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Session 2.

Visual Acuity

Tasmanian Eye Clinics G.P. Seminar

VISUAL ACUITY (20 mins)

RETINAL ARCHITECTURE

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• Dark adaptation function. • Reliance on cones.Central vs Peripheral Vision • Macula function. • Discerns movement and action. • Relies on rods. • Parvocellular pathway. • Magnocellular pathway . • Detailed with high definition. • Reading and colour vision.

fovea macula .

Form acuity is only one way of assessing visual function. Other functions are contrast sensitivity and dark adaptation.Recording Visual Acuity is not complex and measures the most essential function of the eye. .

.VISUAL ACUITY • • • • RECORD RECORD RECORD You are not defendable if there is no recorded acuity.

Recording • Record the result in the following manner. • Remember no record = no defence .

• Ie 6/6 represents reading the line at 6 metres that should be read at 6 metres. • Young people can read better than 6/6 . • The Numerator represents the distance used and the denominator the line read.usually 6/5 or 6/4.Visual Acuity • Va’s Recorded at 6metres or 3metres. • The Americans use 20/20 ( ie 6 metres ) as the convention. • The chart used is actually based on a fallacy but become imbedded in law .

A fallacy but imbedded inin LAW A fallcy but imbedded LAW .

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Snellens E chart Landolts Ring .

SHERIDAN GARDNER for Children. “One thing like other thing” .

( uncorrected) at distance. • V.l.l. • V. • V. .r (uncorrected) at distance. • corrected ie with glasses) • No glasses with Pin Hole. for near.Recording Visual Acuity. • V. for near.r. • No glasses with Pin Hole. • V.l.r (V.(corrected ie with glasses).

PIN HOLE • A pinhole or stenopaeic device converts the eye into a pinhole camera and neutralises refractive error. • A pinhole is used to create a shorthand refraction. • The pinhole test allows a non optical person to assess the visual potential of the eye. • If Visual Acuity is depressed it may be due to a simple refractive error . .

DEVICE PIN HOLE .

Near Vision • Recorded in point print form. . • N6 the phone book. • N10 most magazines. • Record with reading glasses if used.(remember the readers!) • N8 is approximately the size of newsprint.

Clues from the Visual Acuity • Reading one side of chart may indicate a hemianopia. • “Searching” movements of the head when trying to read the letters may suggest macula changes. . • A poorer reading acuity compared to the distance acuity suggests macula dysfunction.

• Beware the illiterate and the memorised chart. .Technique Points • Cover each eye for the patient carefully to avoid “peeping”. • Record the best line the patient can see even if there are mistakes and record as eg 6/6-2 • Single letter vision charts are easier to read than multiple letters but mask “ crowding”.

Standard Occluder .

. • <6/60 for the blind pension or <5degrees of field in the better eye.ACUITY STANDARDS • 6/12 (corrected or uncorrected ) in at least one eye is the driving standard for an ordinary licence. • 6/9 for public vehicle licences. A visual field of 120 degrees (binocular ) is also required.

• A little about optics and lenses .

. • All optical devices depend on refraction. • This creates REFRACTION.Optics • The power of an optical surface is at the interface between a less dense and more dense medium . • The following illustrate the main types of lenses.

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• Concave. . + lenses • . • Convex. • Magnify. • Identify. • Focal plane concept. • Image moves in opposite direction. • Focal plane concept • Identify.lenses. • Image moves in same direction. • Make object smaller.Lenses.

High + and – and the problems. Bifocals etc. • • • • • Single vision. . Multifocals.Spectacles. Identify main types.

Single Vision Executive Bifocal D Segment Bifocal Round Segment Bifocal Multifoc al demarcation No Trifocal Increasing power of lens .

Spectacle Materials • CR39 1.49 Reducing Edge thickness & weight • High Index Plastics(1.67) .

Methods of recording. Identification of basic optical lenses.Practical Training (20 mins) • • • • • • Visual Acuity Drills. Chart types & advice re use. . Pin Hole use. Identification of basic glasses types.

F. Snellens Acuity charts accurately reflect the resolving power of the eye. 4. 2. F. F. T. T. Visual Acuity is the only method of assessing visual function. 3. Patients with macula dysfunction perform better on distance acuity measurement than near acuity. “Crowding” occurs in partially corrected amblyopia. F. 8. T. Visual acuity is classically recorded on the page as if the examiner was the patient. . Pinholes correct ametropia only in young subjects. 6. F. Recording the Acuity in the affected eye only is “good enough” to save consultation time. Sheridan Gardiner charts are used to assess Acuity in pre verbal children only. T. F. T. T. 7. T. F. T. 5. F.Visual Acuity Multiple Choices 1.