Testing vision testing: quantifying the effect of movement on visual acuity measurement

Purpose Assessment of visual acuity (VA) has been shown to vary between tests, which may be attributable in part to test inaccuracies, such as a change in the distance between the chart and subject. Therefore, the study aim was to quantify changes in chart/ patient separation during near and distance VA testing, and to analyse the relationship between VA and movement observed. Methods Volunteer orthoptists and subjects were filmed during near and distance VA testing, with the amount of movement determined from the recording. Controlling for movement using chin rests and chart stands, VA was retested. Actual changes in VA due to a change in subject or chart movement were compared with theoretical predictions. Results Fifty-one subjects (18-73 years) were assessed. Median (interquartile) movements of 0.06m (0.07) towards and 0.11m (0.08) away from the chart were measured (maximum 0.17m towards and 0.24m away). Significant differences in VA score were measured when movement was restricted, at near and distance (P < 0.05). VA score change agreed with predicted values in 67% of the cases, however, reduced test distance during near vision testing resulted in a degradation of VA, opposite to the improvement expected. Conclusion There were significant variations in subject/ chart separation during testing, which could have affected VA values. While this movement is associated with a change in VA, additional factors to movement appear to influence the score achieved during near testing. Procedures to minimise variation, by eliminating movement of test chart or subject, will improve VA test accuracy.