Assessment of visual acuity and recording

 Definition:-The resolving power of the eye used to

assess and quantify the eye’s ability to resolve
varying letter sizes.
 It is also a test of macular function and should be
done for every patient as part of any eye
examination.
 Visual acuity is dependent on:
 The refractive error of the eye
 The health and the integrity of the eye
 The test targets used.
 The test conditions.
 Visual acuity
 Vision should be tested for both distance and near.
 DVA
 NVA
 Instrumentation – snellen’s E chart, landolt C chart,
Snellen’s litrate chart etc.
 Standard Test Distances
Distance visual acuity (DVA)
 6M is equivalent to optical infinity

Near visual acuity (NVA)

 40cm
Snellen Chart
Tumbling E Chart
Landolt C Chart
 Vision and visual acuity
Vision:- The measurement of how well the eye can
see detail without glasses is called Vision(V)
Visual acuity:-The measurement of how well the eye
can see detail with glasses is called Visual acuity
(VA)
There are several ways that vision and visual acuity
can be recorded. The system that seems to be most
commonly used is the Snellen Fraction notation.
 Basic optics
 Everything we see is seen because light is reflected from
it. The object itself does not produce light (unless it is a
light source!). This explains why we cannot see in the
dark- there is no light to reflect from objects.
A beam of light can be PARALLEL, DIVERGENT or
CONVERGENT.
 Distance Visual Acuity Testing
 VA - Visual acuity
 OD - ocular dexter
 OS - ocular sinister
 OU - oculus uterque

 6/6

 Distance between the patient and the eye chart

_____________________________________________

Distance at which the letter can be read by a person with normal

acuity
 Measurement of V/A
Is recorded as a fraction A/B
A= the distance the patient is from
the chart which is 6 meters.
B= the last line the client reads.
The amount of light on the chart has a
considerable influence on the visual
acuity.
The recommended illumination is 10-
30 foot candles.
 Assessment of VA
 Patient is seated at a distance of 6 meters from the chart.
 The examiner places an occuluder over one of the
patient’s eye without any pressure.
 The right eye is done first and the left eye next.
Vision Charts (cont.)
 Testing Distance
Visual Acuity
General Procedures:
Make sure the room is well lit.
Choose appropriate chart.
Chart at eye level.
Mark off appropriate distance for chart.
patient position their heels on the line.
Use an occluder. Make sure the pt does not
peek.
Ask if the pt to wears glasses, if yes, testing
should be done with the pt wearing the
glasses. (Be sure to mark the form)
 Testing Distance
Visual Acuity (cont.)

Watch carefully to observe if the PATIENT is

peeking, tilting their head, or squinting.
Instruct the PATIENT to keep both eyes open and
read the selected letter or line of letters with the
uncovered eye. Do not use a marking device as a
pointer.
When screening, start at the 6/60 line and move
down to the 6/6 line
pt must identify or match greater than 60% of the
letters on the critical line.
 Distance Visual Acuity Testing
 If VA < 6/60
 Reduce the distance between the pt and the chart
and record the new distance (eg. 5/60, 4/60, 3/60,
2/60, 1/60)
 1/60 IS EQUIVALENT TO COUNTING FINGERS
at one meter.
 If < 1/60 or CF 1meter
 HM (Hand movement is checked) if not
 LP (light perception)
 NLP ( no light perception)
 Classification of V/A
Good vision = 6/6-6/18
Visual impairment= 6/18-6/60
Severe visual impairment=
6/60-3/60
Blind < 3/60 or less than
counting fingers 3 meters.
 Pinhole Visual Acuity
 Purpose
 To determine if a decrease in vision is
correctable by lenses.
 Pin hole:- improves the central vision by
reducing the blurring.
 Pinhole visual acuities are taken VA is
worse than 6/18.
 If VA improves with pin hole then the
patients is considered as having
refractive errors.
 Expected Findings

 If the cause of the patient’s decreased visual acuity

is due to an uncorrected refractive error, the VA is
expected to improve through the pinhole
 If the cause of decreased visual acuity is not
optically based, no improvement, and possibly a
decrease, will occur through the pinhole
Terms to Know

Myopia
Hyperopia
Strabismus
 Childhood Vision Disorders
Condition Negative Impact Intervention
Myopia Blurry distance vision Glasses
Poor school Contact Lenses
performance

Hyperopia Blurry near vision Glasses

Eye strain Contact Lenses
Difficulty reading
Poor school
performance

Astigmatism Blur at distance and Glasses

near Contact Lenses
Eye strain
Myopia

 The most common of

the refractive errors.
Formerly called
“nearsightedness”.
Unable to see clearly at
distance.
 Hyperopia
 A refractive error in which the light rays from an incoming
visual image have not converged by the time they reach
the retina. Formerly called “farsightedness”. Near vision
may be blurry.
 A mild degree of hyperopia is normal and asymptomatic in
young children. High degrees of hyperopia can cause
poor near acuity and/or strabismus.
Strabismus

 A manifest deviation of one or

both eyes from the visual axis of
the other so they are not
simultaneously directed to the
same object. Also referred to as
heterotropia, or tropia.
 Amblyopia
 An ocular condition in an otherwise healthy eye, in
which there is an abnormality of cortical response in
the occipital lobe of the brain due to insufficient or
inadequate stimulation of the fovea, neural pathway,
and cortex that may result in unilateral vision loss if
untreated.
 Near Visual Acuity
Testing the VA at close range
(usually 40cm)
Near visual acuities are taken
through the habitual correction
The purpose is to detect people
with near vision difficulties (e.g.,
uncorrected high hyperopia,
accommodative dysfunction)
In patients over 40 years old, the
reduced near visual acuity is one
of the symptoms of presbyopia
 Near Vision Charts

Types of notation
 Reduced Snellen Acuity card
Test distance at 16in (or 40cm)
 Jaeger Acuity Card
20 letter sizes classified J1 to J20
Test distance at 14in
 Point system
Each point is 0.35mm
 M notation
Based on meter unit
Bailey-Lovie Reading Card
<<Get your eyes tested!!!
>>
Thank you!
School screening