Visual acuity

measurement
(Snellen chart)

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 Visual acuity measurement-snellen chart
• Snellen chart is an eye chart that can be used to
measure visual acuity.
• This chart is composed of a series of progressively
smaller rows of letters and is used to test distance
vision.
• The fraction 20/20 is considered the standard of
normal vision

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 Visual acuity measurement-Terminology
Accommodation: process by which the eye adjusts for
near distance (eg, reading) by changing the curvature of
the lens to focus a clear image on the retina
Anterior chamber: space in the eye bordered anteriorly
by the cornea and posteriorly by the iris and pupil
Aphakia: absence of the natural lens

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 Terminology….
 Astigmatism: refractive error in which light rays are spread over a diffuse
area rather than sharply focused on the retina, a condition caused by
differences in the curvature of the cornea and lens

 Binocular vision: normal ability of both eyes to focus on one object and
fuse the two images into one

 Blindness: inability to see, usually defined as corrected visual acuity of

20/400 or less, or a visual field of no more than 20 degrees in the better
eye

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 Terminology…..
• Chemosis: edema of the conjunctiva
• Cones: retinal photoreceptor cells essential
for visual acuity and color discrimination
• Diplopia: seeing one object as two; double
vision
• Emmetropia: absence of refractive error

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 Terminology…..
• Enucleation: complete removal of the eyeball and
part of the optic nerve
• Exenteration: surgical removal of the entire contents
of the orbit, including the eyeball and lids
• Evisceration: removal of the intraocular contents
through a corneal or scleral incision; the optic nerve,
sclera, extraocular muscles, and sometimes, the
cornea are left intact
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 Terminology…..

• Hyperemia: “red eye” resulting from dilation of the

vasculature of the conjunctiva

• Hyphema: blood in the anterior chamber

• Hypopyon: collection of inflammatory cells that has

the appearance of a pale layer in the inferior anterior
chamber of the eye

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 Terminology…..

• Injection: congestion of blood vessels

• keratoconus: cone-shaped deformity of the

cornea

• keratopathy, bullous: corneal edema with painful

blisters in the epithelium due to excessive corneal
hydration

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 Terminology…..

• limbus: junction of the cornea and sclera

• Miotics: medications that cause pupillary constriction

• Mydriatics: medications that cause pupillary dilation

• Myopia: nearsightedness; a refractive error in which

the focus of light rays from a distant object is anterior
to the retina

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 Terminology…..
• Neovascularization: growth of abnormal new
blood vessels
• Nystagmus: involuntary oscillation of the eyeball
• Papilledema: swelling of the optic disc due to
increased intracranial pressure
• Photophobia: ocular pain on exposure to light

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 Terminology…..

• Proptosis: downward displacement of the

eyeball resulting from an inflammatory
condition of the orbit or a mass within the orbital
cavity
• Ptosis: drooping eyelid
• Refraction: determination of the refractive errors of
the eye and correction by lenses

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 Terminology…..

• Rods: retinal photoreceptor cells essential for

bright and dim light
• Scotomas: blind or partially blind areas in the
visual field
• strabismus: a condition in which there is
deviation from perfect ocular alignment

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 Terminology…..

• Trachoma: a bilateral chronic follicular conjunctivitis

of childhood that leads to blindness during
adulthood, if left untreated

• Vitreous humor: gelatinous material (transparent

and colorless) that fills the eyeball behind the lens

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 Terminology…..

Note: Common abbreviations related to vision and eye

health are OD (ocular de15xter, right eye), OS (ocular
sinister, left eye), and OU (ocular uterque, both eyes).

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 Snellen chart

 Is used to measure eye status and developed by

Dutch eye doctor Hermann Snellen in the 1860.

 It shows 11 rows of capital letters, the top row

contain one letter usually the big “E”.

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 Snellen chart….
 Most people can see the letters on the line
designated as 20/20 from a distance of 20 feet.

 A person whose vision is 20/200 can see an object

from 20 feet away that a person whose vision is
20/20 can see from 200 feet away.

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 Snellen chart….

• The right eye is commonly tested first and then

the left.

• If the patient is unable to read the 20/20 line, he or

she is given a pinhole occlude and asked to read
again using the eye in question.

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 The visual acuity (VA) is recorded in the
following way
• If the patient reads all five letters from the 20/20
line with the right eye (OD) and three of the five
letters on the 20/15 line with the left eye (OS), the
examiner writes OD 20/20, OS 20/15-2, or VA
20/20, 20/15-2.

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 The visual acuity (VA) is recorded in the
following way….
 If the patient is unable to read the largest letter on the chart
(the 20/200 line), the patient should be moved toward the
chart or the chart moved toward the patient, until the patient
is able to identify the largest letter on the chart.
 If the patient can recognize only the letter E on the top line at
a distance of 10 feet, the visual acuity would be recorded as
10′/200.

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 The visual acuity (VA) is recorded in the
following way….
 If the patient is unable to see the letter E at any
distance, the examiner should determine if the
patient can count fingers (CF).

 The examiner holds up a random number of fingers

and asks the patient to count the number he or she
sees. If the patient correctly identifies the number of
fingers at 3 feet, the examiner would record CF/3
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 The visual acuity (VA) is recorded in the
following way….
 If the patient is unable to count fingers, the examiner raises one hand up and
down or moves it side to side and asks in which direction the hand is moving.
This level of vision is known as hand motions (HM).

 A patient who can perceive only light is described as having light perception
(LP). The vision of a patient who is unable to perceive light is described as no
light perception (NLP).

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 LOW VISION AND BLINDNESS
• Low vision is a general term describing visual
impairment that requires patients to use devices and
strategies in addition to corrective lenses to perform
visual tasks.
• Blindness is defined as a BCVA of 20/400 to no light
perception. The clinical definition of absolute blindness is the
absence of light perception.

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 Discussion points

1. What is 20/20 vision?

Ans.is a term used to express normal visual
acuity measured at a distance of 20 feet.
2. What is the best method to measure visual
acuity?
Ans. Snellen eye Chart

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