Name: ________________________________________
Date: _________________________________________
Procedure 38-1:
Assessing and Recording Distance Vision Acuity Using a Snellen
Eye Chart
Objective: Screen a patient for distance acuity using a Snellen eye chart.
Equipment and Supplies: Snellen eye chart placed at a distance of 20 feet; eye shield or
occluder; pointer; pen and paper; alcohol and gauze
Affective Behaviors: Affective behaviors provide a professional approach to a skill that enhances
the patient encounter. These behaviors may also display sensitivity to a patient’s rights and
enhance communication. Pay close attention to these skills, which will be in bold, italicized font.
Skills Assessment Requirements
Read and familiarize yourself with the procedure. Complete each procedure within a reasonable
amount of time, with a minimum of 85% accuracy.
Use the area below for any documentation needed to complete the procedure.
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1. Assemble equipment.
2. Review physician’s order.
3. Perform hand hygiene and
identify the patient.
4. Explain the procedure.
5. Determine the patient’s ability
to recognize letters. If the patient
is unable to read letters, use the
necessary chart to accommodate
the patient’s abilities.
6. Place the patient 20 feet from the
chart, either seated or standing,
as long as the Snellen eye chart is
at eye level (Figure A).
7. Follow oce policy regarding
testing with or without corrective
8. Following oce policies regarding
which eye to test first, have the
patient cover the other eye with
a cup or occluder. The occluder
should be held in such a way so
as not to interfere with the normal
position of a patient’s glasses.
9. Instruct the patient to keep
both eyes open even though
one eye is covered. Have the
patient read the lines with both
eyes first at a distance of 20 feet.
10. Use a pointer and point to letters
or appropriate symbols in random
11. Starting with the 20/70 line, ask
the patient to identify each line
and proceed down the chart to
the last line the patient can read
without error. Observe for signs of
squinting or tilting the head, which
indicate diculty identifying letters.
= 3–6 points
= 7–9 points
Name: ________________________________________
Date: _________________________________________
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12. Record the ratio numbers
adjacent to the line the patient
can read without error. If there is
an error, note it (e.g., “Right eye
20/40—1”; or “Right eye 20/40—1
with correction,” meaning glasses
were worn during testing).
ISMP recommends using
words instead of abbreviations
for eye designations to avoid
misinterpretation. In many cases,
the patient is allowed to make
no more than two errors per line
when acuity is being assessed.
However, it is important to follow
oce policy in such instances.
13. Repeat the procedure with the
other eye and record the result,
noting any unusual symptoms such
as squinting or blinking excessively.
14. Clean the occluder with gauze
and alcohol.
15. Remove gloves and perform hand
16. Document the results accurately.
Points Earned
Points Possible 114 114
Percent Grade (Points Earned/
Points Possible)
Instructor Sign-O
Instructor: ______________________________________________ Date: _________________________
= 3–6 points
= 7–9 points
Name: ________________________________________
Date: _________________________________________
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