Vision & Visual Acuity

This is Free sample Note.

Buy “Clinical Refraction” Course to
get notes of all the Topics.
Prepared by:
Samir Sutradhar
Founder “Smart Optometry”

Full course available on our App: Optometry Notes & MCQs

1 Subscribe us on Youtube
Smart Optometry
 Subscribe us on Youtube: Smart Optometry

Introduction

Fig-2: Letters with different Contrast

● Vision is the ability of eyes to see an object with
its:
○ Form/Shape (Fig-1). Fig-1: Form/shape
○ Contrast(Fig-2).
○ Colour(Fig-3).
● The measurement of form sense of vision is called Fig-3: Letters with Color
visual acuity.
● That's why in our visual chart, we don't have any
colorful letters or letters with various
contrast(Fig-4).
● If two points A & B are so close to each other that
they stimulate two adjacent cone in the retina
then we will appreciate them as a single object.
● At least one un-stimulated cone must be there in
between two stimulated cone to see two adjacent Fig-4: VA chart only measure Form sense
points separately that is possible when two
adjacent points A & B subtend an angle of not less
2
than 1 min arc at the nodal Point.
 Subscribe us on Youtube: Smart Optometry

Principle of VA Chart
● Two distance points are visible separately only when they subtend an angle
of at least 1 min arc at the noodle point of the eye.
● Each letter of VA chart is so designed that it fits in a square, the sides are five
times wider than the constituent line (1min), thus each letter subtend an
angle of 5min at the nodal point of the eye.

This is Free sample Note.

Buy “Clinical Refraction” Course
on our app Optometry Notes &
MCQs to get notes of all the Topics

Fig-5: Principle of VA
chart.

By keeping angle at nodal point (5 min arc) constant,

chart distance and optotype size can vary.
3
 Subscribe us on Youtube: Smart Optometry
Download our App: Optometry Notes & MCQS
Components of VA

Visual acuity has following components: 3. Recognition.

1. Minimum Visible.
2. Minimum Resoluble.
3. Recognition.
4. Minimum Discrimination.
1. Minimum Visible:
●Ability to determine whether or not an
object is present in the visual field.
●It depends upon object’s specification:
Size, shape, illumination etc.
2. Minimum Resoluble:
●Discrimination of two spatially separated
tar gets is termed resolution.
●The minimum separation between the
two points, which can be discriminated, is
known as minimum resolvable.
4
●Ability of not only discriminates the spatial
characteristics of the test pattern but also
identifies the patterns with which one has had
some experience.
●Recognition is thus a task involving cognitive
components in addition to spatial resolution.
4. Minimum Discriminable:
●Minimum discriminable refers to spatial
distinction by an observer when the threshold
is much lower than the ordinary acuity.
●The best example of minimum discriminable is
vernier acuity, which refers to the ability to
determine whether or not two parallel and
straight lines are aligned in the frontal plane.
 Subscribe us on Youtube: Smart Optometry
Does 6/6 vision
Development of VA present since
birth?
● In newborn visual acuity range between 6/360 to 6/120 that means the
objects that a normal person can see from 360 or 120 meters, the same
objects can be seen by the newborn from 6 meters only.
● So, you can guess how less visual acuity a newborn has after birth and
at the age of 5 years we reach 6/6 or normal Vision

Age Visual Acuity

Newborn 6/360 – 6/120
2 months 6/120 – 6/60
5 months 6/90 – 6/24
9 months 6/48 – 6/12
18 months 6/18 – 6/7.5
2-3 years 6/12- 6/6
5 years 6/6 – 6/5
5
 Subscribe us on Youtube: Smart Optometry
What does it mean
Meaning VA Score by 6/6 or 6/12 ?

● We express the vision with two number one on top another.

● The top number is called Numerator and bottom number is
called Denominator.
● Top Number/Numerator: Distance from which patient can read
a particular line in the chart.
● Bottom Number/Denominator: Distance from which a normal
person can read the same line in the chart.
● 6/6 means(Fig-6): a normal person can see a particular line in
Fig-6: Meaning of 6/6..
the chart from 6 meters and Patient can also see the same line
in the chart from 6 meters. So patient’s Visual acuity is normal.
● 6/12 means(Fig-7): a normal person can see a particular line in
the chart from 12 meters and Patient can see the same line in
the chart from 6 meters only (Need to go closer to see the
object). So patient’s Visual acuity is not normal.

This is Free sample Note. Fig-7: Meaning of 6/12..

Buy “Clinical Refraction” Course on our app Optometry

6
Notes & MCQs to get notes of all the Topics
 Subscribe us on Youtube: Smart Optometry
How will we know, if
Few Tips for VA someone Visual
Acuity is not normal?
1. Half shutting of the eyelids:
●Due to half shut of eyes the peripheral rays are
eliminated which reduce the spherical aberration
of the eye and increase the visual acuity.
●Due to anatomical structure of the eyelids, half 4. Deviation of eyes:
shut of the eyelids produce stenopaic slit effect ●When the difference of refractive
which increase visual acuity in astigmatism. error/reduce VA is high (more than 2
dioptres) between the eyes then our
2. Tilting head to see any object: eyes deviate.
●This sign is more common in astigmatism.
●Patient try to bring their axes nearer to the 5. Child becomes More prone to indoor activities:
horizontal or vertical meridians. ●With reduce visual acuity child’s performance
becomes poor in sports and other outdoor
3. Watching TV from near: activities.
●This is more common in myopic patient. ●Gradually they becomes more prone to indoor
●In myopia, the anterior focal point comes activities.
closer to eyes due to which myopic patient
can see clearer at near as compare to
7 distance.
 Subscribe us on Youtube: Smart Optometry

Indication of VA Why do we need

to measure VA?
1. To identify Vision is normal or not:
● Many patients have reduced visual acuity in one eye but won’t realise
as in the other eye they are having 6/6 vision.
● A simple vision acuity measurement can detect such condition.
2. To get idea about Progression of disease:
● Almost all ocular condition can affect the vision.
● When a patient comes to us first we measure the vision along with
other investigation.
● In follow up depending upon their VA improvement we can have an
idea about the progression of the disease.
3. To choose right Treatment Plan:
● VA is also important to choose right treatment plan.
● In vision therapy, first we measure VA and start therapy. In follow
up, depending upon the improvement of VA therapy may need to
change or even need to stop the therapy if vision is not improved.
4.Medico-Legal Purpose:
● Few profession need 6/6 vision in both eyes or 6/6 in dominant eye
with 6/12 or 6/9 in non-dominant eye.
8
 Subscribe us on Youtube: Smart Optometry
Download our App: Optometry Notes & MCQS
How to Measure VA

Prerequisites: How to Measure

● Distance: 6 meters or 3m with mirror. Visual Acuity?
● Illumination: not less than 20 ft candles (200 lux).
● Accommodation: No or Minimal stimulation.

PATIENT PREPARATION:
● Describe the procedure to patient.
● Request not to squeeze eye.
● Not to press eye harder.

MEASURING VISION:
● Ask to occlude left eye with palm of left hand or
Trial frame with occluder.
● Then ask to read from top of the chart with right
eye.
● If patient able to read all the line and letters, VA
is recorded as 6/6 unaided.
9
 Subscribe us on Youtube: Smart Optometry

How to Measure VA

What if patient is not able to read all the line?

● For each line a specific score is there.
● Like if the patient is able to read upto 4th line VA will be
6/12, if 5th line 6/9 and so forth.

What if patient is not able to read a complete line?

● If the patient has read 6/12 completely and also 3 more
letter from 6/9 line (fig-8) then this can be write as Fig-8:
6/9P(Partial), 6/12+3 or 6/9-2.
● But 6/9-2 is more accurate then other two, because, out of
5 letters patient has read 3 letters which is more than 50%
of that line.

Question for you

A patient has read 6/12 completely and also 2 more letter
from 6/9 line (Fig-9) then What is visual acuity score?
Send your Answer: smartoptometrywithsamir@gamil.com Fig-9:
10
 Subscribe us on Youtube: Smart Optometry
Download our App: Optometry Notes & MCQS
How to Measure VA

What if patient is not able to read any line or letter?

● Reducing Distance(CF):
● Ideally chart needs to take closer to the patient in 1m steps but in clinical
set up its not possible to take the chart close to the patient.
● In this case we can show our fingers (almost same width of 6/60 line) at 5
meters, 4m, 3m, 2m, 1m, CF CF (Counting Finger Close to Face)
● VA acuity will be recorded as for 5 meters 5/60, for 4m 4/60 and so forth

What if patient is not able to recognize Counting Finger Close to Face?

● Moving Hand(HM):
● If patient is not able to count finger at close face then we will move our
hand.
● If they able to recognise hand movement the VA will record as: HM+ve
● If they not able to recognise hand movement the VA will record as: HM-ve

What if patient is not able to recognize Hand Movements?

11
 Subscribe us on Youtube: Smart Optometry This is Free sample Note.
Buy “Clinical Refraction” Course on
our app Optometry Notes & MCQs to
get notes of all the Topics
What if patient is not able to recognize Hand Movements?
Perception of Light(PL):
● If not able to recognize Hand Movements then we will shine a
torch light(Room should Dim).
● Now ask the patient whether he/she is able to see the light.
● If able to recognize the light then VA will be recorded as: PL +ve
and also need to shine the light from up, down, right and left.
● If patient is able to recognize the light in any direction VA is
recorded as:

● If not able to recognize the light then VA will be recorded as:

No Perception of Light (NPL) or PL –ve.

Here, Ends our Visual Acuity Measurement.

12
 Subscribe us on Youtube: Smart Optometry

Join Us:

Youtube: Smart Optometry App: Optometry Notes & MCQS

13
 THANKS!

14