Ophthalmological Terminology

Ophthalmological jargon uses numerous concepts that are generally unknown by laymen and have to be explained to both hearing and deaf patients. Doctors vary in their ability to avoid unnecessary medical terms and to explain those terms that have to be used. Any medical term that is used slightly differently from its normal use should be clarified by the doctor; the interpreter cannot be responsible for the often subtle nuances in information related to visual phenomena or eye diseases.

Booklets like "Dictionary of Eye Terminology" cover ophthalmological terms well but the explanations given do not always give the information necessary for intelligent signing. For example, "hyperfluorescence" is correctly described as "increased fluorescence" seen in abnormal fluorescein angiography of the retina from abnormal blood vessels, leaking blood vessels, or increased fluorescein transmission". However, when the term is used, the doctor should describe the phenomenon of hyperfluorescence in that particular case, what it looks like in the angiogram and what it means. An interpreter cannot convey the information related to "hyperfluorescence" into sign language without that clarification. Mere finger spelling of the word is inadequate communication.

There are a number of other terms that are well described in the booklets on terminology, but they need further study before they can be used fluently. Refractive errors are hard to clarify if a person does not have background in the structure of the eye and optics. There is, for example, a common misunderstanding related to "hyperopia", farsightedness. People tend to think that hyperopia means clear vision at distance but blurred vision up close. It is therefore important to clarify that although the image falling on the retina of a hyperopic eye is blurred when the lens is in its resting position, the image becomes clear when accommodation is used. When distant objects are viewed, less accommodation is needed than when near objects are looked at. Young persons usually have such good accommodation that they can see clearly both at distance and near, even if they are hyperopic.

Similarly, when myopia is clarified, it is important to mention that the myopic eye sees clearly close up, although the image of distant objects is blurred.

Visual acuity values should be signed as they are written, although the "over" is not said. "Twenty-twenty" visual acuity is thus signed "twenty-slash-twenty".

The numerous acronyms used in a discussion between doctors cause a problem. They do not convey information to a hearing patient either but are more disturbing when used in the presence of a deaf patient who might think that the interpreter is not capable of interpreting in that situation. A group discussion is very difficult to interpret except if one of the doctors functions as a narrator of the discussion in plain English.

Condition, situation, and other place holders are common in medical jargon. Firstly, when they have to be translated, it is evident that they actually do not convey a definitive message. The meaning changes in different contexts. Therefore the interpreter cannot start interpretation before there is enough information for deciding the meaning of a "mush word". Since this causes delay, poorly defined words should be avoided.

"Immediate family" is one of the expressions seldom used in regular English but quite often discussed in medical settings. Whenever this or similar expressions are used and the meaning is even slightly unclear, the doctor should clarify what exactly is meant in this case. Genetic questions are often discussed during ophthalmological examinations and therefore genetic vocabulary and the ways of discussing family trees and modes of inheritance should also be discussed between doctors and interpreters early during the collaborative work.

In the text "Eyes and Vision" there is a list of questions that often occur during assessment of low vision. The content of these questions should be well known by every interpreter who is assigned to work in an ophthalmologist's office.

Questions

2. Light sensitivity, dazzle.
If the sun is shining into your eyes, does your vision become much worse?
Does the sun dazzle you for a long time? How long?
Does bright light cause pain in your eyes? Do you use sunglasses? Goggles?
Do you have several (2-3) different pairs of sunglasses?
Do you bump into people even if you have your sunglasses on in bright light?
Do car headlights dazzle you?

3. Disturbances related to motion.
Is it difficult to move in places where people walk close by?
If you walk in a place where the wind moves branches of bushes and trees, does the movement of the branches bother you?
If you turn your head quickly, does it bother your vision?
If movements disturb your vision, what happens in your vision when it becomes disturbed? How does it change?

4. Contrast sensitivity. Can you see the curb?
Can you see the stairs when you walk downstairs?
Should all stairs have contrasting edges?
Do you see the poles of the traffic signs in time to go around them?
Is it difficult to see light colored food on a white plate?
Has it become more difficult to lipread and see finger spelling?
Is the newspaper text difficult to read because of the light print?

5. Illumination.
Can you sit facing the window?
Do you find small focal lights, like candles, disturbing?
When you read, how do you want to arrange the lights in the room?
Do you have a special reading lamp?
What color of light is most comfortable for you? Do you use filter glasses (tinted glasses) when reading?
Does extra light make reading small print easier?
Did you look around at home and think which lights should be moved to another place? Where would you like to have more light? Are the streetlights strong enough? Do you need a flashlight?

6. Visual field.
How large an area do you see in front of you? Has it happened that you misunderstood a situation because of loss of vision in parts of your field of vision?
When you look straight ahead and move your hand by the side of your head, can you see your hand moving?
Do small objects disappear from your vision and pop up after a while?
When you read, can parts of the letters disappear?
If you use sign language, does the person signing have to go further away to be seen? If the interpreter sits at a distance of four feet, how much do you see of the interpreter without moving your eyes?

7. Visual illusions.
Is there flickering of the picture (image) in any part of your field of vision?
Do you see lights moving around near the blind areas of your field of vision?
Are there any other lights moving in the visual field? What do they look like?
If you cough or laugh, does the image change? If you see lights moving across the visual field, do you see your surroundings as through a frosted glass? Or does the image disappear? Do straight lines become different? How?

8. History of the disease.
When did you notice the first changes in your vision? Before school age, at school, after school?
How rapidly did the changes develop then? Has there been any change in your vision during the last year?
During last five years?
Has there ever been a period of very rapid progression of the changes? When? How did the vision change then?
Have colours become different?
Do you have difficulties seeing any colors? Has your reading speed changed? How much? When?
Do you have pain in your eyes?

9. Visual aids.
Do you have several pairs of glasses? (If you do have, please, bring them all to the office. Also all other visual aids.)
Do you have tinted glasses? Sunglasses? Do you use magnifying lens(es)? Do you have a telescope?
Do you use any other visual aids?
Which visual aids would you like to try this time?