Prevent Blindness Ohio: Survey - Prevent Blindness Ohio Adult Vision Screening Recertification True-False Exam

Prevent Blindness Ohio Adult Vision Screening Recertification True-False Exam

Instructions

Please answer the following questions. You may submit your test online or print and return this test to Lauren Mackowiak at Prevent Blindness Ohio, 1500 W. Third Avenue, Columbus, Ohio 43212. Tests may also be faxed to Lauren’s attention at 614/481-9670.

It is important that you take the time to read through the Adult Vision Screening Participant Guide manual before taking the test. There are several key components to an adult vision screening that you may want to reeducate yourself about to achieve a passing score.

1.

Please provide the following information before starting the test.

*

Name:

Title	First Required	Middle Required	Last Required	Suffix

*

Email: Required

*

Street 1: Required

Street 2:

*

City/State/ZIP:

City Required	StateRequired	ZIPRequired

*

Phone Number: Required

Occupation:

Remember me. What's this?

2.

Company/organization (if applicable)

3.

If you are a primary care provider, do you accept Medicaid patients?

*4.

Date of Vision Screening Training

Month

Day

Year

True/False Exam

*5.

Vision screening tests diagnose persons with eye diseases or disorders.

*6.

Subjects whose near vision is corrected with glasses or contacts should wear them for the near acuity screening.

*7.

The subject whose acuity is 20/50 or worse in either eye is referred to an eye doctor.

*8.

The visual field test is used to screen for possible visual field loss that may be due to macular degeneration.

*9.

Previous eye surgery increases an individual's risk for developing glaucoma.

10.

When conducting screening tests the right eye is checked first.

*11.

Loss of central vision is a typical symptom of glaucoma.

*12.

The purpose of a vision screening is to prescribe appropriate treatment for eye diseases.

*13.

To demonstrate safety, swab equipment with alcohol in the presence of the next subject.

*14.

A family history of diabetes is considered a factor in the risk assessment.

*15.

When asking the subject "if they have blood relatives with glaucoma," blood relatives means: parents, great grandparents, and children.

*16.

A subject should be told to see an eye care professional "now" if they have not had a dilated eye exam in the last two years.

*17.

The exit interview of a subject who passes the screening includes telling the subject he/she has no eye problems.

*18.

Visual field is defined as: the area or extent of physical space visible to an eye in a given position.

*19.

A consideration for follow-up is educating the referred subject about the importance of seeing an eye doctor.

*20.

Discussion of screening test results is best addressed at the exit interview station.

*21.

When "yes" is checked for "subjects has persistent pain in or around the eye," tell the subject he/she may have glaucoma and instruct him/her to call his/her doctor.

*22.

One example of an appropriate follow-up practice is regular periodic contact until confirmation of an exam is received, or for about 6 months.

*23.

One example of an exit interview procedure for a subject who fails the screening is explaining the results and making a recommendation to see a doctor.