AV

• Cela mai simplu test pentru determinarea

functiei vizuale.
• AV este capacitatea de a deslusi un element al
obiectului sau obiectul in intregime.
 Tabelul Snellen
• Este raport – numitor
distanta la care s-a efectuat
masurarea 6m - 6/6,sau 20
feet ( 1foot=30cm, 20feett
=6m.
• Numarator- distanta la care
marimea verticala a
obiectului este 5 min.angle.
• Astfel obiectul exprimat
prin6/6 contine la distanta
de 6m 5 angle minut pe
verticala.
 Tabelul Snellen
• Obiectul 6/12 are 10
angle/minut la dist.6m.
• Obiectul 6/60 are 50
angle /minut.
• Optyotipurile Slellen se
pot scrie prin sistemul
zecimal 6/6-1,0, 6/12
=0,5.
• URSS tabele Sivtcev.
 Neajunsurile tab. Snellen
• Nu este corespunderea
permannta dintre
dimensiunea literelor si
spatiul dintre ele si dintre
rinduri.
• Corespunzator literele de jos
sunt asezate mai aproape si
se percep cu greu.
• In rindurile de sus numarul
de litere e mai mic – ce scade
veridicitatea rezulatelor.
 Log MAR
• Este standard international
• Tabelul Beil-Lovi – carac
terizeaza AV in unitati MAR.
• MAR exprima capacitatea
vizuala de a recunoaste
elemente a aunor
simboluri.
• De ex. 6/6 corespunde
MAR=1 angle/min.
• MAR e primit de scris in
forma de Log MAR
 Log MAR
• Fiecare rind contine 5 litere .
• Distanta dintre optotipuri si
rindurieste proportionala
latimii si inaltimii optotipului.
• Rez-te se scriu in forma de
LogMAR –baluri.
• Deoarece diferenta marimii
literelor cu litere din rind
vecin este 0,1 Logmar, in rind
sunt 5 litere atunci la o litera
revine 0,02 LogMAR baluri.
 Log MAR
• Cantitatea de baluri se socoate – cite litere a
citit pacientul.
• Astfel se socot literele citite corect, spre
deosebire de tabel Snellen.
 Log MAR
• Standard international
• Micsorarea optotipurilor are loc cu 1,25 log unit. –
stricta marime.
• Fiecare rind are 5 optotipuri (spre deosebire de altele)
• Distanta dintre optotipuri si rinduri este strict supusa
functiei logaritmice si este egala.
• Orice optotip corespunde minimal angle resolution
egal si AV 0,02
• AV precisa in DZ, DMLV.
Log MAR
Log MAR
Recording visual acuity using the LogMAR chart

• Each letter has a score value of 0.02 log units.

• Since there are 5 letters per line, the total score for a line on
the LogMAR chart represents a change of 0.1 log units.[5]
• The formula used in calculating the score is:
LogMAR VA = 0.1 + LogMAR value of the best line read – 0.02 X
(number of optotypes read)
• Given that each line has 5 optotypes, the equivalent formula is:
• LogMAR VA = LogMAR value of the best line read + 0.02 X
(number of optotypes missed)
• Some digital eye charts like Visual Acuity Charts can calculate
the score.
 AV retiniana potentiala - posibila
• In cataracta p.l.certa, pl.incerta, zero
• Cu cyl Meddox.
• Cu instrument special.
 Advantages of LogMAR over other charts

• he LogMAR chart is designed to enable more accurate estimates

of acuity as compared to other acuity charts (e.g., the Snellen
chart).[3]
• Each line of the LogMAR chart comprises the same number of test
letters (effectively standardizing the test across letter size); the
Sloan font is used (Sloan letters are approximately equally legible
one from another); letter size from line to line varies
logarithmically, as does the spacing between lines (making the
chart easy to use at nonstandard viewing distances).
• Zero LogMAR indicates standard vision, positive values indicates
poor vision, and negative values indicates good visions. This is less
intuitive than other VA notations. However, LogMAR is actually a
notation of vision loss.
 Louise Sloan optotypes
• loan letters, designed by
Louise Sloan in 1959, are a set of
optotypes used to test
visual acuity generally used in
Snellen charts and logMAR charts.
• This set of optotypes consists of
ten specially formed "letters", C,
D, H, K, N, O, R, S, V and Z.[1]
• These letters, unlike the ones
used in older Snellen charts, are
designed to give acuity testing
results that are comparable to
tests made using Landolt
broken rings.
 La copii -Teste ce fixeaza reactia copilului:

• 1. PL-preferential
looking
Visual evoked potential -VEP
• AV 1,0 – 1,3 –media statistica

• AV6/6 - --6/4 unitati ai istemului metric

Snellen
• 20/20 ----20/15

1 foot =30cm
20feet =20X30=6m
• AV este cea mai inalta in centrul retinei –
conuri.
 AV depinde de
• Luminozitate in cabinet
• Contrast
• Claritatea optotipulrilor
• Culoarea optotipurilor
• Tipurile optotipurilor.
 AV departe
• Infinit optic (luna, orizont) – razele sunt
paralele – acomodare nu este
• Infinit optic- in practica internationala - la 6m
(acomodare 0,16 (1/6=0,16666D)
• Mai aproape are loc acomodare + reactia
binoculara.
• La 6m lipseste reactia binoculara la stimul.
• De ce 6m – Snellen a socotit 6m la elaborarea
optotipurilor.
AV inalta in fovea – mai departe scade
 AV
• Pacient priveste departe
• Cu ocludor acoperim
• Rugam sa citeasca cel mai mic ce e posibi – 0,7
sau mai mici
• Da ca a citit 7 si 2 optotipuri din 8_ AV 0,7 +2
• Daca a citit rind 9 dar s-a gresit la 1 ----0,9 -1
• AV OS AV binocular
• AV cu corectie
 AV
• Cifre e mai usor-
• Cifre complicate - 8,9,6,
• Usoare 4,7
• Inele La ndolt e mai greu dureaza mai mukt
 Regula Snain
• Tabel – dupa AV
 Test cu diafragma
• In patologia macvulei – va vede amai rau
• Este o diafragma de 1- 2 mm.
• Se efectuiaza daca AV ,0,6 – de inteles daca e
posibil de .AV cu corectie.
• Diafr. La centrul pupilei
• Se mareste adincimea focusuluisi se
micsoreaza neclaritatea imaginii.
 Test cu diafragma
• Daca nu este patotlogie organica sau
ambliopie AV se va marti.
• AV cu diafragma este AV la care tindem cu
corectia optica (combinarea de sph cu cyl.)
 Test cu diafragma

– The abbreviation PH is followed by the visual acuity as measured with a

pinhole occluder, which temporarily corrects for refractive errors such as
myopia or astigmatism.
• So, distant visual acuity of 6/10 and 6/8 with pinhole in the right
eye will be: DscOD 6/10 PH 6/8.
• Distant visual acuity of count fingers and 6/17 with pinhole in the
left eye will be: DscOS CF PH 16/17. Near visual acuity of 6/8 with
pinhole remaining at 6/8 in both eyes with spectacles will be:
NccOU 6/8 PH 6/8.
• "Dynamic visual acuity" defines the ability of the eye to visually
discern fine detail in a moving object.
• sc: (Latin sine correctore ,Latin cum correctore)
 History
• Vision test types are invented in 1843 by the German
ophthalmologist Heinrich Kuechler (1811–1873), in
Darmstadt, Germany. He argues for need to standardize
vision tests and produces three reading charts to avoid
memorization. 1843.
• Herman Snellen,a Dutch ophthalmologist, publishes in
Utrecht his "Optotypi ad visum determinandum"
("Probebuchstaben zur Bestimmung der Sehschärfe"), the
first visual chart based on "Optotypes", advocating the need
for standardized vision tests. Snellen's Optotypes are not
identical to the test letters used today. They were printed in
an 'Egyptian Paragon' font (i.e. using serifs).[12][13]., 1862
 History
• 1888-Edmund Landolt introduces the broken
ring, now known as the Landolt ring, which
later becomes an international standard.
• Hugh Taylor uses these design principles for a
"Tumbling E Chart" for illiterates, later used[17]
to study the visual acuity of
Australian Aborigines.[13] 1978
 History
• Rick Ferris et al. of the National Eye Institute chooses
the LogMAR chart layout, implemented with Sloan
letters, to establish a standardized method of visual
acuity measurement for the
Early Treatment of Diabetic Retinopathy Study (ETDRS).
These charts are used in all subsequent clinical studies,
and did much to familiarize the profession with the new
layout and progression. Data from the ETDRS were used
to select letter combinations that give each line the
same average difficulty, without using all letters on each
line. -1982
 Minimum angle of
20 ft 10 ft 6m 3m Decimal LogMAR
resolution

20/1000 10/500 6/300 3/150 0.02 50 1.70

20/800 10/400 6/240 3/120 0.025 40 1.60

20/600 10/300 6/180 3/90 0.033 30 1.50

20/500 10/250 6/150 3/75 0.04 25 1.40

20/400 10/200 6/120 3/60 0.05 20 1.30

20/300 10/150 6/90 3/45 0.067 15 1.20

20/250 10/125 6/75 3/37 0.08 12.5 1.10

20/200 10/100 6/60 3/30 0.10 10 1.00

20/160 10/80 6/48 3/24 0.125 8 0.90

20/125 10/62 6/38 3/19 0.16 6.25 0.80

20/100 10/50 6/30 3/15 0.20 5 0.70

20/80 10/40 6/24 3/12 0.25 4 0.60

20/60 10/30 6/18 3/9 0.33 3 0.50

20/50 10/25 6/15 3/7.5 0.40 2.5 0.40

20/40 10/20 6/12 3/6 0.50 2 0.30

20/30 10/15 6/9 3/4.5 0.63 1.5 0.20

20/25 10/12 6/7.5 3/4 0.80 1.25 0.10

20/20 10/10 6/6 3/3 1.00 1 0.00

20/16 10/8 6/4.8 3/2.4 1.25 0.8 −0.10

20/12.5 10/6 6/3.8 3/2 1.60 0.625 −0.20

20/10 10/5 6/3 3/1.5 2.00 0.5 −0.30

20/8 10/4 6/2.4 3/1.2 2.50 0.4 −0.40

20/6.6 10/3.3 6/2 3/1 3.00 0.333 −0.50

 Counting Fingers-CF
• Ability to count fingers at a given distance.
• This test method is only used after it has been determined
that the patient is not able to make out any of the letters,
rings, or images on the acuity chart.
• The letters CF, and the testing distance, would represent the
patient's acuity.
• For example, the recording CF 5' would mean the patient
was able to count the examiner's fingers from a maximum
distance of 5 feet directly in front of the examiner.
• (The results of this test, on the same patient, may vary from
examiner to examiner.
 Hand Motion -HM
• Ability to distinguish whether or not there is
movement of the examiner's hand directly in front
of the patient's eyes. This test method is only used
after a patient shows little or no success with the
Counting Fingers test. The letters HM, and the
testing distance, would represent the patient's
acuity.For example, the recording HM 2' would
mean that the patient was able to distinguish
movement of the examiner's hand from a maximum
distance of 2 feet directly in front of the examiner.
 Light Perception - PL
• Ability to perceive any light. This test method is used only
after a patient shows little or no success with the Hand
Motion test. In this test, an examiner shines a pen light at the
patient's pupil and asks the patient to either, point to the
light source, or, describe the direction that the light is coming
from (up, out, straight ahead, down and out, etc.). If the
patient is able to perceive light, the letters LP are recorded to
represent the patient's acuity. If the patient is unable to
perceive any light, the letters NLP (No Light Perception) are
recorded. A patient with no light perception in one eye is
considered blind in the respective eye. If NLP is recorded in
both eyes, the patient is described as having total blindness.
 Legal definitions

• Simbolul20/200 e de 10 ori mai mare ca 20/20

• In multe tari –criteriu de baza juridic al ajutorului social.
• Various countries have defined statutory limits for poor
visual acuity that qualifies as a disability. For example, in
Australia, the Social Security Act defines blindness as:
• A person meets the criteria for permanent blindness
under section 95 of the Social Security Act if the
corrected visual acuity is less than 6/60 on the Snellen
Scale in both eyes or there is a combination of visual
defects resulting in the same degree of permanent visual
loss.[29]
 Legal definitions

• In the US, the relevant federal statute defines

blindness as follows:[30]
• [T]he term "blindness" means central visual acuity of
20/200 or less in the better eye with the use of a
correcting lens.
• An eye that is accompanied by a limitation in the fields
of vision such that the widest diameter of the visual
field subtends an angle no greater than 20 degrees
shall be considered for purposes in this paragraph as
having a central visual acuity of 20/200 or less.
 Legal definitions
• A person's visual acuity is registered documenting the following:
whether the test was for distant or near vision, the eye(s) evaluated and
whether corrective lenses (i.e. glasses or contact lenses) were used:
• Distance from the chart
– D (distant) for the evaluation done at 20 feet (6 m).
– N (near) for the evaluation done at 15.7 inches (400 mm).
• Eye evaluated
– OD (Latin oculus dexter) for the right eye.
– OS (Latin oculus sinister) for the left eye.
– OU (Latin oculi uterque) for both eyes.
• Usage of spectacles during the test
– cc (Latin cum correctore) with correctors.
– sc: (Latin sine correctore) without correctors.
Low vision and blindness definition with LogMAR

Foot Metre Decimal LogMAR

• The
20/200 6/60 0.10 1.00
World Health Organization 20/160 6/48 0.125 0.90
established criteria for low 20/125 6/38 0.16 0.80

vision using the LogMAR 20/100 6/30 0.20 0.70

scale. 20/80 6/24 0.25 0.60

• Low vision is defined as a 20/63 6/19 0.32 0.50

best-corrected visual acuity 20/50 6/15 0.40 0.40

worse than 0.5 LogMAR but 20/40 6/12 0.50 0.30

equal or better than 1.3 20/32 6/9.5 0.63 0.20

LogMAR in the better eye.[6] 20/25 6/7.5 0.80 0.10

20/20 6/6 1.00 0.00

• Blindness is defined as a best-
20/16 6/4.8 1.25 −0.10
corrected visual acuity worse 20/12.5 6/3.8 1.60 −0.20
than 1.3 LogMAR.[6] 20/10 6/3 2.00 −0.30
 Sensibilitatea la contrast
• Principiu: sensibilitatea la contrast
caracterizeaza nivelul minim de contrast
necesar pentru recunoasterea obiectului
testat.
• Permite de a sesiza modificari foarte recente a
functiilor visuale, chiar in AV normala.
• In practica zilinica rar se utiizeaza.
Sensibilitatea la contrast – Tabel Pelli-
Robson
 Sensibilitatea la contrast – Tabel Pelli-
Robson
• Contine optotipuri de
aceias dimensiune cu
scaderea contrastului
(care scade la fiecare 3
litere cu pasul 0,15
unitati logaritmice.
• Se arata la 1m si se
determina sensibilitatea
la contrast
dup[ numarul de cifre
citite.
 Brightness – luminozitatea - iarcosti
• Este primordial pentru functia nervului optic.
• In afectiuni ale maculei arata rezultate bune,
exceptie afectiunile avansate.
• Se lumineaza cu sursa de lumina OD si apoi
OS.
• Pacientul mentioneaza diferenta dintre OU
dupa scorul 1-5.
• In neuropatie – scaderea lumiunozitatii.
 Brightness Acuity Test (BAT) --Michigan College Of Optometry

• Multe ori in cataracte scade perceperea culorii –

contrastul.
• Se studiaza in trei tipuri de conditii:
• La soare
• O zi partial cu nori
• Lumina aprinsa artificială .

• Many people with cataracts or other ocular media

opacities are disabled in bright light conditions,
due to the intraocular scatter.
• The BAT test is used to test glare disability in three
common bright light conditions. These three
conditions consist of:
• direct overhead sunlight
• partly cloudy day
• bright overhead commercial lighting
• The patient s vision can be measured using low,
medium or high light settings on the BAT
instrument.
 Brightness Acuity Test (BAT) --Michigan College Of Optometry

• The patient s vision can be measured using

• Cu intensitatea joasa
• Medie
• Inaltă
• Conditia este similara luminii artificiale la loc de
lucru: șofat,
• low, medium or high light settings on the BAT
instlucru la constructie,
• Computer.
• Se foloseste lumina de intensitatea inalta sau cerul
intens.
• daca nu corespunde normelor - - -disabilitate la
lumina
• The low lighting condition is similar to lighting in the
workplace (driving, construction work, computer
use, etc).
• The strong high light sources replicate oncoming
headlights or a bright sky surrounding a visual
target. If the patient s vision gets worse using the
BAT, the patient is considered to have a glare
disability. Usually this is caused by a cataract.
Adaptarea la intuneric – adaptometria
• PRINCIPIU: Adaptarea la intuneric se numeste
acomodarea sistemului visual ( inclusiv a
pupilei, retinei si cortexului visual) la
micsorarea luminozitatii de fond.
• Este important la pacientii cu hemeralopie
Adaptarea la intuneric – adaptometria
• Primar retina se supune iluminarii intense,
necesar pentru a ilumina nu mai putin de 25 %
din rodopsina.
• Bastonasele devin nesensibile la lumina, dar
conurirle raspund doar la stimuli puternici.
• Pacientul se afla in incapere intunecata.si
periodic se determina pragul de sensibilitate,
adica valoarea minima a stimulului care este
perceput de pacient.
 Metoda adaptometrie Goldman -Wix
• Pacxientul I n intuneric.
• La anumite perioade se
determina
sensibilitatea.
• In norma sensibilitatae
treptata cereste.
 Curba adaptometriei.
• Are 2 faze.
• Partea conuri – primele
5-10minute de adaptare
la intuneric – are loc
sensibilitatea conurilor
treptat creste.
Sensibilitatea
bastonaselor la fel
creste dar mai incet.
 Curba adaptometriei
• Faza conuri- bastonase
are loc peste 7-10
minute de adaptare
cind conurile ajung la
sensibilitate maxima.
Mai departe cresterea
sensibilitatii are loc doar
din contul bastonaselor.
 Curba adaptometriei
• Faza bastonaselor – nu este
atit de abtupta – are loc
cresterea lenta a sensibilitatii
bastonaselor.
• Dupa 15-30min. Sensibilitatea
revenita total a bastonaselor
permit de a percepe stimuli
de 100 ori mai intense.
• Daca de proiectat stimuli doar
la macula, fovea unde sun
doar conuri se va inregistra
doar faza de conuri a curbei.
• Visual Response to
Darkness. Cones work
at high light levels
(during the day but also
during driving at night
in the headlamp
spotlight; rods take
over at twilight and
night. The y-axis has
logarithmic scaling.
 Light adaptation

• With light adaptation, the

eye has to quickly adapt to
the background
illumination to be able to
distinguish objects in this
background. The process
for light adaptation occurs
over a period of five
minutes.
• The photochemical reaction
is:
• Rhodopsin ⇌ retinal + opsin
 Light adaptation
• Many animals such as cats possess high-
resolution night vision, allowing them to
discriminate objects with high
frequencies in low illumination settings.
The tapetum lucidum is a reflective
structure that is responsible for this
superior night vision as it mirrors light
back through the retina exposing the
photoreceptor cells to an increased
amount of light.[9] Most animals which
possess a tapetum lucidum are
nocturnal most likely because upon
reflection of light back through the
retina the initial images become
blurred.[9] Humans, like their primate
relatives, do not possess a tapetum
lucidum and therefore were
predisposed to be a diurnal species.[10]
• Extreme red light used
on a ship's bridge at
night to aid dark
adaptation of the crew's
eyes
Effect of night blindness. Left: good night
vision. Right: nightblind.
 Light adaptation
• Ophthalmologists sometimes measure patients' dark adaptation
using an instrument known as a dark adaptometer. Currently,
there is one commercially available dark adaptometer, called the
AdaptDx.
• It works by measuring a patient's Rod Intercept (RI) time. RI is the
number of minutes it takes for the eye to adapt from bright light to
darkness.
• This RI number provides a clear and objective measurement of
retinal function with 90% sensitivity and specificity.[23]
• An RI of less than 6.5 minutes indicates a healthy dark adaptation
function.
• However, an RI higher than 6.5 indicates impaired dark adaptation.