Clinical Pearls

• Learn to use the Acuity Pro remote control. We only use a few buttons on it, so don't be intimidated as there are many 

• Make sure patients are not holding the occluder so they are looking out of both eyes!

• 20/40 vision means that at 20 feet, you can see what a "normal" person with perfect vision sees 40 feet away

• Results can be logged as + or - (20/30 -2 means that they missed 2 letters on the 20/30 line)

Abbreviations

• Dva: Distance vision

• Nva: Near vision

• sc: Without correction (sin correctore)

• cc: With correction (con correctore)

• ph: Pinhole test

• NI: Means no improvement. We use this when there is no improvement to pinholing

• BCVA: Best corrected vision

If a patient cannot see the 20/400 line (the Big E), we gauge their vision in a stepwise fashion listed below

• CF 1/3/5: Counting Fingers ( at 1, 3, or 5 feet away). Hold up 2 fingers and see if the patent can see how many are up

• HM: Hand Motion. Wave your hand in font of the eye 3-5 feet away and ask the patient what you are doing. Ask the direction your hand is moving (up & down, left & right, or a circle)

• LP: Means Light Perception. Flash a light in the eye and see if they see the light

• NLP: No Light Perception. This means the eye is essentially dead 

Clinical Pearls

• Do the pinhole test if vision is 20/40 or worse! 

• The pinhole test basically tell you whether or not a patient's vision can be corrected with glasses/CTLs/LASIK (refractive error), or if there is something more serious going on

• A patients vision that improves significantly as a result of using the pinholes is a very good sign

• If a patient has lower vision in an eye that does not improve with use of the pinholes, or very minimal improvement, likely they are experiencing retinal issues (detachment, AMD, diabetic retinopathy, etc..) or something physically blocking the light from reaching the retina (moderate to severe cataract, or a vitreous hemorrhage). 

• Keep in mind, if a patient does not pinhole past a certain point, it is highly unlikely that glasses or CTLs will get their vision better than this!

• For NV, we record their vision using these "J" numbers (jaeger) and one eye at a time

• We do not pinhole when checking NV

• J1+: Best NV (bottom of card) 

• J10: Worst NV (the top of the card)

1. Have the patient hold the card 16 inches away from their face (about a half- stretched arm)

2. Ask the patient to read the smallest line they can without difficulty and then record the J number in NextGen

3. You will memorize these lines after a while, which makes it easier for you!

• Checking eye dominance is important, especially if they are a new patient looking to get surgery done

• Eye dominance is used to determine which types of lenses and prescriptions will be used for cataract surgery, as well as LASIK/PRK/EVO ICL surgery

Ways to Test this

1) Camera Test (preferred)

• All rooms should have a disposable camera in the top drawer 

• Hand it to the patient and tell them to take a picture of you (they will look at you confused, but assure them it has a purpose)

• The eye they bring it to is their dominant eye!

2) Hand Test

• Tell the patient to create a small triangle or circle with both their outstretched hands and look at you though it

• Tell them to  slowly move it towards their face but also while keeping yours visible

• The eye they are looking at you with is their dominant eye!