Checking near and distance vision

Attention

  • Only need to do for 3 years old and above
  • Aim to find and record visual acuity (best vision) person can manage
  • Specialist consult for any loss of vision 

What you need

  • Near-point chart for reading vision OR Table 8.1 printed CPM only
  • Chart for distance vision

Figure 8.1  

Figure 8.2  

Figure 8.3  

What you do

Check NEAR visual acuity (vision) first

  • If person normally wears glasses for near tasks — do test with glasses on
  • Ask person to keep both eyes open
  • Have them hold near-point chart at distance they would normally hold things to read or do near tasks — usually 30–40cm
    • If you don't have a chart and are using a printed CPM — Table 8.1
  • Record in file notes — N point score of smallest sized print they can read correctly and whether wearing glasses/contact lenses aided or unaided
    • (​Eg Near vision = N8 unaided)

Table 8.1 Near point scores using text in common use

Important: This Table is only for use in printed manual — it cannot be used online or printed out as text size will not be correct

Check DISTANCE visual acuity (vision) next

  • Put chart against a well-lit wall at about eye level
  • Position person correct distance from chart — 6m or 3m depending on chart design
  • If person normally wears glasses for distance — test with their glasses on
  • Ask person to cover 1 eye with palm of their hand or piece of thick card while you test the other eye. Make sure they are not peeping or pressing their fingers against the eyeball
    • Cover right eye and check left eye THEN cover left eye and check right eye
  • If using lettered chart
    • Ask person to read the first letter from each line, continue down until it becomes difficult, then read along the whole line
    • Continue down until they get more than half the line wrong
    • Line awarded is the last line they got at least half right
  • If using tumbling E chart — ask person to show, with fingers of their spare hand, which way 'legs' of the 'E' are pointing
  • Record vision as a fraction

Distance vision is recorded as a fraction (eg 6/5, 6/6, 6/12, 6/60)

  • First number is the testing distance — this is a 6 even when using a 3m chart
  • Last number is smallest line of text or symbols that person can read at least half correctly. The lines are numbered next to characters
  • Record whether wearing glasses/contact lenses aided or unaided.
    • (Eg Distance VA: Aided R 6/9, L 6/18)

If person can’t see top line of eye chart (6/60)

  • Ask person to count fingers (CF) on your hand, while you gradually move closer to them, from 6m away to 1m away
  • Record greatest distance at which they can count fingers as ‘CF at (number of) metres'
    • (Eg If able to CF at 4m with left eye and no glasses — Distance VA: Unaided L CF 4m)

If person can’t count fingers

  • Ask person if they can see hand movement (HM) while you gradually move closer to them, from 6m away to 1m away
  • Record greatest distance at which they can see hand movement as 'HM at (number of) metres'
    • (Eg If able to see HM at 1m with right eye wearing glasses — Distance VA: Aided R HM 1m)

If person can’t see hand movement

  • Check if they can see any light at all by shining penlight torch in eye
  • Note whether ‘LP’ (light perception) or ‘NLP’ (no light perception)
    • (Eg If able to see light with right eye but not with left — Distance VA: Unaided R LP, L NLP)

If vision worse than 6/6 (normal vision) — test again with pinhole occluder

  • If you don’t have made-up pinhole occluder — Figure 8.3
    • Pierce a sheet of paper or business card with 19G needle
    • OR use otoscope earpiece with an opening of about 1mm
  • Ask person to hold pinhole occluder in front of eye to be tested and cover other eye. Tape pad over eye if needed
  • Repeat distance visual acuity test through pinhole
  • Do this again for other eye, if needed
  • Record as for distance vision indicating ‘with pinhole’ (PH)
    • (Eg Distance VA: PH R 6/6, L 6/18)
  • When using pinhole occluder
    • If distance vision improves through pinhole — person has some refractive error (focussing problems). New glasses will help — optometry consult
    • If distance vision doesn't improve at all through pinhole — probably another cause (eye problem) for reduced vision. New glasses won't help — eye specialist/optometry consult