensive series of
080981 - tests to evaluate balance, hearing and vision. ref SDS 40 GV7H
080983 - ..
080984 - On 181206 1622 received calls from both ENT and Neurosurgery to
080985 - schedule meetings, following up referrals from Melissa in Audiology &
080986 - Balance. ref SDS 41 RS5F
080988 - ..
080989 - On 190111 0815 meeting Doctor Szu requesting explanation for
080990 - presbyopia (near sightedness) improving after 20+ years of declining
080991 - vision reading small text in documents. ref SDS 0 GV7H Past few weeks
080992 - noticed problems reading text on computer screen 6' - 7' feet across
080993 - room. ref SDS 0 6N5R Ben did vision tests, and then ordered glasses
080994 - to improve distance vision. ref SDS 0 FB5Q Complained about
080995 - irritation in right eye. Doctor Jones found a hair folicle touching
080996 - the eye; Ben removed it, and this solved problem. ref SDS 0 6N64
080997 -
080998 -
080999 -
081000 -
081002 - ..
0811 -
0812 -
0813 - Progress
0814 -
081401 - This morning met...
081402 -
081403 - Ben J Szu, OD
081404 - Optomitry Resident, Surgical Service
081405 - SFVA Medical Center
081407 - 415 760 2208
081409 - ..
081410 - Doctor Jones, Attending
081412 - ..
081413 - Requested explanation for presbyopia - vision declining reading small
081414 - text about age 50, and so required magnifying glass to read magazines,
081415 - books, newspapers, documents, etc - but, now, 20+ years later about
081416 - April or May of last year, at age 73, discovered could read small text
081417 - again. This significant improvement was reported to Primary Care
081418 - provider, Lauren Rettberg, NP, in a letter dated, 180515 2228,
081419 - ref SDS 26 7863, and discussed on 180724 1645. ref SDS 33 1I78, and
081420 - discussed again a few days ago on 190109 1700. ref SDS 42 N957
081422 - ..
081423 - [...below on 190111 0815 review of patient history shows VA
081424 - tested eyes on 060512, and found borderline near
081425 - sightedness. ref SDS 0 8K9G
081427 - ..
081428 - [...below on 190111 0815 at 1452 research indicates
081429 - presbyopia (reading small text "up close") worsens as you
081430 - age ref SDS 0 QM7J Another source notes "distant vision
081431 - can seem to improve with age. ref SDS 0 HN41
081433 - ..
081434 - Vision improvement in mid-70s, after declining about age 50 was also
081435 - reported to Doctor Simpson in Cardiology in a letter requesting CCTA
081436 - to test results from having raised HDL 30 at time of CABG x4 on
081437 - 091022, to HDL 83, after hiking 17400 miles past 5 years, and over
081438 - 3,000 miles this year, shown on 180916 1318. ref SDS 35 TU45 This was
081439 - discussed again during meeting with Cardiology on 181031 1000.
081440 - ref SDS 39 BE4F At that time, on 181031, Doctor Simpson reporting
081441 - finding patient heart function recovered to normal condition for young
081442 - people, which like vision, normally declines with age. ref SDS 39 JS83
081448 -
081449 - [...below on 190111 0815 at 1452 research indicates
081450 - presbyopia (reading small text "up close") worsens as you
081451 - age ref SDS 0 QM7J Another source notes "distant vision
081452 - can seem to improve with age. ref SDS 0 HN41
081454 - ..
081455 - Reported that in the past 3 weeks or so, noticed difficulty reading
081456 - text on computer screen about 6' - 7' across the room. This may be
081457 - due to rising myopia (nearsightedness)...
081459 - ..
081460 - After the meeting, research on the Internet found...
081461 -
081462 - Mayo Clnic
081463 -
081464 - https://www.mayoclinic.org/diseases-conditions/nearsightedness/symptoms-causes/syc-20375556
081465 -
081466 - Nearsightedness (myopia) is a common vision condition in which
081467 - you can see objects near to you clearly, but objects farther
081468 - away are blurry. It occurs when the shape of your eye causes
081469 - light rays to bend (refract) incorrectly, focusing images in
081470 - front of your retina instead of on your retina.
081472 - ..
081473 - In this case, for the past 20 years, could not see small text clearly
081474 - enought to read it, but could see objects at a distance clearly.
081476 - ..
081477 - Ben did a series of vision tests that entailed patient reading text
081478 - across the room about 8 - 9' away.
081480 - ..
081481 - On conclusion, he ordered glasses to aid reading text at a distance.
081482 - This will help working with computer c21 in the bedroom.
081483 -
081484 - [On 190114 1050 James ordered glasses; should be delivered
081485 - in about 10 days. ref SDS 45 RS5F
081486 -
081487 - [On 190131 1051 letter to Doctor Szu notifies glasses
081488 - ordered on 190111, have not been received. ref SDS 47 XG48
081490 - ..
081491 - [On 190207 1340 received glasses from Korrect Optical.
081492 - ref SDS 48 RS5F
081494 - ..
081495 - Complained of irritation in right edge of right eye. This just
081496 - occurred today, or maybe yesterday.
081498 - ..
081499 - Doctor Jones, attending made examination. Using eye examination
081500 - instruments, Doctor Jones suspected seeing an eyelash follicle nearly
081501 - touching the eye lens.
081503 - ..
081504 - Ben was able to use the same instrument and specialized clippers to
081505 - cut this follicle. After this procedure, the eye felt better.
081507 - ..
081508 - Ben's examination further identified several issues...
081509 -
081510 - 1. Mole within the eye structure.
081511 - 2. Minor cataracts
081512 - 3. Signs of initial glaucoma.
081514 - ..
081515 - Doctor Jones concurred.
081517 - ..
081518 - Ben asked about prior eye examinations.
081520 - ..
081521 - Advised that about 12 years ago at the VA Clinic in Martinez, Doctor
081522 - Linda Margulies treated left eye for ulcerated cornea caused by
081523 - rosacia, reported on 070221 0819. ref SDS 3 BM62
081525 - ..
081526 - The year before on 060512, Doctor Rita Hannum, also at VA Clinic in
081527 - Martinez, made examination for eye disease and diagnosed possible
081528 - glaucoma, ref SDS 1 UF6K, due to indented optic nerve observed during
081529 - examination at that time on 060512. ref SDS 1 VU4W The doctor said
081530 - indented optic nerve can be a herediary trait, rather than a sign of
081531 - gluacoma.
081533 - ..
081534 - On 060512 Doctor Hannum further found borderline near sightedness -
081535 - difficulty reading small print close. The material has to be either
081536 - bigger or moved some distance for clear vision. ref SDS 1 XA6H This
081537 - problem worsened for several years, but, as noted above, in about
081538 - April of last year, it significantly resolved. ref SDS 0 6N40
081539 -
081540 - [...below on 190111 0815 at 1452 research indicates
081541 - presbyopia (reading small text "up close") worsens as you
081542 - age ref SDS 0 QM7J Another source notes "distant vision
081543 - can seem to improve with age. ref SDS 0 HN41
081545 - ..
081546 - On 060926 VA follow up test indicated peripheral vision is okay; no
081547 - evidence of glaucoma. ref SDS 2 6D3F
081549 - ..
081550 - On 170406 0900 another examination found no progression of continuing
081551 - "suspect glaucoma due to indented optic nerve. ref SDS 7 SK6I
081553 - ..
081554 - Today, Ben moved examination to another room. He used 2 sets of
081555 - advanced examination equipment to test for cataracts and glaucoma.
081557 - ..
081558 - Ben subitted document with protocol for...
081560 - ..
081561 - Dry Eye Therapy
081562 -
081563 - 1. Warm compresses twice a day
081564 -
081565 - 1. Thermalon Dry Eye Mask /Bruder Mask
081566 -
081567 - Follow directions to heat in microwave
081568 - Gently rest over eyes for 10 minutes.
081570 - ..
081571 - Ben will submit the "Bruder Mask" seperately through the mail.
081572 -
081573 - [On 190131 1051 letter to Doctor Szu notifying have
081574 - not received Bruder Mask. ref SDS 47 XG51
081576 - ..
081577 - [On 190207 1340 received Bruder Mask for dry eyes.
081578 - ref SDS 48 NN7K Instructions say to microwave 20 -
081579 - 30 seconds, and place over eyes with a supplemental
081580 - "sheet". ref SDS 48 ZH4M
081581 -
081583 - ..
081584 - 2. Homemade option
081585 -
081586 - Put uncooked rice in a sock
081587 - Heat in microwave for 20-30 seconds
081588 - Gently rest over eyes for 10 minutes.
081589 - May be reused
081590 - Do not overheat and burn eyes
081591 -
081593 - ..
081594 - 4. Lid hygiene daily
081595 -
081596 - 1. Purchase Ocusoft lid scrubs
081597 -
081598 - With eyes gently closed, rub eyelashes gently from
081599 - corner to corner
081601 - ..
081602 - Rinse off excess
081604 - ..
081605 - 2. Baby Shampoo
081606 -
081607 - Lather up baby shampoo
081608 - Scrub along eyelash margins from corner to corner
081609 - Rinse off excess
081611 - ..
081612 - 3. Artificial Tears
081613 -
081614 - Use as needed
081615 -
081616 - [On 190122 2037 received prescription for Systane from VA.
081617 - ref SDS 46 WV6M
081619 - ..
081620 - Use 4 times per day in each eye for 1 week, then as
081621 - needed
081623 - ..
081624 - Use 8 times per day in each eye
081626 - ..
081627 - Avoid rubbing eyes, smoke dry air & wind, and dehydration.
081628 -
081630 - ..
081631 - Ben then moved examination to another office, where another
081632 - professional, think her hame was "Mo" took pictures of the eyes to
081633 - show condition of the mole Ben had initially discovered, per
081634 - above. ref SDS 0 6O33
081636 - ..
081637 - After several pictures were taken, Ben took me to the workstation
081638 - for getting glasses, which is in the patient waiting room.
081640 - ..
081641 - After sitting in the workstation chair for getting glasses, another
081642 - patient complained that he had been waiting. Therefore got up and
081643 - offered him the chair to go ahead, as he wished.
081645 - ..
081646 - Went to the customer counter and talked to Alexandria.
081648 - ..
081649 - She scheduled 2 meetings to run consecutively to get 4 month follow up
081650 - examination checking for progression of cataract and glaucoma
081651 - disease...
081652 -
081653 - 190508 0830
081654 - 190508 0930
081656 - ..
081657 - Walked back to the glass making workstation. The patient, who asked
081658 - to go ahead of me, had completed his meeting. Another patient was
081659 - getting service. Another patient asked if he could go next, because
081660 - his issue would only take a few minutes.
081662 - ..
081663 - Agreed again, for another patient to advance in the line.
081665 - ..
081666 - Went to 3rd floor to schedule meeting with Doctor Stewart, reported in
081667 - another record today on 190111 0920. ref SDS 44 WV5I
081669 - ..
081670 - Then forgot to return and get the glasses.
081671 -
081672 - [On 190114 1050 James ordered glasses; should be delivered
081673 - in about 10 days. ref SDS 45 RS5F
081674 -
081675 - [On 190131 1051 letter to Doctor Szu notifies glasses
081676 - ordered on 190111, have not been received. ref SDS 47 XG48
081678 - ..
081679 - [On 190207 1340 received glasses from Korrect Optical.
081680 - ref SDS 48 RS5F
081681 -
081682 -
081684 - ..
0817 -
0818 -
0819 - 1452
0820 -
082001 - Called VA Eye Clinic...
082002 -
082003 - 415 760 2208
082005 - ..
082006 - Talked to Ray. She will notify James, who makes the glasses, that
082007 - patient who missed the work earlier today, will be on campus next
082008 - Monday, on 190114, and will get glasses at that time.
082010 - ..
082011 - Sent letter to Ben saying...
082012 -
082013 - 1. Subject: Eye Examination
082014 - Date: 2019-01-11, 15:11
082018 - ..
082019 - 2. Ben,
082021 - ..
082022 - 3. Thanks for terrific care today, including ordering glasses to
082023 - aid distance vision. Possibly the hair follicle you removed
082024 - will also help resolve this recent issue. Thanks as well to
082025 - Doctor Jones for her work on this. There was immediate relief
082026 - after you made the removal. When I use the computer in the
082027 - other room this evening, hoping things look normal even without
082028 - glasses; but, be assured I am very grateful for getting this
082029 - vision aid.
082031 - ..
082032 - 4. I will follow up with home care protocols you prescribed.
082034 - ..
082035 - 5. While waiting in line to get the glasses, another patient asked
082036 - to go ahead of me, explaining his work would only a take a
082037 - minute or so. I agreed to this, and went to the 3rd floor for
082038 - a minute to schedule a meeting with Doctor Stewart in General
082039 - Surgery. They sent me to Module 2 on the ground floor. Didi
082040 - set the meeting with Doctor Stewart for next week Tuesday.
082041 - There was a brief encounter in the elevator lobby with another
082042 - doctor. I left the VA rushing for a meeting in San Jose.
082043 - Halfway to SJ on 280, realized I forgot to get the glasses.
082044 - On returning to Concord, called the Eye Clinic. Ray at the
082045 - front desk, said she will convey apologies to James, and let
082046 - him know I will be onsite next Monday, 190114 AM to complete
082047 - work on getting glasses.
082049 - ..
082050 - 6. Thanks for comprehensive explanation about near and far (long
082051 - and short) sightedness changing with advancing years.
082052 - Fascinating I could see things large and small both near and
082053 - far until about age 50, then needed a magnifying glass to read
082054 - small print for the past 20+ years; but in about April or May
082055 - of last year, suddenly realized I could read small print again.
082057 - ..
082058 - This confirmes understandings during the meeting with Ben, per above.
082059 - ref SDS 0 6N4W
082060 -
082061 - [...below on 190111 0815 at 1452 research indicates
082062 - presbyopia (reading small text "up close") worsens as you
082063 - age ref SDS 0 QM7J Another source notes "distant vision
082064 - can seem to improve with age. ref SDS 0 HN41
082066 - ..
082067 - Letter to Ben continues...
082068 -
082069 - 7. Enjoyed working with you, as with all the doctors and nurses
082070 - and VAMCSF.
082071 -
082079 -
082081 - ..
082082 - In the evening, research on the Internet found...
082083 -
082084 - 1. How Your Vision Changes As You Age
082085 - By Gary Heiting, OD
082086 -
082087 - https://www.allaboutvision.com/over60/vision-changes.htm
082089 - ..
082090 - Just as our physical strength decreases with age, our eyes also exhibit an
082091 - age-related decline in performance particularly as we reach our 60s and
082092 - beyond.
082094 - ..
082095 - Presbyopia. After you pass the milestone age of 40, you'll notice it's more
082096 - difficult to focus on objects up close because of presbyopia. This is a
082097 - perfectly normal loss of focusing ability due to hardening of the lens inside
082098 - your eye.
082100 - ..
082101 - When you first notice presbyopia affecting near vision at around age 40, you
082102 - may be able to compensate by holding your reading material farther away. But
082103 - presbyopia worsens as you age, and you will need vision correction at some
082104 - point.
082106 - ..
082107 - Another source...
082108 -
082109 - Wikipedia
082111 - ..
082112 - Presbyopia
082113 -
082114 - https://en.wikipedia.org/wiki/Presbyopia
082116 - ..
082117 - Presbyopia is a condition associated with the aging of the eye
082118 - that results in progressively worsening ability to focus
082119 - clearly on close objects.[1] Symptoms include difficulty
082120 - reading small print, having to hold reading material farther
082121 - away, headaches, and eyestrain.[1] Different people will have
082122 - different degrees of problems.[1] Other types of refractive
082123 - errors may exist at the same time as presbyopia
082125 - ..
082126 - Presbyopia is a natural part of the aging process.
082128 - ..
082129 - This sources links to a schematic diagram of the human eye...
082130 -
082131 - https://en.wikipedia.org/wiki/Lens_(anatomy)#/media/File:Schematic_diagram_of_the_human_eye_en.svg
082132 -
082133 - It shows "Retinal blood vessels" which indicates that reduced
082134 - blood flow that occurs naturally with aging, correlates with
082135 - gradual loss of ability to read text in magazines, books,
082136 - newspapers, etc.
082137 -
082138 -
082140 - ..
082141 - American Optometric Association
082143 - ..
082144 - Adult Vision: 41 to 60 Years of Age
082145 -
082146 - https://www.aoa.org/patients-and-public/good-vision-throughout-life/adult-vision-19-to-40-years-of-age/adult-vision-41-to-60-years-of-age
082148 - ..
082149 - Beginning in the early to mid-40s, many adults may start to
082150 - have problems seeing clearly at close distances, especially
082151 - when reading and working on the computer. This is among the
082152 - most common problems adults develop between ages 41 to 60.
082153 - This normal change in the eye's focusing ability, called
082154 - presbyopia, will continue to progress over time.
082156 - ..
082157 - Print in the newspaper or on a restaurant menu may appear
082158 - blurred, especially under dim lighting.
082159 -
082161 - ..
082162 - Harvard Health Publishing
082163 - Harvard Medical School
082165 - ..
082166 - Presbyopia
082167 -
082168 - https://www.health.harvard.edu/a_to_z/presbyopia-a-to-z
082170 - ..
082171 - Published: May, 2017
082173 - ..
082174 - As we age, the lens of the eye becomes increasingly
082175 - inflexible, making it harder to focus clearly on near objects.
082176 - This is called presbyopia. No one knows exactly what causes
082177 - the lens to become inflexible, but it happens to everyone as a
082178 - natural part of aging.
082180 - ..
082181 - By the time we are in our 40s, the lens has trouble focusing up
082182 - close, and we begin to experience blurred vision when we try to
082183 - do tasks that require up-close focus, such as reading or
082184 - needlework. The lens continues to stiffen until about age 65,
082185 - when nearly all its flexibility has been lost.
082187 - ..
082188 - Presbyopia cannot be reversed and gets worse as we get older.
082189 - Vision changes stop around age 65. The only exception is that
082190 - which occurs when people develop a type of cataract that
082191 - causes them to be myopic (nearsighted). Such cataracts cause
082192 - "second sight". Reading vision returns but of course distance
082193 - vision becomes blurred.
082195 - ..
082196 - There is no evidence of catatracts in this case - distance vision
082197 - remains effective.
082198 -
082199 - Nothing can be done to prevent presbyopia. It is an
082200 - inevitable part of aging.
082202 - ..
082203 - Maybe walking raises HDL cholesterol and EPCs, which together regpress
082204 - otherwise natural increase in plaque that reduces blood flow in
082205 - retinal blood vessels. Possibly restoring full blood flow in the
082206 - retina restores normal vision reading text, as has occurred in this
082207 - case.
082208 -
082209 -
082210 -
082212 - ..
082213 - 2. Improving Eyesight As You Get Older
082214 -
082215 - https://endmyopia.org/improving-eyesight-get-older/
082217 - ..
082218 - Presbyopia. ... Almost all studies concerning the hardening of the lens relate
082219 - to presbyopia findings, not, myopic changes. Because spoiler alert, myopia
082220 - reduction due to hardening lens isn't significant enough to warrant much
082221 - study. And yes, your distance vision can certainly appear to improve with
082222 - age.Nov 9, 2016
082224 - ..
082225 - These sources seem conflicting with understandings during the meeting
082226 - with Ben earlier this morinng at the VA, per above. ref SDS 0 6N40
082227 -
082228 -
082229 -
082230 -
082231 -
082232 -
0823 -
SUBJECTS
Default Null Subject Account for Blank Record
0903 -
090401 - ..
090402 - Progress Notes Audiology & Balance Meeting on 181204
090403 -
090404 - Follow up ref SDS 40 5X6G.
090405 -
090406 - VA Progress Notes for meeting with health care providers are
090407 - available at...
090408 -
090409 - https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel=mhvHome
090410 -
090422 -
090423 -
090424 - 1. Date/Time: 11 Jan 2019 @ 0801
090425 - Note Title: EYE CLINIC F/U NOTE (SURG)
090426 - Location: San Francisco CA VAMC
090427 - Signed By: SZU,BENJAMIN
090428 - Co-signed By: SZU,BENJAMIN
090429 - Date/Time Signed: 11 Jan 2019 @ 1636
090430 - -------------------------------------------------------------------------
090432 - ..
090433 - 2. LOCAL TITLE: EYE CLINIC F/U NOTE (SURG)
090434 - STANDARD TITLE: EYE OUTPATIENT E & M NOTE
090435 - DATE OF NOTE: JAN 11, 2019@08:01 ENTRY DATE: JAN 11, 2019@08:02:04
090436 - AUTHOR: SZU,BENJAMIN EXP COSIGNER:
090437 - URGENCY: STATUS: COMPLETED
090439 - ..
090440 - 3. The attending physician of record for this patient care is Dr
090441 - Jones
090443 - ..
090444 - 4. REASON FOR VISIT: comprehensive eye exam
090445 - - blur at distance, able to read without glasses
090446 - - uses television as monitor and is beginning to have trouble
090447 - seeing monitor that is roughly 5 feet away
090448 - - LEE 2017 and monitored for glaucoma
090450 - ..
090451 - Patient requested:
090452 -
090453 - 1. Explanation for improvement in ability to read small text
090454 - in books, magazines, newspapers, which for past 20 years
090455 - could not read, until about May of last year, when primary
090456 - care provider, was notified of significant improvement,
090457 - reported on 180515 2228. ref SDS 26 7863 This record
090458 - indicates resolution of former presbyopia OU, and the
090459 - patient requested how this recovery occurred, see above.
090460 - ref SDS 0 6N40
090462 - ..
090463 - 2. Resolving recent irritation in right edge of right eye,
090464 - past few hours.
090466 - ..
090467 - 3. Resolve reduced vision reading text on large screen (60")
090468 - monitor across room about 6 - 7' away.
090469 -
090471 - ..
090472 - 5. Ocular Hx:
090473 -
090474 - Denies surgeries, trauma, FOHx
090475 - ========================
090476 - Glaucoma suspect 2/2 ONH appearance and abnormal TSNIT contour OD
090477 - - no family Hx
090479 - ..
090480 - DATE IOP MEDS
090481 - 01/11/19 18/19 none
090483 - ..
090484 - Fundus photos 01/11/2019
090486 - ..
090487 - HVF 30-2 2017
090488 - OU: reliable, defects temp to blind spot c/w thinner nasal rim
090490 - ..
090491 - Spectralis OCT RNFL 01/11/19
090492 - OD: g78 borderline, reduced TSNIT inf rim
090493 - OS: g73 thin, borderline TS(101) T(50), TSNIT wnl
090495 - ..
090496 - Zeiss OCT RNFL 01/11/19
090497 - OD: avg 73um borderline, borderline inf quadrant, reduced TSNIT
090498 - inf rim
090499 - OS: avg 76um wnl, wnl all quads, normal TSNIT
090501 - ..
090502 - Zeiss OCT GCA 01/11/19
090503 - OD: avg GCL+IPL 66um thin, thin sup, temp, inf sectors
090504 - OS: avg GCL+IPL 65um thin, thin temp sectors, borderline sup
090505 - sector and inf-nas sector
090506 - ========================
090508 - ..
090509 - 6. Past MedHx:
090510 -
090511 - Computerized Problem List is the source for the following:
090512 -
090513 - 1. Benign unconjugated bilirubinaemia syndrome 10/31/2018
090514 - GI/Liver clinic 8-2-18
090515 - 2. Metatarsalgia 05/25/2016
090516 - 3. Fall on same level, Onset 00/00/2015 05/25/2016
090517 - 4. History of coronary artery bypass grafting, 10/14/2015
090518 - Onset 10/00/2009
090519 - SFVA LIMA, SVGs diag, ramus, PDA
090520 - 5. Hyperlipidemia 10/14/2015
090521 - 6. Body mass index 30+ - obesity 10/14/2015
090522 - 7. Chronic ischemic heart disease 10/14/2015
090523 - 8. Esophageal stricture (SNOMED CT 63305008) 05/04/2016
090524 -
090526 - ..
090527 - 7. ACTIVE MEDICATIONS:
090528 -
090529 - Active Outpatient Medications (including Supplies):
090530 -
090531 - Active Outpatient Medications Status
090532 - =========================================================================
090533 - 1) AMMONIUM LACTATE 12% LOTION APPLY LOTION TOPICALLY ACTIVE
090534 - EVERY DAY AS DIRECTED TO FEET AFTER BATHING FOR DRY
090535 - SKIN
090536 - 2) ATORVASTATIN CALCIUM 20MG TAB TAKE ONE-HALF TABLET ACTIVE
090537 - ORALLY EVERY OTHER DAY FOR CHOLESTEROL **NOTE
090538 - DIRECTIONS**
090539 - 3) CALCIUM CARB 500MG (CA 200MG) CHEW TAB CHEW TWO ACTIVE
090540 - TABLETS ORALLY AT BEDTIME
090541 - 4) EZETIMIBE 10MG TAB TAKE ONE TABLET ORALLY EVERY OTHER ACTIVE
090542 - DAY
090543 - 5) HYDROCODONE 5MG/ACETAMINOPHEN 325MG TAB TAKE 1 TABLET ACTIVE
090544 - ORALLY EVERY DAY AS NEEDED FOR PAIN. MAY TAKE 1
090545 - ADDITIONAL TABLET EACH TIME IF PAIN IS NOT
090546 - CONTROLLED.
090548 - ..
090549 - 8. Allergies:
090550 -
090551 - SIMVASTATIN, ROSUVASTATIN
090553 - ..
090554 - 9. Oriented/State of Mind: Oriented X3, Alert.
090556 - ..
090557 - V:sc 20/70+2
090558 - 20/70
090560 - ..
090561 - IOP: 18/19 @ 0825
090562 -
090564 - ..
090565 - Pupils: ERRL, no RAPD
090566 - Duct/Versions: FULL
090567 - Cover Test: Ortho @ D sc
090568 - Confront VF: FTFC OD, OS
090570 - ..
090571 - 10. Manifest: -2.00 +0.75 x015 20/20
090572 - -1.25 DS 20/25+2
090573 - ADD +2.50
090575 - ..
090576 - 11. External: normal
090577 - SLIT LAMP EXAM
090578 - Lids & Lashes: OD one misdirected lash UL
090579 - OU 2+bleph/MGD
090580 - Conjunctiva/Sclera: OU ping N/T, chalasis
090581 - Cornea: OU arcus, 1+PEE inf
090582 - Ant Ch: OU D&Q
090583 - Iris: OU flat, intact
090584 - Lens: OD 1+NS
090585 - OS 1+NS, tr PSC, posterior cortical vacuole
090586 - Ant Vit: OU PVD, (+)Weiss ring
090587 -
090589 - ..
090590 - 12. OCULAR FUNDUS EXAM Dil c 1%T & 2.5%P
090591 - Optic Nerve: OD 0.85h/0.80v, thin nasal rim, slopes temp, thinner
090592 - inf>sup, distinct margins, temp PPA no DH/notch
090593 - OS 0.75h/v, sloped IT, thin nasal rim, distinct margins,
090594 - temp PPA, no DH/notch
090596 - ..
090597 - Macula: OU flat, even
090598 - Vessels: OU normal contour and caliber
090599 - Post Pole: OD 0.55DD choroidal nevus with overlying drusen 1 disc
090600 - diameter sup-nasal to ONH, no lipofuscin/remarkable
090601 - elevation/halo/symptoms
090602 - OS 0.15DD flat choroidal nevus inf arcades, no
090603 - lipofuscin/remarkable elevation/halo/symptoms
090604 - Periphery: OU attached 360
090606 - ..
090607 - 13. Fundus photos taken today.
090609 - ..
090610 - 14. Spectralis OCT RNFL 01/11/19
090611 - OD: g78 borderline, reduced TSNIT inf rim
090612 - OS: g73 thin, borderline TS(101) T(50), TSNIT wnl
090614 - ..
090615 - Zeiss OCT RNFL 01/11/19
090616 - OD: avg 73um borderline, borderline inf quadrant, reduced TSNIT inf rim
090617 - OS: avg 76um wnl, wnl all quads, normal TSNIT
090619 - ..
090620 - Zeiss OCT GCA 01/11/19
090621 - OD: avg GCL+IPL 66um thin, thin sup, temp, inf sectors
090622 - OS: avg GCL+IPL 65um thin, thin temp sectors, borderline sup
090623 - sector and inf-nas sector
090625 - ..
090626 - 15. Diagnosis...
090627 -
090628 - A Glaucoma suspect secondary to optic nerve head appearance and OCT
090629 - retinal nerve fiber layer OU
090630 - - IOP's within normal limits today but borderline with unknown central
090631 - corneal thickness
090632 - - no family history of glaucoma
090633 - - abnormal TSNIT inf rim OD on spectralis and zeiss OCT
090634 - - HVF 30-2 2017: temporal defects c/w thinner nasal rim, otherwise
090635 - clear OU, given nerve appearance, continue monitoring with HVF 30-2
090636 - Choroidal nevus OU
090637 - - risk factors for malignancy: proximity to optic nerve head
090638 - - baseline fundus photos taken today
090639 - Cataracts OU, not visually significant OU
090640 - Dry eyes OU
090641 - Refractive Error OU/presbyopia OU
090643 - ..
090644 - Unclear what "presbyopia OU means hear, since patient requested eye
090645 - examination to determine what caused resolution of presbyopia that
090646 - began about 20 years ago, and seems improved since May 2018.
090647 -
090649 - ..
090650 - P Explained glaucoma. Patient understands this is a
090651 - potentially blinding condition that requires follow-up.
090652 - Continue monitoring without treatment at this time and
090653 - get baseline visual field 30-2 in 4 months.
090654 -
090655 - Monitor for change in 4 months.
090657 - ..
090658 - Monitor, no indication for surgery at this time.
090660 - ..
090661 - Warm compress, lid hygiene instructions given.
090662 - Prescribed artificial tears and order Bruder Mask.
090664 - ..
090665 - Release prescription
090667 - ..
090668 - RTC in 4 mo for OFU, HVF 30-2, sooner PRN.
090670 - ..
090671 - The patient was educated and understands the findings listed in
090672 - the assessment above.
090674 - ..
090675 - Current medications reviewed with patient/caregiver and reconciliation
090676 - of medications related to today's visit completed, including non-VA
090677 - medications and discrepancies, if identified, were addressed.
090678 - Medication changes and the importance of medication management were
090679 - reviewed with the patient/caregiver today based on individual needs.
090680 - Patient/caregiver acknowledged understanding of instructions as
090681 - stated.
090683 - ..
090684 - An updated list of reconciled medications has been provided to the
090685 - patient/caregiver.
090686 -
090687 - /es/ Benjamin Szu, O.D.
090688 - Optometry Resident: PGY -1
090689 - Signed: 01/11/2019 16:36
090690 -
090691 -
090692 -
090693 -
090694 -
090695 -
090696 -
090697 -
090698 -
090699 -
090700 -
0908 -