VISUAL
ACUITY
Done by: Fatma Al Musharrafi
SSN JPC
Ophthalic clinic
Aims And
Objectives
Understand the principles Perform an accurate
behind vision testing. visual acuity.
Definition
Visual acuity is a measurement of central
vision only.
Assessment of total visual system from cornea
to occipital cortex.
Visual acuity can be tested for both distance
and near vision. Distance visual acuity is the
most common test. This presentation deals
only with distance vision testing.
Normal Vision 6/6
Normal vision relies on the following:
• Both eyes in alignment (extraocular muscles
functioning)
• Clear cornea
• Clear lens of the eye
• Clear ocular media (aqueous and vitreous)
• Intact retina, optic nerve, visual pathway
Patient Requirements
•Patient's co-operation.
• Patient's comprehension of what is required.
• Ability to recognise images used on the
various charts (letters, numbers or pictures.
• Distance correction (glasses or contact
lenses).
Why do a visual
acuity test?
Diagnostic tool Baseline data Legal
Evaluates treatment
requirement
Measures To measure the patient's progress visual acuity
progression of must be assessed at every presentation.
disease
Vision Testing Tools
THE SNELLEN CHART IS USED IN MOST
FACILITIES FOR TESTING DISTANCE
VISION.
THEY ARE DESIGNED TO BE READ AT 6
METRES OR 3 METRES (USUALLY
INDICATED ON CHART)
VISION CHARTS ARE STANDARDISED
FOR SIZE AND CONTRAST AND SO DO
NOT PHOTOCOPY OR MAKE YOUR OWN
Vision Testing Tools
THE SNELLEN CHART COMES AS A FREE
STANDING CARDBOARD CHART OR ON
A LIGHT BOX.
CHART SHOULD BE IN GOOD ORDER
IF USING A LIGHT BOX, ALL GLOBES
MUST BE WORKING TO ENSURE
STANDARD ILLUMINATION.
ONLY USE 25 WATT CLEA GLOBES (NOT
PEARL OR FROSTED)
Vision Testing Tools
Hundred and thousands: Sheridan Gardiner: E chart:
useful test for very young For use with children, illiterate,
For use in NESB or illiterate
children (contrast test). aphasic patients Patients match
letter seen with letter on patients
handheld card Often used by Patient matches direction of
Community / Rural nurses. E with fingers.
Distance Correction
• Visual acuity is a measure of best corrected distance vision.
• People who are short-sighted and normally wear glasses or contact
lenses should have their visual acuity tested wearing their glasses,
i.e. their vision has been corrected.
• If glasses or contact lenses are prescribed and available, testing
without them provides no relevant information.
• If glasses or contact lenses are prescribed but not available
document before testing.
Distance Correction (cont)
• Always ask if patients have distance glasses (e.g. to drive or watch TV) as
some people do not wear them all the time.
• Reading glasses (magnifiers) should not be worn during distance testing.
• Reading glasses can distort distance vision.
• Contact lenses should be documented but not removed for the test.
Check with patient that the Glasses prescriptions need to be
glasses they are wearing were updated regularly so some old glasses
prescribed for them. Many may not correct vision adequately.
people borrow glasses. Ensure glasses are clean / scratch free.
Occlusion •Each eye needs to be tested separately.
•Use an occluder to cover the eye that is
not being tested.
•If glasses are worn, the occluder goes
over the top of the glasses.
•If occluder is not available use the
patient’s cupped hand or a patch.
•Avoid pressure on the eye and be aware
of patients peeking through their fingers.
Using the Snellen Chart
PLACE PATIENT 3 OR 6 METRES FROM
CHART (DEPENDING ON THE CHART).
USE ADEQUATE ILLUMINATION.
COVER LEFT EYE WITH OCCLUDER / PAD
OR CUPPED HAND.
ASK PATIENT TO READ FROM THE TOP
LETTER.
KEEP GOING UNTIL THEY CANNOT READ
THE LINE CLEARLY AND START TO MAKE
MULTIPLE ERRORS. THE PREVIOUS LINE
IS THE LINE YOU DOCUMENT.
Documentation (cont)
• If the patient cannot see the top line of the chart, walk patient towards the chart so they
are at 3 metres.
• Still can’t read the chart? Ask patient to count how many fingers you are holding up at 1
metre. Keep fingers still. Recorded as Count Fingers (CF @1m).
• If they cannot count fingers see if they can see a moving hand. Recorded as Hand
Movements (HM @1m).
• Still no result: can they see a pen torch light : Light perception (LP).
• Unable to perceive light: No Light Perception (NLP).
Documentation Examples
RVA HM @1m LVA 6/60 (forgot glasses)
PH6/60 PH 6/9
RVA 6/9 LVA HM @1m
PH no improvement PH CF @1m
RVA 6/60 @3m LVA 6/6
PH no improvement
Points to
• Test each eye separately .
Remember
•Use distance correction if
normally worn.
• Use an occluder, cupped
hand or patch.
• Use pinhole if patient
does not reach 6/6 line