Visual Assessment Flashcards
Introduction
Hello, I’m An Nakamura, a 3rd year medical student.
Can I confirm your name and DOB?
I’ve been asked to assess your vision. I’ll use these charts, a penlight, an opthalmoscope to look at the backs of your eyes and I’ll ask you to do some short tasks to examine your eyes. Will this be ok? Do you have any questions? Are you in any pain today?
Inspection
- around the bed
- patient
Glasses, contacts?
Eyedrops?
Eye trauma? Ptosis? Pupil sizes? Inflammation? Exudates?
Visual acuity => far vision
- explanation
- if adjustments need to be made
- documentation
Do you wear glasses or contacts? Please wear them for this part of the examination. I will assess your distance vision
I will stand 6m away from you with this chart.
I’d like you to cover one eye, read out loud the letters you can see from the top downwards.
Ok, let’s do the same but with the other eye covered.
Can you read any of the letters if I move the chart closer to you? => 3m, 1m
Can you see how many fingers I’m holding up => Counting fingers
Can you see my hand moving? => Hand movements
Can you see the light I’m shining at you? => Light perception/No perception of light
Line with leeway of up to +-2
Visual acuity => near vision
- explanation
- documentation
Do you wear glasses or contacts? Please wear them for this part of the examination. I will assess your near vision
I’d like you to cover 1 eye and starting from the top, read out loud the first paragraph you can see
Ok, let’s do the same but with the other eye covered
Visual colour
- explanation
- documentation
Do you wear glasses or contacts? Please wear them for this part of the examination. I will assess your colour vision
I’d like you to cover 1 eye and read out loud the number you can see on each page
Ok, let’s do the same but with the other eye covered
13/13
Visual fields
-explanation
So now I will sit opposite you. I’d like to assess your field of vision
I’d like you to cover one eye, I will mirror you. Keep your eyes focused on my nose.
Does any part of my face look distorted?
I will be wiggling my finger tips like this whilst slowly moving my hand from the sides into center. Let me know when you can see my fingers wiggling.
Keep the same eye covered, I’ll quickly switch hands
Ok, I’d now like you to cover your other eye. We’ll do the same.
Blind spot assessment
-explanation
I’d like you to cover your eye and focus your gaze on my nose. I will do the same. I’m going to assess your blind spot
I’ll slowly move the red neurotip to the side. Please tell me when you no longer see the tip and when it reappears.
Let’s do the same but with your other eye.
Pupil responses
-explanation
Accommodation
I’m now going to assess your pupil responses. I’d like you to look at my finger, then quickly look at (something in the distance) and back at my finger. And again?
Direct, consensual, swinging light
I’m now going to use a penlight. I’d like you to focus your gaze on my nose.
Eye movements
-explanation
Now I’m going to assess your eye movements. If you have double vision or pain at any point, please let me know. Whilst keeping your head still, I’d like you to follow my fingers with your eyes
Fundoscopy
-explanation
I’m now going to assess the backs of your eyes. For this, I will need to get quite close to your face but I will place 1 hand on your forehead so we don’t bump into each other. I will also need to use dilating eyedrops but once I use them, you will not be able to see clearly for a few hours and you will be more sensitive to light. Did you drive here with someone? They will need to drive you home.
I’d like you to look straight ahead during this part of the exam.
- red reflex
- Optic disc 3 Cs
- macula and fovea
- retina quadrants
- 4 optic vessels
Further examinations
Amsler chart => central vision loss in AMD
Cranial nerve exam => II, III nerve palsy
BP => optic disc swelling
Cap BG => diabetes concerns
