7/5/13 Vision Tests: Color, Refraction, Visual Acuity and Visual Field Tests

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Eye Health Center
Vision Tests
Vision tests check many different functions of the eye. The tests measure your ability to see details at near
and far distances, check for gaps or defects in your field of vision, and evaluate your ability to see different
colors.
Visual acuity tests are the most common tests used to evaluate eyesight. They measure the eye's ability
to see details at near and far distances. The tests usually involve reading letters or looking at symbols of
different sizes on an eye chart. Usually, each eye is tested by itself. And then both eyes may be tested
together, with and without corrective lenses (if you wear them). Several types of visual acuity tests may be
used.
Refraction is a test that measures the eyes' need for corrective lenses (refractive error). It is usually done
after a visual acuity test. Refractive errors, such as nearsightedness or farsightedness, occur when light
rays entering the eye can't focus exactly on the nerve layer (retina) at the back of the eye. This causes
blurred vision. Refraction is done as a routine part of an eye examination for people who already wear
glasses or contact lenses, but it will also be done if the results of the other visual acuity tests show that your
eyesight is below normal and can be corrected by glasses.
Visual field tests are used to check for gaps in your side (peripheral) vision. Your complete visual field is
the entire area seen when your gaze is fixed in one direction. The complete visual field is seen by both
eyes at the same time, and it includes the central visual field-which detects the highest degree of detail-
and the peripheral visual fields.
Color vision tests check your ability to distinguish colors. It is used to screen for color blindness in
people with suspected retinal or optic nerve disease or who have a family history of color blindness. The
color vision test is also used to screen applicants for jobs in fields where color perception is essential,
such as law enforcement, the military, or electronics. Color vision tests only detect a problem-further testing
is needed to identify what is causing the problem.
Why It Is Done
Visual acuity tests may be done:
As part of a routine eye exam to screen for vision problems. How often you should have routine eye exams
changes as you age. For more information, see:
Eye exams for adults.
Eye exams for children and teens.
To monitor an eye problem, such as diabetic retinopathy.
To determine if you need glasses or contact lenses to improve your vision.
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After an injury to the eye.
When you obtain or renew your driver's license or for some types of employment.
Refraction is done:
To determine the correct prescription for eyeglasses or contact lenses.
Why It Is Done continued...
Visual field tests may be done:
To check for vision loss in any area of your visual field.
To screen for eye diseases, such as macular degeneration and glaucoma, which cause gaps in the visual
field.
To look for damage to the nerves of the eye following a stroke, head injury, or other condition that causes
reduced blood flow to the brain.
Color vision tests may be done:
As part of a routine eye exam.
To screen for or diagnose color blindness.
To screen applicants for jobs in which color perception is important, such as truck driving, electronics, or
the military.
How To Prepare
No special preparation is required before having vision tests. If you wear glasses or contact lenses, bring
them with you to the examination since the tests cannot be properly performed without them. If you have a
copy of your current eyeglass prescription, bring it with you.
Many medicines may affect the results of vision tests. Be sure to tell your health professional about all the
over-the-counter and prescription medicines you take.
Talk to your health professional about any concerns you have regarding the need for vision tests, how they
will be done, or what the results will mean. To help you understand the importance of these tests, fill out the
medical test information form.
How It Is Done
Visual acuity testing
Visual acuity tests are used to evaluate eyesight. Several types of visual acuity tests may be used.
The Snellen test checks your ability to see at distances. It uses a wall chart that has several rows of
letters. The letters on the top row are the largest; those on the bottom row are the smallest. See a picture of
a Snellen chart .
You will stand or sit 20 ft (6 m) from the chart and be asked to cover one eye and then read the smallest
row of letters you can see on the chart. If you are unable to cover your eye, an eye patch will be placed
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over your eye.
Each eye is tested separately. You may be given a different chart or asked to read a row backward to
make sure that you did not memorize the sequence of letters from the previous test.
If you wear glasses or contacts, you may be asked to repeat the test on each eye while wearing them.
Let your health professional know if you have trouble reading the letters on one side of the row, or if
some letters disappear while you are looking at other letters. You may have a visual field problem, and
visual field tests may be needed.
The E chart tests the vision of children and people who cannot read. The E chart is similar to the Snellen
chart in that there are several rows, but all of the rows contain only the letter E in different positions. The top
row is the largest and the bottom row of Es is the smallest. You will be asked to point in the same direction
as the lines of the E. Similar charts use the letter C or pictures. These charts are also available in a
handheld card. See a picture of an E chart .
The Near test uses a small card (Jaeger chart) containing a few short lines or paragraphs of printed text to
test your near vision. The size of the print gradually gets smaller. You will be asked to hold the card about
14 in. (36 cm) from your face and read aloud the paragraph containing the smallest print you can
comfortably read. Both eyes are tested together, with and without corrective lenses. This test is routinely
done after age 40, because near vision tends to decline as you age (presbyopia).
How It Is Done continued...
If you cannot read any of the letters or print on these charts because of poor vision, your visual acuity will be
tested by other techniques, such as counting fingers, detecting hand movements, or distinguishing the
direction or perception of light sources (such as room light or a penlight held up close to the face).
Visual acuity tests usually take about 5 to 10 minutes. They may be performed by a nurse, a medical
assistant, an ophthalmologist, an optometrist, a teacher, or some other trained person. Testing may be done
at a doctor's office, school, workplace, health fair, or elsewhere.
Refraction
Refraction is a test that measures the eye's need for a corrective lens (refractive error). For this test, you will
be asked to describe the effects of looking at an eye chart through various corrective lenses.
Your health professional may use eyedrops to widen (dilate) your pupils before you start this test. The
eyedrops take about 15 to 20 minutes to dilate the pupil fully.
Using a retinoscope, your health professional may shine light into your eyes. A series of trial lenses will be
placed in front of your eyes and adjusted until the light rays are properly focused on your retina. Testing one
eye at a time, the health professional will ask you to compare the effects of two lenses (first one lens, then the
other). You should state which lens of each pair gives you better vision. The health professional will continue
to test your eyes with different lenses until it is determined which lenses correct your vision the best.
Visual field tests
Visual field tests are used to check for gaps in your range of vision. They can help detect eye diseases or
nervous system problems that limit your ability to see objects clearly in the entire visual field or in one part of
it. Several tests are commonly done to evaluate a person's visual field.
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The confrontation test. Your health professional will sit or stand 2 ft (0.6 m) to 3 ft (1 m) in front of you.
You cover one eye while fixing your gaze on his or her nose. He or she slowly moves a finger or hand from
the outer edge of your visual field toward the center and from the center toward the edge through all areas
of your visual field. You will focus your eye on your health professional's nose and signal when you first see
his or her finger or hand. The test is then repeated for the other eye.
The Amsler grid test checks for macular degeneration, a disease that causes loss of vision in the center
of your visual field. The test uses a 4 in. (10 cm) square chart with straight lines that form boxes. The grid
has a black dot at the center. The chart is held about 14 in. (36 cm) from your face. You will cover one eye
while focusing your other eye on the black dot. The test is then repeated on the other eye. Tell your health
professional if:
You cannot see the black dot.
You see a blank or dark spot (other than the center dot).
The lines in the grid look wavy, blurred, or curved instead of straight. You will be asked to point to the
specific abnormal area of the grid.
Perimetry testing uses a machine that flashes lights randomly at various points in the visual field. You
look inside a bowl-shaped instrument called a perimeter. While you stare at the center, lights will flash, and
you press a button each time you see a flash. A computer records the location of each flash and whether
you pressed the button when the light flashed in that location. At the end of the test, a printout shows any
areas of your visual field where you did not see the flashes of light. In an alternative manual perimetry test,
your health professional moves a light target and notes your visual field on paper.
The tangent screen test uses a black screen with concentric circles and lines leading out from a center
point (like a bull's-eye). Sitting 3 ft (1 m) to 6 ft (2 m) away from the screen, you cover one eye while fixing
your gaze on a target point marked on the screen. Test objects of various sizes at the tip of a wand are
then moved inward from the outer edge of the screen toward the center. You will signal when you can see
the object, and that point is then marked on the screen. The points on the screen where you see the
objects are connected to provide an outline of your visual field. The test is then repeated for the other eye.
An alternative manual tangent screen test uses a white object against a black background. If you wear
glasses, you will keep them on for this test.
Color vision test
How It Is Done continued...
Color vision tests check your ability to distinguish colors. In the most commonly used color vision test, you
look for different colored numbers or symbols hidden in varying backgrounds of colored dots.
First, you are shown sample patterns and told what symbols and numbers you can expect to see. You then sit
at a table and cover one eye. The health professional holds the color test patterns about 14 in. (36 cm) away
from you. Some patterns are harder to pick out than others. As the health professional holds up a pattern, you
will identify the number or symbol you see and trace it using a pointer. Some patterns may not have a number
or symbol. The test is then repeated with the other eye.
How It Feels
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You should not feel any discomfort during these vision tests.
When dilating eyedrops are used
Dilating drops may make your eyes sting and cause a medicine taste in your mouth. You will have trouble
focusing your eyes for up to 12 hours after your eyes have been dilated. Your distance vision usually is not
affected as much as your near vision, though your eyes may be very sensitive to light. Do not drive for several
hours after your eyes have been dilated. Wearing sunglasses may make you more comfortable until the
effect of the drops wears off.
Risks
In some people, the dilating eyedrops can cause an allergic reaction.
Results
Vision tests check many different functions of the eye.
Visual acuity testing
The visual acuity score compares your distance vision with that of people who have normal vision, using an
eye chart. Each eye's score is expressed as two numbers, such as 20/20 (6/6) or 20/100 (6/30). The first
number is the distance you stand from the chart, usually 20 ft (6 m) when using a typical wall chart. The
second number is the distance from which people with normal eyesight can read the same line on the eye
chart.
20/20 (6/6) vision is considered normal. A person with 20/20 vision can see at 20 ft (6 m) what people with
normal vision can see at this distance.
When the second number is smaller than the first number, the person's vision is better than normal. For
instance, a person with 20/10 (6/3) vision can see from 20 ft (6 m) what people with normal vision can see
from 10 ft (3 m).
When the second number is larger than the first number, the person's distance vision is worse than normal.
A person with 20/200 (6/60) vision or less in his or her best eye when wearing corrective lenses is
considered legally blind.
Results continued...
For near vision, 14/14 (35/35) is normal, with 14 in. (36 cm) being the normal distance for reading. If the
second number is greater than 14 (14/20, for example, or 35/50), it means that you have reduced near
vision. You have to be 14 in. (36 cm) away to read print that people with normal near vision can read from 20
in. (51 cm).
A Jaeger (J) number is another way to rate your near vision. The J number relates to the size of text you
could read on the Jaeger chart. The J number goes up as the print size of the text you read goes up. The
higher the J number, the worse your near vision. The number can range from J1 to J16. For example:
J1 means that you could read the smallest text on the chart and that you have 20/15 vision.
J2 means the line of text you were able to read had larger print than J1, and your vision is 20/20.
J3 means the line of text you were able to read had larger print than J1 and J2, and your vision is 20/40.
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Visual acuity tests usually take about 5 to 10 minutes.
Refraction
The health professional tests your eyes with different lenses until the lens that corrects your vision the best
(sometimes better than 20/20 or 6/6) is found. The result of a refraction test determines your prescription
eyeglass or contact lens strength.
A refraction test takes 5 to 30 minutes (30 minutes if dilating drops are used).
Visual field test
Normally, a person's visual field forms a rough circle with a natural blind spot. If your vision is normal, you
should be able to see objects clearly throughout the entire visual field except for the area with the natural
blind spot. When you are using both eyes to see, the blind spots do not interfere with your vision.
You may have vision loss in certain areas of the visual field if you are not able to see:
Test objects during tangent screen testing.
Movements or light flashes during perimetry testing.
Abnormal results during Amsler grid testing include:
Not being able to see the black dot at the center of the grid.
Not being able to see all four edges of the grid.
Having blank spots or dark spots on the grid (other than the black dot at the center).
Seeing lines that look wavy or curved.
Gaps in different parts of the visual field may have many causes, including eye diseases (such as glaucoma
and macular degeneration) or nervous system problems (such as stroke). If results on any of the visual field
tests are abnormal, you will need further tests to determine the cause.
Results continued...
Confrontation tests and Amsler grid tests take just a few minutes. More thorough visual field testing that uses
perimetry and tangent screens can take more than 45 minutes when both eyes are tested.
Color vision test
People who have normal color vision are able to distinguish the colored numbers, symbols, or paths from the
background of colored dots.
If you are not able to distinguish some or all of the colored patterns from the background, you may have a
color vision problem. You may be able to pick out some patterns of colors but not others, or you may be able
to pick out patterns that are different from a person with normal vision, depending on what type of color vision
problem you have.
This test takes only a few minutes.
Many conditions can change your vision test results. Your health professional will discuss any significant
abnormal results with you in relation to your symptoms and past health.
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WebMD Medical Reference from Healthwise
What Affects the Test
Reasons you may not be able to have the test or why the results may not be helpful include:
Your ability to understand or follow instructions. Some vision tests cannot be done on babies, small
children, or people who cannot understand or follow the instructions.
Your ability to stay alert and respond to questions.
Failure to wear prescribed eyeglasses or contact lenses.
Poor lighting.
What To Think About
Eye charts that use pictures or symbols (such as an E chart) may be needed to test children or people who
cannot read. Vision tests are also available for babies and young children.
A complete eye and vision evaluation also includes a physical examination of the structures inside the eye.
For more information, see the topic Ophthalmoscopy.
A test to screen for increased intraocular pressure (IOP), which increases your risk for glaucoma, is often
part of a routine eye exam. It also is used to monitor treatment for glaucoma. Tonometry can be used to
determine whether a medicine is keeping your IOP below a set target pressure determined by your doctor.
For more information, see the topic Tonometry.
Home tests for near vision in adults and distance vision in children are available. These tests should not
replace a thorough eye examination by a health professional.
Other Works Consulted
Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott
Williams and Wilkins.
By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Christopher J. Rudnisky, MD, MPH, FRCSC - Ophthalmology
Last Revised June 9, 2011
Last Updated: June 09, 2011
This information is not intended to replace the advice of a doctor. Healthwise disclaims any
liability for the decisions you make based on this information.
1995-2012 Healthwise, Incorporated. Healthwise, Healthwise f or every health decision, and the
Healthwise logo are trademarks of Healthwise, Incorporated.
My Notes:
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