Assessment of Near Visual Acuity

Near visual acuity (NVA) testing assesses the patient's ability to read close objects (i.e., at a reading or worldng dis­tance); the test results are used to detect hyperopia and presbyopia.

The test is conducted with a card similar to the Snellen eye chart; however, the size of the type ranges from the size of newspaper headlines down to considerably smaller print such as would be found in a telephone directory. The test card is available in a variety of forms such as printed paragraphs, printed words, and pictures.

The test should be performed in a well-lit room free of distractions. It is conducted with the patient holding the test card at a distance between 14 and 16 inches. If the pa­tient wears reading glasses, they should be worn during the test. The acuity should be measured in each eye separately, traditionally beginning with the right eye. An eye occluder should be held over the eye not being tested. The patient should be instructed to keep the covered eye open because closing it may cause squinting of the eye that is being tested. The patient is asked to identify orally each line or paragraph of type. During the test, the patient should be observed for unusual symptoms such as squinting, tilting the head, or watering of the eyes, which may indicate that patient is having difficulty reading the card. The patient continues until reaching the smallest type that can be read.

The results are recorded as the smallest type that the patient could comfortably read with each eye at the distance at which the card is held (i.e., 14 to 16 inches). The recording will be based on the type of test card used to conduct the test. For example, one type of card uses a recording method similar to that used with the Snellen eye test. For this type of NVA card, the results would be recorded as 14/14 for a patient with normal near visual acuity. This means the patient read what was supposed to be read at a distance of 14 inches. Also included in the recording should be the date and time, corrective lenses worn, and any unusual symptoms exhibited by the patient.