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A 65-year-old woman comes to the office because of "blurry vision." She states that her vision has been getting worse for years and that it is now difficult for her to read the newspaper. Further questioning reveals that she has stopped driving at night because of difficulty with her vision. Her past medical history is remarkable for well-controlled hypertension, peptic ulcer disease, obesity, and anxiety. When examining the patient's visual acuity in the office, it is clinically most helpful to
A. check each eye separately with appropriate spectacle correction
B. exam the patient's color vision and stereo visual acuity
C. record the visual acuity in both eyes simultaneously to best evaluate the functional vision of the patient
D. record the visual acuity without spectacle correction to most accurately assess the patient's functional vision
E. use a near card instead of Snellen (distance) visual acuity
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A. check each eye separately with appropriate spectacle correction
not sure
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thats very nice vrox2000!
The correct answer is A. It is important to evaluate the visual acuity of each eye separately with the appropriate refractive correction. Refractive errors are generally not considered a medical reason for decreased vision. Eliminating or reducing this factor will best allow the clinician to assess the patient's vision. Remember that the testing of visual acuity is a subjective test and that many factors need to be considered such as lighting, patient effort, and patient concentration.
Color vision and stereovision are more specific methods of evaluating visual acuity. These tests are used in more special circumstances in ophthalmology clinics. They would not be more helpful than Snellen visual acuity in this instance (choice B).
Record the visual acuity in both eyes simultaneously to best evaluate the functional vision of the patient (choice C) is incorrect because recording the visual acuity of both eyes is rarely helpful. Patients may have 20/20 vision with one eye and no light perception in the other eye and still have 20/20 vision if both eyes are tested together. Often patients do not notice marked decreased vision if only one eye is affected.
Again, visual acuity without correction can be misleading (choice D).
Near cards are helpful in the hospital setting, but they are not as accurate as a standardized Snellen vision measured at 20 feet (choice E). Also, remember that accurate near visual acuity needs appropriate near correction (bifocal). Thus, checking a near visual acuity in a presbyopic patient without their glasses can be misleading (for example a hospitalized patient who has forgotten to bring their glasses with them to the hospital).
