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VISUAL

ACUITY
Edalyn R. Capili
Metropolitan Medical Center
College of Medicine

DEFINITION OF TERMS
VISUAL ACUITY
ability to resolve fine details and contours of objects
FOCAL POINT
where light rays cross
NEAR POINT / LEAST DISTANCE OF DISTINCT VISION
point nearest to the eye at which an object is visible distinctly
minimum distance from the eye an object can be clearly focused with
maximum accommodation
PUPIL
a rounded opening through which light passes
SUSPENSORY LIGAMENT
attached to the ciliary body and are fibers that hold the lens in its upright
position in the eye
ACCOMMODATION
ability of the eye to focus differentially for objects of near vision (< 6 m, or
20 feet)

Methodology (Far Vision)

The subject
was asked to
stand 20 ft.
away from
the Snellens
Chart.

One eye was


covered with
a card.

The subject
was asked to
read the
letters
progressively
up to the
small letters.

Repeat the
procedure to
the other eye
and record
results.

Methodology (Near Vision)

Jaegers
Chart was
positioned
14 in. away
from the
subject.

One eye was


covered with
cardboard.

Subject was
asked to read
the
paragraphs
progressively
to smaller
size.

Repeat the
procedure to
the other eye
and record
results.

Methodology
(Near Point of Distinct Vision)
Test card is held in front of the subject at a
normal reading distance and he is told to select
the smallest type which he can read.

The examiner gradually brings the card


closer to the eye until the subject is unable to
read them.

Distance from the eye to the to the card is


measured in cm. This is the subject's nearest
point of distinct vision.

Results
Near Vision
OS (Left Eye)

OD (Right Eye)

0.37 m

0.37 m

Far Vision
OS (Left Eye)

OD (Right Eye)

20/15

20/10

Near Point of Distinct Vision


25 cm

Discussion
Visual Acuity Test

The diameter of the cones in the fovea is 1.5 m

When the ciliary muscles are relaxed, the suspensory


ligaments of the ciliary body maintain elastic pressure on
the lens, thereby keeping it relatively flat and allowing for
distant vision.
Emmetropia - the condition in which the lens is flattened
so that nearly parallel rays from a distant object are
focused on the retina; normal resting condition of lens.
Far point of vision - point at which the lens does not
have to thicken for focusing to occur; normally is 20
feet or more from the eye.
When an object is brought closer than 20 feet to the eye,
3 events occur to bring the image into focus on the
retina: accommodation (lens), constriction (pupil), and
convergence of eyes.

MECHANISMOFACCOMMODATION
Contraction pulls
ligament forward
relaxing tension on
suspensory ligament
making the lens fatter

University of Jordan

ACCOMMODATION
Refractive power of the lens is 20 diopters.
Refractive power can be increased to 34 diopters by changing shape of the
lens - making it fatter (more convex).
Accommodation is necessary to focus the image on the retina.
Normal image on the retina is upside down.
When shifting the gaze from far object to near object, the process of
accomodation involves:
Making the lens more convex
Narrowing the pupillary diameter
Adducting (vergence) both eyes
When the lens is in a relaxed state with no tension exerted on the edges of
its capsule, it assumes nearly spherical shape owing to its own intrinsic
elastic properties.
When the inelastic zonule fibers attached to the lens perimeter become taut
and pulled radially by their attachment to the inactive ciliary muscle.

Near Vision: JAEGERS CHART


ranges from J1 to J11 or larger, with J1 being the smallest type
J2 is the equivalent of 20/20 distance visual acuity at the reading
distance indicated on the card (usually 12-14 inches from eyes).
If held around 14 inches (356 mm) away, then a 14/14 result means
subject can read at 14 inches what one with normal vision would be
able to see at 14 inches
Normal = 14/14
Used routinely starting the age of 40 when near vision starts to
decline
Those with myopic vision will have higher acuity at near than far
For detection of presbyopia: lens become less elastic and does
not change its shape thus refractive power and accommodation is
decreased.

Distant object
move towards the
eyes

Increase firing of
parasympathetic
nervous system

Suspensory
ligament relaxes

Contraction of
meridional and
circular ciliary
muscles

Lens become
thicker and
increases its
refractive power

Eye focuses on
near objects
nearer than when
eye has less
refractive power

Far Vision: SNELLENS CHART


20/20

NORMAL
A person can see detail from 20 ft away

20/200

The letters that the person can read at 20


feet distance from the chart is the same
as a person standing 200 feet away from
the chart

<20/20

Superior visual acuity

LEGAL BLINDNESS
reduced central visual acuity of 20/200 or less in your better
eye with use of the best eyeglass lens to correct your eyesight; or
limitation of your field of view such that the widest diameter of the
visual field in your better eye subtends an angle no greater than 20
degrees.

FOCUSING POWER OF THE EYE


Most of the refractive power of the eye results from
the surface of the cornea.
Diopter is a measure of the power of a lens
1 diopter is the ability to focus parallel light rays at
a distance of 1 meter, it is a measure of power of
lenses
Diopter = 1/ focal length in meters i.e the power of a
lens with focal length 0.5 meter is 2 (more convex)
Retina is considered to be 17 mm behind the
refractive center of the eye
Eye has a total refractive power of 59 diopters
(1000/17)

GREATER DEPTH OF FOCUS


Pupil is extremely
small

Small aperture

All rays pass through


the center of the lens

Central most rays

Always in focus

Retina can be
displaced
considerably
and image
remains sharp!

REFRACTIVE ERRORS

Causes

Correction

MYOPIA

HYPEROPIA

PRESBYOPIA

ASTIGMATISM

Nearsightedness

Farsightedness

Old
sightedness

Eyeball too long

Eyeball too
short

Inelasticity of
lens

Uneven
curvature of
cornea

Lens too strong

Lens too weak

Denaturation of
proteins in lens

Oblong shape
cornea or lens

Biconcave lens

Biconvex lens

Bifocal or
progressive
lens

Cylindrical lens

PRESBYOPIA
Loss of accommodation caused by progressive
denaturation of the proteins of the lens.
Makes the lens less elastic, less responsive and less able to
focus on near objects
Begins about 40-50 years of age.
Corrected with reading glasses designed to magnify near
objects or with bifocals in which one lens (upper portion)
is designed to enhance distance vision and the second lens
(lower portion) has greater refractive capability to improve
near vision

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