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
• 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
