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Krug Vision Disability Screening Card

Item #: KVDSC1

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Vision Disability Screening Card. The Vision Disability Screening Card has been developed for Agency professionals and primary eye and medical physicians to easily screen for functional loss of near vision affecting activities of daily living (ability to read 1 M newsprint). It also incorporates a line of 20/100 distance vision letters to screen for legal blindness using the updated 2007 criteria (71 FR 67037).

By quickly determining if a person is visually impaired, referral to Vision Rehabilitation professionals can be made in a timely manner. And it provides non-vision professionals with more confidence in making referrals to eye care providers.

The Vision Disability Screening Card is manufactured from plastic stock with a 40cm cord attached for testing at a uniform distance. It is printed on both sides of the card with different text on each side to facilitate screening the two eyes.

Directions for Use of Screening Card

• Patient is seated in the exam chair.
• Use direct illumination with the exam chair light at approximately 20″.
• Use the patients' habitual reading prescription.
• Test the patient at the 40 cm test distance (string length).Section 1 (1M High Contrast Text):

Section 1 (1M High Contrast Text):

• Test is Monocular - use occluder.
• If patient cannot read accurately in 6-10 seconds or less-Fail. Six seconds is a reading speed of 100 words per minute. Average for normally sighted adults is >200 words per minute. The goal is fluent reading at a reasonable speed.
• Results are Pass or FailSection 2 (1M Low Contrast text):

Section 2 (1M Low Contrast text):

• Test is Monocular - use occluder.
• If patient cannot read accurately-Fail.
• Results are Pass or Fail

Section 3 (Amsler Grid):

• Test is Monocular - use occluder.
• Can patient read the letter at fixation? Use back of card for second eye.
• Results are Pass or Fail
• Does patient report distortion, or scotoma?
• Results are Pass or Fail

Section 4 (Legal Blindness Screening):

Test is Monocular - use occluder.
• Card is placed at 10 feet.
• Patient should be wearing their best distance correction.
• If patient cannot read any letters on the 20/100 test line, they are worse than 20/100 distance acuity. If worse than 20/100 in each eye, they may be "Legally Blind".
• Note, this acuity test only screens for central acuity loss. Legal blindness can also be caused by a loss of visual field to 20 degrees or less in each eye. Only an Optometrist or Ophthalmologist can certify a patient as Legally Blind.

*Failure of any section of this screening test indicates the possibility of a significant visual impairment. Referral to an eye care provider familiar with low vision rehabilitation is recommended*
Chart Distance: Multi-Distance Utilize with a Cabinet: No Utilize with which Cabinet: None Contrast Level: High Patient Type: General/Literate ETDRS Format: No MassVAT Chart: No Cord: Yes Translucent Chart: No Chart Size (Inches): 16.125×11.5 in Chart Size (cm): 41×29.2 cm

Call Toll Free 1-800-348-2225 or (574) 259-2070

Fax to (574) 259-2102 or (574) 259-2103