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Vision Tests & Tools for Assessing Individuals who are Blind or Visually Impaired

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Vision Tests & Instruments

By Carmen Willings
teachingvisuallyimpaired.com
​Updated 10/24/2015


In order to determine how well a child is able to use their vision, an optometrist or ophthalmologist  will formally assess the child's vision. Vision tests check many different functions of the eye. The tests measure a persons ability to see details at near and far distances, check for gaps or defects in the field of vision, and evaluate the ability to see different colors.

Amsler grid test

Picture of Amsler grid
The Amsler grid test checks for macular degeneration, a disease that causes loss of vision in the center of your visual field. The test uses a 4 inch square chart with straight lines that form boxes. The grid has a black dot at the center. The chart is held about 14 inches from the face. The student must report when they cannot see the black dot; they see a blank or dark spot; or the lines in the grid look wavy, blurred or curved instead of straight.

Biomicroscope (Slit-Lamp)

Picture of a Slit-Lamp/Biomicroscope
A Biomicroscope, or slit lamp, is an instrument used to view the cornea, iris, lens, and vitreous (the parts of the eye that bend light). It sends out an intense beam of light as it views the eye. It provides a magnified view of the eye structures in detail.

Confrontation Test

The confrontation test is done by having the student focus on the health professionals nose. He or she will slowly move a finger or hand from the outer edge of the visual field toward the center and from the center toward the edge through all areas of the visual field.

Keratometer

Picture of a keratometer
The keratometer, also known as an ophthalmometer, is a diagnostic instrument that measures the shape of the cornea and reflection of the anterior surface of the cornea. It is primarily used to diagnose the presence of astigmatism. It can also be used in surgery using the light as a point of focus for the patient.

Ophthalmoscope

Picture of ophthalmoscope
The ophthalmoscope is an instrument used to view the optic disk, retina, macula, and choroid in the back of the eye. It is typically used in routine exams and is important in determining the health of the retina and the vitreous humor. There are two types: the direct ophthalmoscope and the indirect ophthalmoscope.

Perimetry testing

Picture of perimetry test.
Perimetry testing uses a machine that flashes lights randomly at various points in the visual field. The student will be asked to look inside a bowl-shaped instrument called a perimeter. While the student stares at the center, lights will flash, and they will be asked to press a button each time they see a flash. A computer records the location of each flash and whether the student pressed the button when the light flashed in that location.

Refraction

Picture of glasses.
Refraction is a test that measures the eyes' need for corrective lenses (refractive error). It is typically done after the visual acuity test. Refractive errors, such as nearsightedness or farsightedness, occur when light rays entering can't focus exactly on the nerve layer (retina) at the back of the eye. The eyes will be dilated with eyedrops prior to the test. Using a retinoscope, the health professional may shine light into the eyes. A series of trial lenses will be placed in front of the eyes and adjusted until the light rays are properly focused on the retina. The phoropter is another tool that can be used to measure the refractive error in the eyes.

Tonometer and Tono-pen

Picture of tonometer
The tonometer is used to ensure a persons optic nerves are healthy by measuring the intraocular pressure. The small disk is placed lightly on the anesthetized eye for a brief period. The tono-pen uses a puff of air to measure eye pressure. Measurements that are higher than normal can be a sign of early glaucoma or retinal detachment.

Visually Evoked Response/Potential (VER/VEP) Test

Picture of VER/VEP test
A computerized recording of electrical activity in the vision portion of the brain that result from stimulating the retina with light flashes. These tests are used to evaluate vision functioning in the retina-to-brain nerve pathway and can be helpful in diagnosing Cortical Visual Impairment (CVI).

Tangent Screen Test

Picture of tangent screen test.
The tangent screen test uses a black screen with concentric circles and lines leading out from a center point (like a bull's-eye). Sitting 3 ft to 6 ft away from the screen, the student will be asked to cover one eye while fixing their gaze on a target point marked on the screen. Test objects of various sizes at the tip of a wand are then moved inward from the outer edge of the screen toward the center. The student will signal when he can see the object, and that point is marked on the screen. The points on the screen that objects are seen are connected to provide an outline of the visual field.

Visual Acuity Tests

Picture of an acuity chart.
Visual acuity tests are the most common tests used to assess vision. They measure the eye's ability to see details at near and distance. The tests involve reading letters, numbers or symbols of different sizes on an eye chart. Usually, each eye is tested by itself. Then, both eyes may be tested together, with and without corrective lenses if they're worn.

The Snellen test checks the persons ability to see at distances, measured at 20 feet. It is a wall chart that has several rows of letters. The letters on the top row are the largest and those on the bottom row are the smallest. The E chart tests the vision of children and people who cannot read, but can verbally respond to questions. It is similar to the Snellen chart in that it has several rows. Each row contains only the letter E, but in different positions. The student will be asked to point in the same direction as the lines of the E.

There are guidelines for standardized eye chart design as the design can significantly affect visual acuity scores. For school age children and older, the following guidelines should be followed:
1. Optotypes (The name for the picture, symbol, letter, or number the child is to identify) should be of approximate equal legibility.
2.  Each line on an eye chart should have the same number of optotypes.
3. Horizontal spacing between optotypes should be equal to the width of the optotypes on a line.
4. Vertical spacing between lines hsould be the height of the optoypes in the next line down.
​5. The size of optotypes should progress down the chart by 0.1 log units between rows.
​6. Optoptypes should be black on a white background under good lighting conditions. 

Visual Field Test

Grid depicting results of a visual field test.
Visual field tests are used to check for gaps in your side (peripheral) vision. Your complete visual field is the entire area seen when your gaze is fixed in one direction. The complete visual field is seen by both eyes at the same time, and it includes the central and peripheral visual fields.

Unique Testing for Infants and Toddlers

Infants and toddlers will not be able to read typical visual acuities charts, nor will students with significant cognitive impairments. This can make the assessment more challenging and will also make it difficult to get a precise acuity. For that reason, the doctor may use other tests or measurement techniques in order to gather information about the child's vision. Some of these tests are listed below:

Confrontation field test

A screening method for detecting gross visual field loss. An interesting visual target is slowly moved inward toward the eyes of a child from various locations (above; below; from the sides) as the child looks straight ahead. The examiner watches to see at what point the child notices the visual target coming from each direction and can determine if there seem to be areas of the child's visual field in which the child cannot see.

Cover Test

Procedure for detecting eyes that are not in alignment, by watching for eye movements as a child's eyes are covered and uncovered one at a time.

Photoscreening

Picture of a photoscreener.
A screening procedure in which a special camera takes photographs of the eyes. The resulting pictures can identify eyes that may be nearsighted or farsighted or have astigmatism, eyes that are not in alignment, and 'cloudiness' of the eyes that may indicate a vision problem.

Picture-based vision tests

Picture of an LEA symbol chart.
Tests that use simple line drawing pictures, instead of letters or numbers, as targets to measure a young child's visual acuity.

Preferential Looking Test

Picture of preferential looking test.
This is a visual acuity test for nonverbal children that uses black and white striped patterns. As the stripes get thinner (and thus more difficult to see), an evaluator observes to see if a child continues to look toward the stripe patterns, an indication that the child can still see them. An acuity measure is then calculated.

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      • Visual Efficiency & Magnifier Grab & Go
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      • Vocabulary Cards & Checklists
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      • Determining Service Intensity Using the VISSIT
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    • Foundations of Teaching the ECC in the Age of Virtual Instruction
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    • Itinerant Teaching Strategies & Tips
    • Accommodations for VI
    • Strategies & Activities for Standard Course of Study
    • Using Themes to Teach the ECC
    • Accessible Content for BLVI
    • Conducting a FVLMA
    • Developing SMARTER Goals
    • Selecting the Right AT
    • Tips for Being a "Physically Fit" TVI
    • The Art of Teaching the ECC
    • Activities to Teach the ECC
    • Determining Service Intensity Using the VISSIT
  • Professional Practice
    • Vision Professionals >
      • Become a Vision Professional
      • Professional Preparation Programs
      • Teacher of Students with Visual Impairments
      • Orientation & Mobility Specialist
      • Low Vision Specialist
      • Rehabilitation Specialists
      • CATIS
      • Parapros & Braille Transcribers
    • Professionalism >
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      • Caseload Analysis
      • Itinerant Teaching Tips
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      • Role of the Classroom Teacher
      • Simulation Activities
    • Professional Publications >
      • General VI Resource Books
      • CVI & MD Resource Books
      • Braille Resource Books
      • O&M Resource Books
      • Early Intervention Resource Books
      • Journal Resources
  • Foundations of VI
    • History of Visual Impairments >
      • Timeline of VI
      • Biblical Passages Concerning Blindness
      • Notable People
      • Helen Keller
      • APH Museum
      • Leaders & Legends
      • History of Braillewriters
      • Legislation
    • Visual Impairments >
      • Structure & Function of the Eye
      • Vision Classifications
      • Common Vocabulary
      • Common Visual Impairments
      • Cortical Visual Impairments
      • Convergence Insufficiency (CI)
      • Deaf-Blind
    • VI Resources >
      • VI Organizations
      • US Government Agencies
      • Support Networks
      • Deaf-Blind Resources
      • Georgia Vision Resources
      • Online Parent Resources
    • V.I. Book Resources >
      • Children's Books
      • Young Reader Books
      • Books about Dog Guides
      • Teen & Young Adult Books
      • Non-Fiction Books
      • Helen Keller Books
      • Parent Resource Books
      • Grief & Suffering Books
    • Impact on Development & Learning
    • Psychological Impact
    • Social Etiquette
    • Financial Assistance
  • VI Service
    • Educational Programming >
      • National Agenda
      • The Expanded Core Curriculum
      • IDEA and Vision
      • Federal Quota Funds
      • Deaf-Blind Child Count
      • State SpEd Agencies
      • Schools for the Blind
    • Referrals >
      • Vision Concerns
      • Referral Process
      • Eligibility Guidelines
      • Vision Therapy Controversy
      • When Student Doesn't Qualify
    • Medical Vision Exams >
      • Medical Professionals
      • Vision Tests & Tools
      • Visual Acuity
      • Lenses
      • Visual Fields
    • FVLMA >
      • What is the FVE
      • Interpret the Eye Report
      • Environmental Observations
      • FVLMA Observations
      • Interviews
      • Assessment Kit Materials
      • Oculomotor Skills
      • Near Visual Acuities
      • Print Comparisons
      • Distance Acuity
      • Test Visual Fields
      • Vision Skills
      • Learning Media Assessment
      • Reading Rates
      • Writing the FVE Report
    • Service Planning >
      • ECC Annual Needs
      • Service Delivery Models
      • Least Restrictive Environment
      • Early Intervention Services
      • Students with Multiple Disabilities
      • Student Led IEPs
      • 504 Plans
      • Transition Plans
    • Writing Goals >
      • Writing SMART Goals
      • Blooms Taxonomy
      • Independent Living Goals
      • Compensatory Goals
      • Sensory Efficiency Goals
      • Assistive Technology Goals
      • Social Skills Goals
      • Recreation & Leisure Goals
      • Self Determination Goals
      • Career & Vocational Goals
    • Low Vision Eval
    • O&M Evaluation
    • Educational Assessments
  • Adaptations
    • Unique Visual Needs
    • Accommodations & Modifications
    • Home Adaptations >
      • General Home Safety
      • Kitchen Adaptations
      • Bathroom Adaptations
      • Medication Adaptations
      • Clothing Management Adaptations
    • Curriculum Adaptations >
      • Numbers & Counting
      • Algebra
      • Geometry & Spatial Sense
      • Measurement & Data
      • Early Literacy Experiences
      • Create Tactile Books
      • Reading Instruction
      • Reading Efficiency
      • Science Adaptations
      • Social Studies Adaptations
    • Material Adaptations >
      • Accessible Educational Materials
      • Large Print
      • Braille Code
      • Photocopying
      • Font Legibility
      • Increase Contrast
      • Pictures and Worksheets
      • Tactile Graphics Guidelines
      • Creating Tactile Graphics
      • Teacher Made Materials for Students with MD
    • Instructional Adaptations >
      • Individual Schedules & Communication Cards
      • Movies & Assemblies
      • Lectures & Instruction
      • Board Work (Chalk, Interactive, White)
    • Environmental Adaptations >
      • School Campus Adaptations
      • Classroom Design Tips
      • Labeling System
      • Adjust Lighting
      • Playground Adaptations
      • Sensory Areas & Rooms
    • Early Childhood Adaptations >
      • Daily Schedule
      • Morning Meeting
      • Weather Check
      • Dramatic Play
      • Blocks
    • Adaptations to the Arts >
      • Art Adaptations
      • Art Materials
      • Music
      • Music & Movement
      • Dance
    • Recreation & Leisure Adaptations >
      • Recreation Adaptations
      • VI Sports Associations
      • Recreation Resources
      • Camps for VI
      • Card and Board Game Adaptations
      • Transcribe Playing Cards
  • VI AT
    • Overview of Assistive Technology
    • VI Assistive Technology >
      • Non-Optical Low Vision Devices
      • Low/Medium Tech Devices for Tactual Learners
      • Optical Devices for Near
      • Optical Devices for Distance
      • Video Magnifiers
      • Screen Magnification & Readers
      • Braille Technology
      • Tactile Graphics Technology
      • Auditory Access Devices
      • Braillewriter Repair
    • Apps for VI >
      • Note Taking Apps
      • Apps for Accessing Books
      • Identification Apps
      • Navigation & Location Apps
      • Braille Apps
      • Magnifier Apps
      • Sound Making Apps
      • Cause & Effect Apps
      • Vision Skills Apps
      • Apps for Early Learning
      • Read to Me Story Apps
      • Apps for Communication
      • Android Apps for VI
    • AT Instruction >
      • Video Magnifier Instruction
      • Notetaker Instruction
      • Accessing Audio Books
      • Navigate Computer without a Mouse
      • Word Processing and Shortcuts
      • Keyboarding Instruction
    • iOS for VI >
      • iPads as Instructional Tools
      • Making the iOS Device Accessible
      • iOS Accessibility Resources
      • VoiceOver
    • Assistive Technology Assessment
    • VI AT Resources
    • Vendors
  • Instruction
    • Virtual Instruction
    • Instructional Strategies >
      • Development of ECC Resources
      • Teaching in Thematic Units
      • Teaching the ECC
      • Summer Reading (braille)
      • Summer Outdoor Activities
      • Rainy Day Activities
    • Compensatory >
      • Guiding Principles of Concept Development
      • Functional Skills
      • Community Based Experiences
      • Concepts to Teach
      • Organization & Study Skills
      • Cranmer Abacus Instruction
      • Time Management
    • Communication Modes >
      • Language Development
      • Braille Instruction
      • Braille Instruction Materials
      • Writing Braille
      • Signature & Handwriting Instruction
      • Nemeth Braille Code
      • Tactile Graphics Instruction
    • Sensory Efficiency >
      • Sensory Input
      • Encourage Use of Vision in Students with MD
      • Lightbox Use
      • Sensory Activities for Students with MD
      • Sensory Table
      • Visual Efficiency Skills
      • Visual Attend and Scan Activities
      • Visual Tracking Activities
      • Visual Discrimination Activities
      • Visual Motor Activities
      • Optical Device Use
      • Tactual Readiness
      • Developing Skillful Hands
      • Auditory Readiness
      • Listening Skills Instruction
    • Independent Living >
      • Responsibility & Independence
      • Mealtime Independence
      • Eating Adaptations
      • Food Preparation
      • Recipe Activities
      • Hygiene & Grooming
      • Dressing & Clothing Management
      • Money
      • Housekeeping Instruction
    • Orientation & Mobility >
      • Transition Between Activities
      • Proper Guide Techniques
      • Orienting Student to Environment
      • Mobility Skills
      • Travel
      • Dog Guides
    • Social Skills >
      • Non-Verbal Communication
      • Social Interactions
      • Self Concept
      • Icebreakers & Mixers
    • Career Education >
      • Classroom Jobs
      • Career & Vocational
      • Prepare for College & Career
    • Recreation & Leisure >
      • Learn to Play
    • Self Determination