Verhoeff-A New Test for Visual Acuity

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7/23/2019 Verhoeff-A New Test for Visual Acuity http://slidepdf.com/reader/full/verhoeff-a-new-test-for-visual-acuity 1/6  NEW TEST FOR VISUAL ACUITY F. H. VERHOEFF M.D. Boston Vision is so complicated a phenomenon and is dependent upon so many variables that no single test can be devised by which it can accurately be measured for all purposes. In practical life, however the most important factor in visual acuity no doubt is the resolving power of the eye. This is commonly measured by determining the smallest visual angle perceptible the minimum separable. Such determi- nations, however do not reveal the full resolving power of the eye, for the best possible vision shown by them corresponds to a visual angle of only about 30 minutes, whereas by certain methods which measure the aligning power it can be shown that the eye is capable of much finer discrimination than this. It should not be assumed from this fact, however that tests based upon the minimum separable are necessarily less precise than are those based upon the aligning power. While, so far as I know the aligning power has not been accurately correlated with the perception of the minimum separable, my own observations indicate that relative differ- ences in the former cannot be so accurately determined as relative differences in the latter. Moreover if a person has the best possible perception of the minimum separable, he will, no doubt, be found to have the best possible aligning power. The Snellen test measures the minimum separable with a considerable degree of accuracy, and the practical value of this test has been demonstrated over a period of many years.  From the Howe Laboratory of Ophthalmology Harvard University, and, the Massachusetts Eye and Ear Infirmary. 6 161

Transcript of Verhoeff-A New Test for Visual Acuity

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NEW TEST FOR

VISUAL ACUITY

F . H.

VERHOEFF

M.D.

B o s t o n

V i s i o n

i s s o

c o m p l i c a t e d

a

p h e n o m e n o n

a n d i s

d e p e n d e n t

u p o n

s o

many

v a r i a b l e s

t h a t

n o

s i n g l e

t e s t c a n

b e

d e v i s e d

b y

w h i c h

i t

c a n

a c c u r a t e l y

b e m e a s u r e d

f o r

a l l

p u r p o s e s .

I n

p r a c t i c a l

l i f e , h o w e v e r

t h e

m o s t

i m p o r t a n t

f a c t o r

i n

v i s u a l

a c u i t y

n o d o u b t

i s t h e

r e s o l v i n g

p o w e r

o f

t h e

e y e .

T h i s

i s

c o m m o n l y

m e a s u r e d

b y d e t e r m i n i n g

t h e

s m a l l e s t

v i s u a l

a n g l e

p e r c e p t i b l e t h e

m i n i m u m

s e p a r a b l e .

S u c h

d e t e r m i -

n a t i o n s ,

h o w e v e r

d o

n o t

r e v e a l

t h e f u l l

r e s o l v i n g

p o w e r

o f

t h e

e y e ,

f o r t h e

b e s t

p o s s i b l e

v i s i o n

s h o w n

b y

t h e m

c o r r e s p o n d s

t o

a

v i s u a l a n g l e

o f

o n l y

a b o u t

3 0

m i n u t e s ,

w h e r e a s

b y c e r t a i n

m e t h o d s

w h i c h

m e a s u r e

t h e

a l i g n i n g p o w e r

i t

c a n

b e

s h o w n

t h a t

t h e

e y e

i s

c a p a b l e

o f

much

f i n e r

d i s c r i m i n a t i o n

t h a n

t h i s .

I t s h o u l d

n o t

b e

a s s u m e d

f r o m

t h i s

f a c t ,

h o w e v e r

t h a t t e s t s

b a s e d u p o n

t h e

minimum

s e p a r a b l e

a r e

n e c e s s a r i l y l e s s

p r e c i s e

t h a n

a r e

t h o s e

b a s e d

u p o n

t h e

a l i g n i n g

p o w e r .

W h i l e ,

s o

f a r

a s

I

k n o w

t h e

a l i g n i n g

p o w e r

h a s

n o t b e e n

a c c u r a t e l y

c o r r e l a t e d

w i t h t h e

p e r c e p t i o n

o f

t h e

minimum

s e p a r a b l e , m y

own

o b s e r v a t i o n s i n d i c a t e

t h a t

r e l a t i v e

d i f f e r -

e n c e s

i n t h e

f o r m e r

c a n n o t b e

s o

a c c u r a t e l y

d e t e r m i n e d

a s

r e l a t i v e d i f f e r e n c e s

i n

t h e

l a t t e r .

M o r e o v e r

i f

a

p e r s o n h a s

t h e

b e s t

p o s s i b l e

p e r c e p t i o n

o f

t h e

m i n i m u m

s e p a r a b l e ,

h e

w i l l ,

n o

d o u b t ,

b e

f o u n d

t o h a v e

t h e

b e s t

p o s s i b l e

a l i g n i n g

p o w e r .

T h e

S n e l l e n

t e s t m e a s u r e s

t h e minimum

s e p a r a b l e

w i t h

a c o n s i d e r a b l e

d e g r e e

o f

a c c u r a c y ,

a n d

t h e

p r a c t i c a l

v a l u e

o f

t h i s

t e s t

h a s

b e e n

d e m o n s t r a t e d

o v e r

a

p e r i o d

o f

many

y e a r s .

 

From t h e

H owe

L a b o r a t o r y

o f

O p h t h a l m o l o g y

H a r v a r d

U n i v e r s i t y ,

a n d ,

t h e

M a s s a c h u s e t t s

E y e

a n d

E a r

I n f i r m a r y .

6

1 6 1

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1 6 2

V E R H O E F F : A New

T e s t

f o r V i s u a l A c u i t y

O n e

o f

i t s

p r i n c i p a l

a d v a n t a g e s

i s t h a t i t

d e t e r m i n e s

d i r e c t l y

t h e

a b i l i t y t o

r e c o g n i z e

l e t t e r s ,

w h i c h

i s

o n e

o f

t h e

m o s t

i m p o r t a n t f u n c t i o n s

o f v i s i o n

i n

d a i l y

l i f e . I t s

c h i e f

d i s -

a d v a n t a g e s a r e t h a t

d i f f e r e n t l e t t e r s u s e d i n

t h e t e s t a r e

n o t a l l a f f e c t e d a l i k e b y a s t i g m a t i s m

a n d

o t h e r

a b e r r a t i o n s

o f

t h e o p t i c a l s y s t e m

a n d

h a v e

d i f f e r e n t d e g r e e s

o f

l e g i b i l i t y .

T h e m o s t n o t a b l e

o f

t h e

a t t e m p t s t o i m p r o v e

o n

S n e l l e n s

t e s t w e r e t h o s e

o f

L a n d o l t a n d o f

I v e s . T h e

L a n d o l t

r i n g

a n d

t h e

I v e s g r a t i n g

e a c h

p o s s e s s t h e

s e r i o u s

d i s a d v a n t a g e

h o w e v e r

t h a t

n u m e r o u s

d e t e r m i n a t i o n s

m u s t

b e

m a d e

t o

a l l o w f o r t h e e f f e c t

o f

a s t i g m a t i s m ,

t h u s e m p h a s i z i n g

t h e

f a c t o r s

o f

f a t i g u e

a n d

f a u l t y o b s e r v a t i o n .

R e c e n t l y

I

h a v e

d e v i s e d

a

t e s t

f o r v i s u a l

a c u i t y

t h a t

s e e m s

t o

b e n o t

o n l y m o r e d e l i c a t e

a n d

a c c u r a t e t h a n

t h e S n e l l e n

t e s t a t

l e a s t f o r

v i s u a l

a c u i t y

b e t t e r

t h a n

2 0 / 4 0 b u t

i s

a l s o

s i m p l e r . M o r e o v e r

i t s r e s u l t s s h o w a s c l o s e a

c o r r e s p o n d

e n c e

w i t h

t h e S n e l l e n

t e s t

a s

t h e

a c c u r a c y - o f

t h e l a t t e r

w i l l

d e t e r m i n e .

A s

a

t e s t

f o r

i l l i t e r a t e s

i t s

v a l u e

w i l l

a t

o n c e

b e

a p p a r e n t .

F o r

o r d i n a r y

u s e

t h e t e s t

i s

m a d e

b y

u t i l i z i n g

a

c h a r t

t o b e v i e w e d

a t

2 0 f e e t

  f i g .

1 ,

w i t h

g r a d a t i o n s

c o r r e s p o n d i n g

t o

t h e

u s u a l S n e l l e n c h a r t

a n d

a n

a d d i t i o n a l

g r a d a t i o n

c o r r e s p o n d i n g

t o V .

= 2 0 / 1 2 . 5 .

T h e

c h a r t , h o w e v e r c a n ,

o f

c o u r s e ,

b e

a d a p t e d

t o t h e f i v e - m e t e r

o r

d e c i m a l

s y s t e m .

T h e r e

a r e e i g h t

r o w s o f

f i g u r e s ,

e a c h r o w

c o n s i s t i n g

o f

t w o

u n i t s . I f

t w o

c o m p l e t e

c i r c l e s a r e s e e n

i n

t h e

f i g u r e

o n

t h e

l e f t

i n

t h e

f i r s t

r o w

V .

=

2 0 / 2 0 0 ;

i f

t h r e e c i r c l e s

a r e s e e n i n

t h e

f i g u r e

o n

t h e

r i g h t ,

V .

= 2 0 / 1 0 0 .

I n

t h e

s e c o n d

r o w

t h e

f i g u r e s

c o r r e s p o n d

t o V .

=

2 0 / 7 0

a n d

V .

=

2 0 / 5 0 ,

r e s p e c t i v e l y .

I f

t h e

v i s u a l

a c u i t y

i s

f o u n d

t o

b e

b e t t e r

t h a n

t h i s ,

t h e

p a t i e n t

i s

i n s t r u c t e d

t o

l o o k a t t h e o t h e r

r o w s

f r o m

a b o v e

d o w n w a r d

a n d

t o s e l e c t

t h e

l o w e s t

r o w

i n

w h i c h

h e

c a n

s t i l l m a k e o u t

t w o

c i r c l e s

i n

t h e

f i g u r e

o n

t h e

l e f t .

L e t u s

s u p p o s e ,

f o r

e x a m p l e

t h a t

h e s e l e c t s

r o w

N o .

4

  f i g . 2 ) :

He

i s

t h e n

a s k e d

i f

t h e t w o

f i g u r e s

i n

r o w

N o . 5

l o o k

a l i k e .

I f

t h e y

d o l o o k

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7 0

  oo

4

 

5

0 0

6

 

I s

 

1 2 S

8

  1 0

F i g .

1 . C h a r t a s

seen w i t h

a

n o r m a l

e y e .

F i g .

3 . C h a r t

as

seen b y

an

eye

w i t h s i m p l e a s t i g m a t i s m ,

a n d

v i s u a l

a c u i t y

o f

2 0 / 4 0 .

F i g . 2 . C h a r t a s seen

b y a m y o p i c

o r

h y p e r m e t r o p i c

eye

w i t h

v i s u a l a c u i t y

s l i g h t l y

b e t t e r

t h a n

2 0 / 3 0 .

F i g . 4 . C h a r t as

seen

b y

an e y e

w i t h

c o m p o u n d

  s t i g m t i s m

a n d v i s u a l

a c u i t y

o f

2 0 / 1 0 0 .

s o

4 0

3 0

2 0

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V E R H O E F F :

A

New T e s t f o r

V i s u a l A c u i t y

a l i k e , h i s v i s u a l a c u i t y

c o r r e s p o n d s

t o

r o w N o .

4 ,

a n d

i s

2 0 / 3 0 .

I f

h e

s t a t e s

t h a t

t h e

t w o

f i g u r e s

i n

r o w N o .

5

d o

n o t

l o o k

a l i k e ,

b u t

t h a t t h o s e

i n

r o w N o . 6

d o l o o k a l i k e ,

h i s

s e l e c t i o n

o f

r o w

N o .

4

w a s i n a c c u r a t e

a n d

h i s v i s u a l

a c u i t y

i s

n e a r l y

2 0 / 2 0 . A s t i l l h i g h e r d e g r e e o f a c c u r a c y

may

b e

o b t a i n e d b y c h a n g i n g t h e d i s t a n c e

f r o m

t h e

c h a r t .

F o r

e x a m p l e

s u p p o s e

t h e p a t i e n t

s e l e c t s

r o w

N o .

5

  V .

=

2 0 / 2 0 ) .

By

b r i n g i n g

h i m c l o s e r t o t h e

c h a r t

i t

may

b e f o u n d t h a t a t

1 8

f e e t

h e s e l e c t s r o w N o . 6 , i n d i c a t i n g V .

=

1 8 / 1 5 .

I n

t h i s

way

I

h a v e

a s c e r t a i n e d

t h a t a

g o o d o b s e r v e r

w i t h

a

v i s u a l

a c u i t y

o f a b o u t

2 0 / 1 2

c a n

d e t e c t a

d i f f e r e n c e

o f

a b o u t

4

m i n u t e s

i n

t h e v i s u a l

a n g l e .

A

p r e c i s e

a n d

c o n v e n i e n t m e t h o d

o f

m a k i n g

t h e t e s t

i s

t o

t h r o w t h r e e

r o w s , 2 0 / 4 0 , 2 0 / 3 0 ,

a n d

2 0 / 2 0 ,

o n

a

s c r e e n

b y

m e a n s o f

a

p r o j e c t o r

w h i c h

v a r i e s t h e

m a g n i f i c a t i o n

  s

d e s i r e d . *

I f

t h e r e

i s

u n c o r r e c t e d

a s t i g m a t i s m ,

i t

i s

e s p e c i a l l y

i m

p o r t a n t

f o r

t h e p a t i e n t

t o

o b s e r v e t h a t t h e

c i r c l e s a r e

c o m p l e t e

i n

t h e

f i g u r e c o r r e s p o n d i n g

t o h i s v i s u a l

a c u i t y

  f i g s . 3

a n d

4 ) .

When

t h e r e

i s

a

c o n s i d e r a b l e a m o u n t

o f

a s t i g m a t i s m ,

h e w i l l

o b s e r v e

t h a t e a c h

f i g u r e

s h o w s

t w o

s e c t o r s , d i a m e t r i c a l l y

o p p o s i t e ,

i n

w h i c h

t h e c i r c l e s

a r e

m o s t

d i s t i n c t .

I n

c a s e

t h e

e y e

i s

e m m e t r o p i c

i n

t h e

m e r i d i a n

a t

r i g h t

a n g l e s

t o

t h e a x i s o f t h e

a s t i g m a t i s m , t h e p a t i e n t may

o b s e r v e

t h a t

t h e r e a r e

t w o

b a n d s

i n

t h e s e c t o r s

i n

t h e

f i g u r e s

o n t h e l e f t

a n d

t h r e e b a n d s

i n

t h e s e c t o r s

i n

t h e

f i g u r e s

o n

t h e

r i g h t .

I f

t h i s

s l i g h t

d i f f e r e n c e

o c c u r s ,

h e s h o u l d

b e

t o l d

t o

d i s r e g a r d

i t .

I n

t h e

f i r s t

t w o

r o w s o f

f i g u r e s

o n

t h e c h a r t

e a c h

i n t e r v a l

i n t h e

f i g u r e s c o r r e s p o n d s

t o a n

a n g l e

o f

o n e

m i n u t e

a t t h e

d e s i g n a t e d

d i s t a n c e . S i n c e

l o w v i s u a l

a c u i t y

i s

o f t e n d u e t o

r e f r a c t i v e e r r o r s

w h i c h

e x a g g e r a t e t h e

e f f e c t s

o f

t h e v a r i o u s

a b e r r a t i o n s

o f

t h e

o p t i c a l s y s t e m

a n d

t h u s

p r o d u c e i r r e g u l a r

 

T h e

A m e r i c a n

O p t i c a l

Company i s

p r e p a r i n g

t o

s u p p l y

t h e

t e s t

c h a r t .

T h e y

w i l l

a l s o

u t i l i z e

i t i n

a new

p r o j e c t i o n

l a n t e r n .

1 6 3

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1 6 4

V E R H O E F F : A

New

T e s t

f o r V i s u a l A c u i t y

d i s t o r t i o n s

i n

t h e

r e t i n a l

i m a g e ,

t h e

e s t i m a t i o n o f

v i s u a l

a c u i t y

w i t h i n

t h i s

r a n g e

i s

l i k e l y

t o

b e

h i g h l y

i n a c c u r a t e .

I n

r a r e

i n s t a n c e s ,

o w i n g

t o

t h e

d o u b l i n g

o f

i m a g e s , i t may

e v e n

h a p p e n

t h a t t h e

p a t i e n t

f a i l s t o

s e e

t w o

c i r c l e s i n

t h e

f i g u r e o n

t h e l e f t ,

a n d

y e t s e e s t h r e e

c i r c l e s

i n

t h e f i g u r e

o n

t h e r i g h t .

 

s i m i l a r

i n a c c u r a c y ,

o f

c o u r s e ,

e n t e r s i n t o

t h e

S n e l l e n t e s t ,

e s p e c i a l l y w h e n

a s i s

u s u a l ,

o n l y

a

f e w

d i f f e r e n t

l e t t e r s

a r e

e m p l o y e d

b u t

a s

t h e

t w o

t e s t s

o f t e n

d o n o t c o r r e s p o n d w i t h i n

t h i s

r a n g e ,

i t i s

p r o b a b l y

b e s t , f o r

p r a c t i c a l p u r p o s e s ,

t o

r e l y h e r e u p o n

t h e

S n e l l e n t e s t ,

e x c e p t

i n t h e c a s e o f

i l l i t e r a t e s .

I n

e a c h

r o w b e l o w

t h e

s e c o n d

r o w i t

w i l l

b e

s e e n

t h a t a

new

p r i n c i p l e

i s

i n t r o d u c e d

o n

t h e

c h a r t ,

n a m e l y

t h e

u s e

o f a

f i g u r e

o n

t h e

r i g h t

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V .

 

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L a b o r a t o r y

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H a r v a r d

U n i

v e r s i t y .

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V E R H O E F F :

A

New

T e s t f o r V i s u a l A c u i t y

5 . 2

m m . ;

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f i g u r e :

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m m . ;

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o f

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m m . ; w i d t h

o f m i d d l e

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o f

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T h e

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t h e v i s u a l

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t i m e , t h r o u g h

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t w o

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T h i s

p r o c e d u r e may

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i n

t h e c a s e o f

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who

c l a i m

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v i s u a l

a c u i t y

t h a n

t h e y

r e a l l y

p o s s e s s .

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