VISUAL ACUITY
CLINICAL MEDICINE L6
DR BADRIA MUSHI
11/05/2024 1
Contents
• Definition
• Importance of VA
• Measuring VA
• Levels of VA
11/05/2024 2
DEFINITION
• VISUAL ACUITY is a measure of your
central vision, the ability to distinguish
details and shapes of objects
• Is the measure in keenness of sight-
detection of a feature
• This refers to the smallest object that
one can detect
11/05/2024 3
• -Normal vision is usually at 6/6 (meters) or
20/20 (feet)
• -Thus if you can read 20/20 you can discern
detail that subtend 1 minute of arc
11/05/2024 4
Minimum resolvable acuity
• Resolution of two features
• Refers to the smallest angular separation
between neighboring object that one can
resolve
11/05/2024 5
• VA is a form sense
• Enables to perceive shapes of objects
• It is performed by cone
11/05/2024 6
• Most acute at the fovea
• 20 degrees parafoveal VA falls to 1%
• VA can be measured at a distance and near
object
11/05/2024 7
Why doing Visual Acuity?
• Assessing for Refractive errors
• Evaluating the effectiveness of medical and
surgical treatment
• Monitoring changes in vision eg DM patients
• Screening for ocular health following a course of
eye disease
• Prescribing Aids for the visually impaired
• Setting visual standard for driving and
employment
11/05/2024 8
• VA acuteness depends on
• Sharpness of the retina focus within the eye
• The sensitivity of nervous elements
• Interpretation faculty of the brain
• So visual acuity is the most common clinical
measurement of visual function
11/05/2024 9
How to measure VA
• Test chart should be well printed
• Good and uniform illumination
• Distance from chart 6m (20ft)
• Each eye separately, Right eye first then the
other eye
• Occlude the other eye
• Test without and with spectacles
11/05/2024 10
• Distant object is tested by a chart with
different sized letters read from a distance of
6 meters away
• This is called the SNELLEN’S test types
11/05/2024 11
• SNELLENS (Literate, Illiterate, children)
• Constructed on the minimum visual angle
• Letters arranged in diminishing sizes
.
• Letters subtend an angle of 5 min at the nodal
point of the eye
11/05/2024 12
Snellen chart
11/05/2024 13
• Numerator=Distance from test chart or
testing distance
•
• Denominator=Distance at which person with
standard vision should see
• Eg: 6/5, 6/6,6/9,6/18, 6/60
11/05/2024 14
11/05/2024 15
11/05/2024 16
• Patient is asked to fixate at a distance, read
the chart as far down as possible
• Record the standard numerator of 6 and the
denominator is where the patient stopped
reading
• Repeat for the other eye
11/05/2024 17
Failure to see the biggest letter on the chart at
6m, proceed as follows:
• Patient moved towards chart by 1m,2m etc
• Patient asked to read the largest letter
• Record 5/60, 4/60,3/60,2/60, 1/60
• Denominator is Distance at which eye with
standard vision should see that letter
11/05/2024 18
Failure to see the largest letter at any distance.
Proceed as follows:
• Ask he patient to count your fingers held in his
field of vision
• Record as CF 1M, NEAR
• Move your hand in front of the eye
• If patient can see the hand in motion record as
HM
11/05/2024 19
Failure to See hand in motion, do the following:
• Shine torch close to the eye
• Record Va=LP (Light perception)
• Do the same for the other eye
11/05/2024 20
• Failure to perceive light:
• Record Va= NLP (No light perception).
11/05/2024 21
• 6/6 = Normal Va
• VA Less than 6/9= Subnormal
• If VA is less than 6/6 ,you need either
spectacles,contact lens or surgery for
correction
11/05/2024 22
VA WHO criteria
• NORMAL Va=(6/4,6/5,6/6,6/9,6/12,6/18)
• VISUAL IMPAIREMENT
– Moderate (Va= 6/24, 6/36,6/60)
– Severe (Va 5/60,4/60,3/60)
• Blindness (Va=2/60,1/60,HM,LP,NLP)
11/05/2024 23
• Other test for testing VA:
• Random E’s test
• It involve patient identifying the direction
letter E is facing.
• Either upward, downward, left or right
11/05/2024 24
11/05/2024 25
Near VA
• Defined as the smallest type which can be
comfortably read
• Test distance = 25cm - 33 cm
• Measured by the Snellen equivalent for near
vision=JAEGERS
11/05/2024 26
• Test types for measuring visual acuity at near
consist of various printers , types of various
sizes arranged as words and phrases
• Depending on size of test types read acuity is
recorded as J.1 , J.2 up to J .20
11/05/2024 27
11/05/2024 28
11/05/2024 29
Measuring VA in infants
• Ability to fixate
• Ability to follow light or object of regard
• Ability to recognise and smile appropriately at
his mother
• Reaching out for an object
11/05/2024 30