VISUAL ACUITY
Introduction
Acuteness / sharpness of vision
Ability to recognize min size target from specified distance
Depends on optical & neural factors
Indicator of refr error & pathology
Inter eye comparisons
Communicate visual ability to other practitioners
Classification
Minimum detectable`
Presence of target
Minimum Seperable
Detect 2 adjacent
points as seperate
Recognition
Resolution
Detect detail on object
Stereo acuity
Detect slight
differences
Snellen Principle
One unstimulated cone between 2 stimulated cones
for 2 objects to be seen separately (Helmholtz)
Diameter of cone = 0.002mm = 1 min arc
subtense at nodal point of eye
Letters of VA chart constructed using this
principle
Each spatial band (light & dark stripe)
separated by 1’arc and therefore seen
separate
Entire letter subtends 5’arc at nodal point
=> will be seen clearly
Snellen Chart
approx10 lines of decreasing size
6/60, 6/48, 6/36, 6/30, 6/24, 6/18, 6/15, 6/12,
6/9, 6/7.5, 6/6, 6/5
Each letter will subtend 5’arc at nodal pt at a
specified distance => denominator
6/12 letter subtends 5’arc from 12m, 6/36
from 36 m
Healthy eye resolves 6/6 letter from 6m
Snellen Fraction
Denominator =
dist that letter
subtends 5’arc /
Universal method Numerator= dist
furthest distance
of recording VA of chart from Px
at which “normal
sighted px would
see that target”
EXAMPLE: V/A = 6/12
this patient can see a target at 6m away but a
'normal' sighted patient would see this target from 12m
away.
The letter size is 8.7mm X 2 = 17.40mm
VA notations
• 6 as the numerator
Metre • Eg. 6/36
• 6m = 20 feet
Feet • Eg. 20/120
• 20/120 = 6/x, x = 36 => 6/36
• Divide numerator by the denominator
• Eg 6/36 = 0.17
Decimal • To convert to metre => 6/decimal => 6/0.17 = 35,2 closest
to 36
• Reciprocal of decimal acuity value
Min angle of • Eg 6/12 => MAR = 2
resolution (MAR) • Expressed in min of arc
• Log of the MAR
Log MAR • Eg. 6/6 => MAR = 1=> Log 1 = 0.0
Optotypes
Alphabets Tumbling E
Landolt C LEA symbols
Pictures Numbers
VA Charts
VA Charts
Projector Wall chart
projected onto screen Pasted on wall
Numerator always 6
Numerator based on
dist from chart
Different notations
Converted to 6 m
notation
Conversion for diff
notations
VA charts
• Read off
Indirect
directly • Reversed
chart read off
mirror in a
3m room
Direct
Taking Dist VAs
• Explain purpose
to Px
• Normal room
illumination
• Monocular =>
binocular
• Procedure
• Recording
• Peering
• Head position
VAs on the Projector
calibrates for room dist => no
conversion is reqd for room
size - numerator is always 6.
If in decimal notation - convert
to Snellen fraction eg. 0.3 =>
Denominator = 6/0.3 = 20 =>
VA = 6/20, or closest 6/18
VAs on Wall Chart (in m)
Often <6m dist therefore numerator < 6
eg. in 4m room, numerator = 4
Denominator remains as on chart eg
6/24 line in 4m room = 4/24
Have to convert to 6m :
4/24 = 6/x, solve for x
X= 36, therefore VA recorded as 6/36
VAs on Wall Chart (in feet)
Take VA with usual procedure
=> VA=20/50 -2
1. What is 6m equiv of 20/50?
20/50 = 6/x, solve Therefore equiv of
for x; x = 15 20/50 is 6/15
But, wall chart in 4m room
Therefore 4/15 = 6/x,
VA = 6/24 -2
VA = 4/15 x = 22.5,
Near Visual Acuity Notations
M (M) eg 1.0M
Points eg. 8 pts
Jaegar (J) eg J6
N (metre) eg N8
Reduced Snellen / Snellen equiv eg 6/12
Near VA - procedure
Good
illumination
40cm WD,
may vary
OD, OS
and then
OU
Notation
card
dependant
Record
size of • Eg 3M at 40cm
print & dist
VAs poorer than largest letter
Counting Fingers (CF)
Wall
chart Hand Movement (HM)
Light Projection
Light Perception (LP)
Projector
No Light Perception (NLP)
Pinhole VA
