LVA "Routine"

Do current DVA/NVA with aid and specs, noting type of chart and distance used, light level, any head turn, record mon/bin VA. Worst eye first is good to keep morale up. Subjective refraction should use large steps/big x-cyl/reduced testing distance if required (px should be able to see 4 lines)

For distance

• Identify the px's visual task and estimate the required VA for it
• Measure best corrected VA and estimate mag required
• Calculate mag
• Dist generally for younger px, really need to be motivated
• Often not req as main problem is at near

For near

• Identify vis.task and estimate VA required
• Measure BCVA at 25cm with +4.00DS and then estimate mag
• If central field defect suspected check w/amsler - ecc. fix?
• Try predicted mag with simple magnifiers - higher add/hand/stand and use good illumination
• Modify mag if required, prescribe w/full instructions

Other stuff

• Binocularity - cover test
• Contrast sensitivity if req
• Fields, ophth, fundus photo, IOP

Advice/Follow-up

• Ideally 2-4 wks, may need to change LVAs