Eye Conditions C&P Exam Prep

Visual Field Testing (Goldmann Kinetic Perimetry or Automated Perimetry)

What it measures: The extent of peripheral and central vision in each eye, measured in degrees from fixation in multiple meridians. Under DC 6080, the remaining visual field (total degrees) directly determines the disability rating. A normal visual field subtends approximately 120 degrees horizontally and 90 degrees vertically in each eye.

What to expect: You will sit with one eye covered and focus on a central target. A light stimulus (or moving light) will appear at various locations in your peripheral and central vision. You press a button or respond verbally each time you see the target. The test takes 5-15 minutes per eye. Automated perimetry uses computer-generated stimuli; Goldmann uses a moving target adjusted by the examiner. The examiner maps the area you can see and documents the remaining field in degrees.

Pain considerations: Visual field testing itself is not typically painful, but if underlying conditions (such as glaucoma, uveitis, or optic neuritis) cause eye pain, pressure, or photophobia that affects your ability to cooperate with testing or that worsens during the exam, clearly communicate this to the examiner. Document any pain that occurs during or after the exam.

Best Corrected and Uncorrected Visual Acuity (Distance and Near)

What it measures: Sharpness of vision at distance (typically 20 feet or 6 meters) and near (typically 14 inches or 36 cm), both with and without corrective lenses. Documented as a Snellen fraction (e.g., 20/20, 20/200) for each eye separately. Under the VA rating system, corrected visual acuity in each eye is cross-referenced on rating tables to determine combined disability ratings.

What to expect: You will read letters on a standard eye chart (Snellen chart) at distance and a near card, first without glasses, then with your best corrective lenses. Each eye is tested separately. The examiner records the smallest line you can read accurately. For near vision, you may be asked to read standard print sizes.

Pain considerations: If bright light during visual acuity testing triggers photophobia or worsens your symptoms, inform the examiner. Photophobia is a separately documented symptom under the DBQ and should be noted as a functional limitation.

Intraocular Pressure (IOP) Measurement

What it measures: Fluid pressure inside the eye, measured in millimeters of mercury (mmHg). Normal IOP is approximately 10-21 mmHg. Elevated IOP is associated with glaucoma, a common cause of visual field defects. The examiner will use either Goldmann applanation tonometry (gold standard) or non-contact tonometry.

What to expect: A device will touch the front surface of your eye (after numbing drops for Goldmann applanation) or a puff of air will be directed at your eye (non-contact tonometry). The procedure takes only a few seconds per eye. Results are recorded in mmHg for right and left eyes separately.

Pain considerations: Non-contact tonometry (air puff) is not painful but may be startling. Goldmann applanation tonometry requires topical anesthetic drops and is generally not painful. If you have significant dry eye or corneal sensitivity, inform the examiner.

Slit Lamp Examination (Anterior and Posterior Segment)

What it measures: Detailed examination of the anterior segment (cornea, iris, lens) and posterior segment (retina, macula, optic nerve, vitreous) of each eye using a high-magnification biomicroscope with a narrow beam of light. Identifies structural pathology that may cause or contribute to visual field defects, including cataracts, corneal disease, glaucomatous optic nerve changes, retinal pathology, and macular disease.

What to expect: You will rest your chin on a chin rest and forehead against a bar while the examiner uses a bright slit of light and magnification to examine the structures of your eye. Dilating drops may be used to enlarge the pupil for better posterior segment visualization. The exam takes approximately 5-10 minutes per eye. Dilation may temporarily blur your vision for 4-6 hours after the exam.

Pain considerations: Bright light during slit lamp examination may trigger photophobia or discomfort. Inform the examiner if you experience significant light sensitivity so it can be documented.

10%

Bilateral visual field remaining 46-60 degrees, OR each affected eye evaluable as 20/50 (6/15). Unilateral visual field remaining 31-60 degrees, OR affected eye evaluable as 20/50-20/70.

From 38 CFR: Under DC 6080, a remaining bilateral visual field of 46-60 degrees is rated at 10%. Alternatively, if each affected eye is evaluated as having visual acuity of 20/50, the bilateral combined rating yields 10%. For unilateral field loss, the range of 31-60 degrees of remaining field also produces a 10% rating.

20%

Unilateral visual field remaining 6-15 degrees, OR affected eye evaluable as 20/200 (6/60). This rating level applies to significant unilateral field loss approaching legal blindness in one eye.

From 38 CFR: Under DC 6080, a remaining unilateral visual field of 6-15 degrees is rated at 20%, or equivalently if the affected eye is rated as having visual acuity of 20/200.

30%

Bilateral visual field remaining 31-45 degrees, OR each affected eye evaluable as 20/70 (6/21). Represents moderate bilateral visual field constriction significantly impacting functional vision.

From 38 CFR: Under DC 6080, a remaining bilateral visual field of 31-45 degrees is rated at 30%, or equivalently if each affected eye is evaluated as having visual acuity of 20/70.

50%

Bilateral visual field remaining 16-30 degrees, OR each affected eye evaluable as 20/100 (6/30). Represents severe bilateral visual field constriction with major impact on functional independence.

From 38 CFR: Under DC 6080, a remaining bilateral visual field of 16-30 degrees is rated at 50%, or equivalently if each affected eye is evaluated as having visual acuity of 20/100.

60%

Bilateral visual field remaining 16 degrees or less (approaching 6-15 degree range), combined with near-equivalent visual acuity loss. This intermediate level represents the transition to the 70% criteria and is relevant when field loss and acuity loss combine to produce extreme functional impairment across both eyes.

From 38 CFR: DC 6080 references a 60-degree remaining field category for bilateral field evaluation. This is distinct from the 70% and 50% levels and captures field loss producing significant impairment between those thresholds.

70%

Bilateral visual field remaining 6-15 degrees, OR each affected eye evaluable as 20/200 (6/60). Represents extreme bilateral visual field loss - tunnel vision bilaterally at near-legal-blindness levels.

From 38 CFR: Under DC 6080, a remaining bilateral visual field of 6-15 degrees is rated at 70%, or equivalently if each affected eye is evaluated as having visual acuity of 20/200.

100%

Bilateral visual field remaining 5 degrees or less, OR each affected eye evaluable as 5/200 (1.5/60) or worse. Total or near-total bilateral visual field loss - functional blindness.

From 38 CFR: Under DC 6080, the maximum rating of 100% (or the relevant bilateral combined rating approaching 100%) applies when the remaining bilateral visual field is 5 degrees or less, equivalent to visual acuity of 5/200 (1.5/60) in each eye under the VA visual acuity rating table. This is not to exceed 5/200 per DC 6090.

Visual Field Loss - Peripheral Vision

How to describe it: Describe specifically where in your visual field the loss occurs (above, below, to the left, to the right, or all around). Describe how far from center you lose vision. Use concrete examples: 'I cannot see cars approaching from my left side without turning my head' or 'I frequently walk into door frames on my right side because I cannot see them peripherally.' Specify whether the loss is the same in both eyes or worse in one eye.

Example: On my worst days, my vision feels like looking through a narrow tube - I can only see directly in front of me for a small area, maybe the width of a coffee mug held at arm's length. I cannot see the curb below me when I'm walking, and I've stumbled on steps multiple times this week. I could not safely cross a street because I couldn't detect traffic from the sides.

Examiner listens for: Specific descriptions of functional limitations tied to peripheral vision loss, frequency and consistency of the defect, bilateral versus unilateral involvement, any progressive worsening, and impact on work and daily activities.

Avoid: Avoid saying 'my vision is okay' when you mean only your central vision is intact. Do not minimize peripheral vision loss because you can still read. Peripheral field loss is the primary rating factor under DC 6080 - it must be clearly communicated even if central acuity seems acceptable.

Scotoma (Blind Spot within the Visual Field)

How to describe it: Describe a scotoma as a 'blind spot' or 'dark spot' in your vision that does not move when you look around. Specify whether it is in the center of your vision (central scotoma - most disabling) or off to the side (paracentral). Describe its size - does it block words when reading? Does it obscure faces? Is it always present or does it come and go? Specify which eye or eyes are affected.

Example: When I try to read, there is a dark oval spot in the center of my right eye's vision that blots out the word I'm trying to focus on. I have to look slightly to the side of a person's face to see their features because their nose and mouth disappear into the blind spot when I look directly at them. This happens every time I use my right eye alone.

Examiner listens for: Location of the scotoma relative to fixation, size as reported by the patient, impact on reading and fine visual tasks, monocular versus binocular presence, and whether it is absolute (complete loss) or relative (reduced sensitivity).

Avoid: Do not describe a central scotoma as 'slight blurriness' - a scotoma is a distinct blind spot, not blur. Do not suggest it only bothers you occasionally if it is consistently present when using the affected eye.

Hemianopsia (Loss of Half the Visual Field)

How to describe it: Describe it as 'I cannot see anything on the right (or left) side of my vision' - specify whether this is in both eyes simultaneously (homonymous - meaning both eyes lose the same side, indicating a brain/post-chiasmal cause) or in one eye only (monocular). Describe real-world impacts: 'I've driven past exits because I don't see road signs on that side' or 'I walked into a display in a store because I didn't see it on my left.'

Example: I woke up and the entire left half of everything I see was simply gone - like someone pulled a curtain across the left side of both eyes. I could not eat breakfast without turning my head completely to the left to find my coffee cup, which I'd placed directly in front of me. Getting dressed was dangerous because I kept reaching for things that were in my lost visual field without knowing it.

Examiner listens for: Whether the hemianopsia is homonymous (both eyes lose the same side - post-chiasmal lesion) or monocular (one eye - ocular or optic nerve cause), completeness of the field loss, associated neurological symptoms, and etiology (TBI, CVA, intracranial tumor, demyelinating disease).

Avoid: Do not describe hemianopsia as 'trouble seeing to the side.' It is a loss of half the visual field - communicate the severity and bilateral nature accurately. Do not omit the neurological context (TBI, stroke) if present, as this affects the examiner's diagnostic coding.

Photophobia and Glare Sensitivity

How to describe it: Describe photophobia as pain, extreme discomfort, or forced eye closure in response to light. Specify triggers (sunlight, fluorescent lighting, oncoming headlights at night). Describe how it limits activity: 'I cannot be outdoors during daytime without wraparound sunglasses and still experience pain' or 'I have to leave stores with bright overhead lighting because the glare is incapacitating.' Glare sensitivity specifically refers to difficulty seeing in high-contrast lighting (e.g., driving at night with oncoming headlights).

Example: On a bright day, even with dark sunglasses, I have to shield my eyes with my hand to see anything. Yesterday I was unable to drive home in the afternoon because the sunlight through the windshield created so much glare and pain that I pulled over. I had to call someone for a ride.

Examiner listens for: Documented photophobia as a separate symptom (checkbox in DBQ), its severity, triggers, and direct functional impact on the veteran's daily activities and occupational functioning.

Avoid: Do not minimize photophobia by saying 'bright light bothers me a little.' If photophobia is forcing behavioral changes (wearing sunglasses indoors, avoiding outdoor activity, limiting driving), say so explicitly. This is a separately documented symptom in the DBQ.

Incapacitating Episodes

How to describe it: Under 38 CFR - 4.79, Notes 1 and 2, incapacitating episodes of eye conditions (those requiring bed rest or treatment) can justify higher ratings. Describe episodes where your visual condition was so severe it required you to stop activity, see a doctor emergently, or stay home from work. Document frequency (how many per week or month), duration (how many days each), and what treatment was required.

Example: Last month I had three episodes where my vision deteriorated so severely I could not leave my home - I spent two days in bed with eye pain and near-total visual field loss in my right eye, and I had to go to the VA emergency clinic twice in one month. Each episode kept me out of work for at least two days.

Examiner listens for: Frequency and duration of episodes per month, whether they required bed rest or treatment, which specific eye conditions caused the episodes, and their impact on the veteran's ability to work and perform daily activities.

Avoid: Do not say your condition 'flares up sometimes' without providing specific frequency and duration data. Incapacitating episodes have defined rating criteria - two or more per year requiring treatment = 10%, four or more per year = 20% under the General Rating Formula.

Impact on Occupational Functioning

How to describe it: Be specific about which job tasks you can no longer perform due to your visual field defects. 'I cannot safely operate a forklift because I cannot see objects approaching from the sides.' 'I can no longer read documents without assistive technology.' 'I have been moved to a desk role because my employer determined I was a safety risk on the production floor.' If you have had to change jobs, reduce hours, or leave employment, state this clearly.

Example: My supervisor told me last year that I was a safety liability on the warehouse floor because I kept missing cues from the sides and nearly caused two accidents. I was transferred to an office role, but even there I struggle to read the computer screen without enlarged text, and I frequently miss things in my peripheral vision that cause errors. My performance reviews have declined since my vision worsened.

Examiner listens for: Specific occupational tasks precluded by the visual field defect, whether the veteran has had to change roles or reduce workload, and concrete evidence of how vision loss translates to functional employment limitations.

Avoid: Do not say 'I manage okay at work' if you have made significant accommodations or if your performance has been affected. Accurately describe any accommodations made (enlarged monitors, assistance from coworkers, job changes) as evidence of functional limitation.