Short clips for the three visual vital signs, filmed at the bedside. Each one shows the technique end to end and is captioned, so it works with the sound off.
Visual acuity
59 seconds
Near vision at the bedside with a pocket card, one eye at a time, with the patient’s usual reading glasses if they wear them. Narrated, and captioned for watching on mute.
Step 1Hand the patient a near card, or open the online near card, and have them cover one eye. Help them hold the cover if they need it.
Step 2Ask them to read the smallest row they can, with the card about 14 inches away in good light.
Step 3Record the distance equivalent from the far right column. Jaeger is the middle column.
Step 4Cover the other eye and repeat. Record each eye separately.
If an open globe is suspected
Do not press on the eye or ask the patient to squeeze the lids shut. For recording and for patients who cannot read the largest line, see the near acuity card.
Intraocular pressure
59 seconds
Anesthetize first, then measure. The clip runs through topical proparacaine and then Tonopen technique on the same patient.
Step 1Topical anesthetic. One drop of proparacaine into the lower fornix, patient looking up.
Step 2Tonometry. Retract the lid without pressing on the globe, hold the tonometer perpendicular to the cornea, and take the reading.
Before you check pressure
Do not check intraocular pressure if an open globe is suspected. Pressure on the globe can extrude intraocular contents.
Pupillary exam
59 seconds
Pupil size in dark and in light for each eye, then the swinging flashlight test for a relative afferent pupillary defect (APD). Narrated, and captioned for watching on mute.
Step 1Dim the room if you can and have the patient look at a distant target. Swing the light quickly onto one eye and note the pupil size before and after, for example 4.5 mm to 2.5 mm.
Step 2Do the same on the other eye. A small bounce in pupil size under steady light is hippus.
Step 3Swing the light from one eye to the other. Each pupil should stay small as the light lands on it. A pupil that enlarges when the light arrives suggests an APD in that eye.
Filmed with consenting staff, not patients. Preview build for committee review, not yet an ASOT publication.