UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: VISION SCREENING
Effective Date: April, 2002 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed October, 2003 March, 2005 March 2008
To provide guidelines for administering a baseline Vision Screening/Visual Acuity exam
at the UWMF clinics.
The UWMF clinical staff will be able to perform visual acuity testing on patients who
enter the clinic with eye-related problems. The visual acuity testing can also be
completed as part of an annual or routine exam.
The standard vision charts will be the Logarithmic Visual Acuity Chart for testing at least
3 meters (10-20 feet) or the LEA Symbols with notations for testing also at least 3 meters
(10-20 feet). This is done to be consistent with the Ophthalmology Department. The
“standard E chart” remains acceptable practice.
SUPPLIES: Vision Acuity Chart, Gauze, Provider’s order, Patient’s record
1. Each room and hallway marked at a length at least 3 meters (10-20 feet) between
where the eye chart will be held by the tester and where the patient will stand or sit
for the exam.
2. The chart is to be held at eye level of the patient.
3. Patient will cover one eye with gauze, paper cup over eye, eye shield.
NOTE: NO pressure should be placed on eyeball.
4. Have patient read lines from top to bottom of chart until more incorrect than correct.
5. Document the vision test score as the last line where the patient read more than 50%
of the letters correct.
Logarithmic Acuity LEA Symbols chart Standard E chart
6. Record as Right or Left eye, (for example: Right eye 10/#).
7. Repeat the acuity test for the opposite eye and both eyes.
8. The test may be completed in any clinic leaving corrective lenses on, but it should be
noted ”with corrective lenses “ or “with glasses or contacts”.
Ronnie Peterson, R.N, M.S., Clinical Staff Educator
John Temprano, M.D., Former Chair, UWMF, Ophthalmology Department
Connie Looze, CMA, Department of Pediatrics. 2008
1. Basic Skills and Procedures: Perry & Potter, 4th Ed., 1998, Mosby, St. Louis.
2. Clinical Nursing Skills & Techniques, 5th Ed. Perry & Potter, 2002, Mosby, St. Louis.
Medical Director Date