Visual Acuity Testing
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1 Visual Acuity Testing Lynn Lawrence, CPOT, ABOC, COA 1
2 Define Visual Acuity The measurement of the ability of the eye to see detail Vision The ability to see The procedure Lighting Patient position Distant/near Occluder Pin-hole what makes it better? Plus lens 2
3 The Hardest Acuity What is the most difficult acuity you have ever taken Were you prepared for it? Are children difficult? What do you do with the parents? What happens when it is taking too long? Documentation Test distance Test target Pupil reaction Constriction/dist Dilation/near Correction Robots Don t be a robot Know why you are testing a patient Know how the test is to be performed Know what is WNL Know how to document the findings Know when to test When in doubt test it out 3
4 Visual Acuity Baseline data Quantification of visual status Sets criteria to help patient achieve better vision Visual Acuity Types Near Distant Charts Snellen Alignment Conversions Test Distances Types of Acuity Charts Snellen Metric (Bailey-Lovie) Low Vision Charts Illiterate Charts -Landolt C or rings -Tumbling E -Lighthouse charts 4
5 Procedure Always observe patient. No squinting. Why? When do you obtain pinhole acuity? Visual acuity better with one eye or two? Note any consistent pattern in the letters missed by the patient. Why? Preschool Children Allen Picture Chart 11947R Courtesy of Richmond Products Snellen Fraction Numerator -Represents the testing distance in feet or meters - 20/ ; 6/ Denominator -Represents the distance at which the letter subtends a 5-minute angle or arc in distance or meters. Also referred to as the letter size 5
6 Techniques for Testing Monocular and binocular With and without Rx Distance and near Pinhole acuity (20/30) Testing errors What happens when a patient can t see the largest letter at 20 feet? Types of Acuity Charts Snellen Metric (Bailey-Lovie) Low Vision Charts Illiterate Charts Landolt C or rings Tumbling E Lighthouse charts Procedure Patient unable to see the big E Walk up method (15/400, 10/400, 5/400) Count Fingers- ft Hand Motion- ft Light Location Light Perception 6
7 Near VA s Test distance is 16 inches or 40 cm Proper lighting Pinhole The pinhole test is used to confirm whether or not refractive error is the cause of decreased visual acuity. Documentation What happens during the pinhole test? Pinhole Acuity Why is it necessary Who should it be performed on 7
8 Connect the Dots! Listen to the patient Watch the patient when testing pt You need to know what direction to go Force blinking Leaning Squinting Turning of the head Refractive History Past history of corrective lenses Current corrective wear recent Rx? -age of correction -state of correction -quality of vision Case History This is a legal document write everything Use the components of case Hx Chief complaint Medical and ocular history Patient Family New medications or changes in health Occupation and avocation Hobbies piano teacher-vs-cross stitching 8
9 Pre-Testing Visual Acuity - Aided and Unaided - Distance and Near Letter size calibration - 20/200 = 87mm at 20 feet Case History Chief Complaint Reason for the patient visit recorded in Patient s own words. - Ask all the questions necessary to aid your doctor in discovering the root cause of the patients current condition (ie. Who, what, where, how, how long, How old is patient, pain assessment, is there anything that brings relief, last eye exam, last physical exam, illicit and legal drug use, dosage/frequency, alcohol use/amount, and patient/family medical history) Ocular History Cont Rule out specific ocular problems or conditions ie. DES surgery injury vision training Medications (new) Allergies refractive history A great question: Are you wearing your most current Rx? 9
10 Story of the Truck Driver Conditions Timelines Ocular Symptoms Ask open ended questions and document what the patient says itching burning tearing redness irritation other symptoms Ocular History Cont Rule out specific ocular problems and conditions, such as: -glaucoma -cataracts -keratoconus -surgery -previous injuries 10
11 SOAPP Format Subjective Chief Complaint Objective test results Assessment for the O.D. only Plan for the O.D. only Prevention duty to warn/counseling Document Pain Assessment If the patient is in pain, you must evaluate the level of pain Ask if anything relieves the pain Ice Pain associated with trauma Penetrating injuries Recording Visual Acuity Verify with your doctor DVA 20/ NVA 20/ CC SC CC SC 11
12 Thank you Thank you 12
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