ARCHETYPE Visual acuity test result (openEHR-EHR-OBSERVATION.visual_acuity.v0)

Name: Visual acuity test result
License: http://creativecommons.org/licenses/by-sa/3.0/

ARCHETYPE ID	openEHR-EHR-OBSERVATION.visual_acuity.v0
Concept	Visual acuity test result
Description	Visual acuity is a measure of the spatial resolution of the visual processing system.
Use	Use to record a signle measurement of visual acuity. The `Position in front of Eye` cluster allows for flexible combination of device types (such as a pinhole occluder, own glasses, fogging lenses, trial lenses etc.) to be modelled, and the lens specification cluster allows individual lenses or an arrangement of trial lenses to be specified. This way, the archetype can be used to describe VA test with multiple corrective devices in front of the same eye (contact lens overrefraction) or binocular VA test with different corrections in front of each eye. (unilateral hard contact lens due to corneal scar). The `Type of Correction` Element contains the information whether a correction is present, which type of correction was present, and where the values of that correction come from. Pupil dilation can be specified using the "Patient Circumstances affecting Result" element, which is especially relevant to transient pupil dilation due to eye drops.
Misuse	Not to be used to document multiple visual acuity tests within one event. The "Result" Cluster is not to be used to document the same visual acuity test in multiple units - only a unique result is to be documented there. If the same test result is to be expressed with multiple units, only use the result cluster once, and the "derived result" cluster for all others. Not to be used for assessing the light projection in individual quadrants, because that is an assessment of the visual field rather than acuity.
Purpose	For recording the results of a single visual acuity test, normally measured by testing the subject's ability to recognize symbols at a defined distance.
References	Visual Acuity [Internet]. Wikipedia. Available from: http://en.wikipedia.org/wiki/Visual_acuity Aylward W [Internet].Coding Visual Acuity, openEyes Project;2012.Available from http://www.openeyes.org.uk/documents/OpenEyes%20Coding%20Visual%20Acuity.pdf IHE Eye Care Domain. General Eye Evaluation (GEE) [Internet]. IHE; 2012. Available from: http://www.ihe.net/Technical_Framework/upload/IHE_EyeCare_Supp_GEE_Rev1-1_TI_2012-06-29.pdf Royal College of Opthalmologists. Cataract National Dataset for Adults [Internet]. 2011. Available from: http://www.rcophth.ac.uk/page.asp?section=583&sectionTitle=Cataract+National+Data+Set+for+Adults Laidlaw D a. H, Tailor V, Shah N, Atamian S, Harcourt C. Validation of a computerised logMAR visual acuity measurement system (COMPlog): comparison with ETDRS and the electronic ETDRS testing algorithm in adults and amblyopic children. Br J Ophthalmol [Internet]. 2008 Feb 1 [cited 2012 Sep 26];92(2):241–4. Available from: http://bjo.bmj.com/content/92/2/241 CfH, UK. Do Once & Share - Glaucoma [Internet]. [cited 2012 Sep 26]. Available from: http://www.doasglaucoma.org/ DICOM Supplement 30 [Internet]. [cited 2012 Sep 26]. Available from: http://medical.nema.org/ Chiang MF, Boland MV, Brewer A, Epley KD, Horton MB, Lim MC, et al. Special Requirements for Electronic Health Record Systems in Ophthalmology. Ophthalmology [Internet]. 2011 Aug [cited 2012 Sep 26];118(8):1681–7. Available from: http://www.aaojournal.org/article/S0161-6420(11)00374-5/abstract Practical Ophthalmology: A Manual for Beginning Residents, 6th Edition [Paperback] American Academy Of Ophthalmology (Author), Fred M. Wilson II (Editor), MD (Editor)
Copyright	© openEHR Foundation
Authors	Author name: Ian McNicoll Organisation: Ocean Informatics, UK Email: ian.mcnicoll@oceaninformatics.com Date originally authored: 2012-07-18
Other Details Language	Author name: Ian McNicoll Organisation: Ocean Informatics, UK Email: ian.mcnicoll@oceaninformatics.com Date originally authored: 2012-07-18
OtherDetails Language Independent	{licence=This work is licensed under the Creative Commons Attribution-ShareAlike 3.0 License. To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/3.0/., custodian_organisation=openEHR Foundation, references=Visual Acuity [Internet]. Wikipedia. Available from: http://en.wikipedia.org/wiki/Visual_acuity Aylward W [Internet].Coding Visual Acuity, openEyes Project;2012.Available from http://www.openeyes.org.uk/documents/OpenEyes%20Coding%20Visual%20Acuity.pdf IHE Eye Care Domain. General Eye Evaluation (GEE) [Internet]. IHE; 2012. Available from: http://www.ihe.net/Technical_Framework/upload/IHE_EyeCare_Supp_GEE_Rev1-1_TI_2012-06-29.pdf Royal College of Opthalmologists. Cataract National Dataset for Adults [Internet]. 2011. Available from: http://www.rcophth.ac.uk/page.asp?section=583§ionTitle=Cataract+National+Data+Set+for+Adults Laidlaw D a. H, Tailor V, Shah N, Atamian S, Harcourt C. Validation of a computerised logMAR visual acuity measurement system (COMPlog): comparison with ETDRS and the electronic ETDRS testing algorithm in adults and amblyopic children. Br J Ophthalmol [Internet]. 2008 Feb 1 [cited 2012 Sep 26];92(2):241–4. Available from: http://bjo.bmj.com/content/92/2/241 CfH, UK. Do Once & Share - Glaucoma [Internet]. [cited 2012 Sep 26]. Available from: http://www.doasglaucoma.org/ DICOM Supplement 30 [Internet]. [cited 2012 Sep 26]. Available from: http://medical.nema.org/ Chiang MF, Boland MV, Brewer A, Epley KD, Horton MB, Lim MC, et al. Special Requirements for Electronic Health Record Systems in Ophthalmology. Ophthalmology [Internet]. 2011 Aug [cited 2012 Sep 26];118(8):1681–7. Available from: http://www.aaojournal.org/article/S0161-6420(11)00374-5/abstract Practical Ophthalmology: A Manual for Beginning Residents, 6th Edition [Paperback] American Academy Of Ophthalmology (Author), Fred M. Wilson II (Editor), MD (Editor), original_namespace=org.openehr, original_publisher=openEHR Foundation, custodian_namespace=org.openehr, MD5-CAM-1.0.1=879821BEB8228979F4409949787CC785, build_uid=f0ff443d-9158-4856-92cb-e38f9953b44e, ip_acknowledgements=This artefact includes content from SNOMED Clinical Terms® (SNOMED CT®) which is copyrighted material of the International Health Terminology Standards Development Organisation (IHTSDO). Where an implementation of this artefact makes use of SNOMED CT content, the implementer must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/snomed-ct/get-snomed or info@snomed.org., revision=0.0.1-alpha}
Keywords	eye, sight, vision, ophthalmic, visual, refraction
Lifecycle	in_development
UID	93b051f7-c9a6-4728-92aa-13a3af7114d5
Language used	en
Citeable Identifier	1013.1.7723
Revision Number	0.0.1-alpha
All	Archetype [runtimeNameConstraintForConceptName=null, archetypeConceptBinding=null, archetypeConceptDescription=Visual acuity is a measure of the spatial resolution of the visual processing system., archetypeConceptComment=null, otherContributors=Silje Ljosland Bakke, Norway Severin Kohler, Germany Lars Fuhrmann, Germany Bill Aylward, openEyes Project, UK Gustavo Bacelar-Silva, Brazil (Editor) Stephen Chu, NeHTA, Australia Alistair Laidlaw, Guys and St Thomas NHS Trust, UK Heather Leslie, Ocean Informatics, Australia Gustavo M Bacelar-Silva, Brazil Mike Mair, Timaru Eye Clinic, New Zealand Ian McNicoll, Ocean Informatics, United Kingdom (Editor), originalLanguage=en, translators= Norwegian Bokmål: Ingrid Heitmann, Arne Løberg Sæter, Oslo universitetssykehus HF, iheitman@ous-hf.no, arnelsa@gmail.com Spanish (Chile): Poblete Francisco, DuocUC, openehrfpoblete@gmail.com, . , subjectOfData=unconstrained, archetypeTranslationTree=null, topLevelToAshis={events=[ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134], code=at0134, itemType=POINT_EVENT, level=2, text=Any event, description=Default, unspecified point in time or interval event which may be explicitly defined in a template or at run-time., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=POINT_EVENT, bindings=null, values=null, extendedValues=null]], content=[], identities=[], description=[], relationships=[], target=[], ism_transition=[], data=[ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0007], code=at0007, itemType=ELEMENT, level=4, text=Eye(s) examined, description=The eye which is being examined, or both eyes. , comment=Binding to SNOMED Eye region body Structure codes for coherence with other archetypes, and mappability to .BodySite in FHIR, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0012::Left eye [The test result refers to the visual acuity of the left eye only.] [SNOMED-CT::726675003 \| Structure of left eye region] at0013::Right eye [The test result refers to the visual acuity of the right eye only.] [SNOMED-CT::726680007 \| Structure of right eye region] at0014::Both eyes simultaneously [Both eyes were examined simultaneously.] [SNOMED-CT::362508001 \| Both eyes, entire] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053], code=at0053, itemType=CLUSTER, level=4, text=Result details, description=Result details of a single visual acuity test., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=1.., cardinalityText= (Cardinality: 1.., unordered), subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0151], code=at0151, itemType=ELEMENT, level=5, text=Qualitative Measures, description=All measures of visual acuity that are not qualitative, such as "Sees hand Movements" or "Light perception"., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0152::HM - Hand movement [The subject can perceive hand movement.] [SNOMED-CT::260295004 \| Sees hand movements] at0153::CF - Count fingers [The subject can count fingers.] [LOINC::LA24679-5] at0154::PL - Perceives Light [The subject can perceive light] [SNOMED-CT::260296003 \| Perceives light only] at0155::PLAP - Perceives Light, accurate Projection [The subject can percieve light and indicate the direction of its source.] [SNOMED-CT::260297007 \| Perception of light - accurate projection] at0156::PLIP - Perceives Light, inaccurate Projection [The subject can perceive light, but inacurrately indicates the direction of its source.] [SNOMED-CT::260298002 \| Perception of light - inaccurate projection] at0157::CSMF - Central Steady Maintained Fixation [The (pediatric) subject fixates centrally, steadily and is able to maintain this over time.] [LOINC::LA25490-6] at0158::CUMF - Central Unsteady Maintained Fixation [The (pediatric) subject fixates centrally, unsteadily, and is able to maintain this over time.] [LOINC::LA25491-4] at0159::FF - Fix and Follow [The (pediatric) subject is able to fix and follow and object.] [LOINC::LA25492-2] at0160::BFL - Blinks for Light [The (pediatric) subject blinks in reponse to light.] [LOINC::LA25493-0] at0161::NPL - No Light Perception [The subject does not perceive light.] [SNOMED-CT::63063006 \| Visual acuity, no light perception] at0260::OtO - Objection to Occlusion [The (pediatric) subject objects to occlusion of the tested eye] at0280::NI - No Improvement [The performer only tested whether the specified, new correction allows the subject to reach a higher VA threshold, but this was not the case.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0294], code=at0294, itemType=ELEMENT, level=5, text=Decimal Notation, description=Notation commonly used in Europe, defined as the reciprocal of the minimum agle of resolution in arc minutes. Can be calculating by dividing the snellen ratio's numerator by its denominator., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_QUANTITY, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0295], code=at0295, itemType=ELEMENT, level=5, text=Meter Snellen Ratio, description=Snellen Ratio in meters, where the numerator is the (equivalent or real) desting distance in meters and the denominator is the distance in meters at which the spatial pattern would be separated by a visual angle of one minute of arc. This means the denominator is the distance in meters at which a person with 6/6 visual acuity could still read the line. , comment=Often used with the standard of 6 meters (6/x), which may or may not be the real testing distance. When M Notation is used, the nominator is also the real testing distance. , uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_PROPORTION, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0296], code=at0296, itemType=ELEMENT, level=5, text=Feet Snellen Ratio, description=Snellen Ratio in feet, where the numerator is usually 20 feet and the denominator is the distance in meters at which the spatial pattern would be separated by a visual angle of one minute of arc. This means the denominator is the distance in feet at which a person with 20/20 visual acuity could still read the line. , comment=In terms of the definition of the snellen ratio, the numerator should be the testing distance in feet, but usually it is 20 as this is the equivalent testing distance in terms of which the ratios are compared. , uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_PROPORTION, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0297], code=at0297, itemType=ELEMENT, level=5, text=logMAR, description=Base-10 Logarithm of the minimum angle of resolution. The notation used in the majority of scientific publications. , comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_QUANTITY, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0298], code=at0298, itemType=ELEMENT, level=5, text=Minimum Angle of Resolution, description=Minimum angle of resolution in arc minutes, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_QUANTITY, bindings=null, values=Property: Angle, plane Units: ', extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0299], code=at0299, itemType=ELEMENT, level=5, text=N Font Size Notation, description=N font size of the smallest recognized line or text. , comment=Strictly not a unit of Visual Acuity but a measure of symbol size commonly used in near vision testing. A known testing distance is required to estimate the visual angle, 30-40cm is typical for reading distances. , uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_QUANTITY, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0300], code=at0300, itemType=ELEMENT, level=5, text=Number of Recognized Optotypes, description=The number of optotypes correctly identified by the patient on the chart., comment=Commonly reffered to as "Letters read", but can be used for optotypes that are not Letters. Strictly not a measure of VA in itself, but commonly used for VA documentation. Testing distance and Chart Type are required to estimate visual acuity. , uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_QUANTITY, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0356], code=at0356, itemType=ELEMENT, level=5, text=1 Meter-baseline ETDRS Letter Score, description=The number of optotypes correctly identified by the patient on the chart, based on the definition on the ETDRS study. , comment=Used in study settings, this score describes either the number of optotypes identified (letters read): 1. Out of 30 at 1m distance. Or 2. Out of 70 at 4m distance. In which case the 30 letters from the 1m distance are added to the result. , uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_QUANTITY, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0301], code=at0301, itemType=ELEMENT, level=5, text=Visual Acuity Score, description=Visual Acuity Score, defined as: 100 - 50 x logMAR., comment=Used for Intuitive description of logarithmic VA Values, where higher values indicates better vision and 100 = 20/20 Vision. Also called Visual Acuity Rating, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_QUANTITY, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0355], code=at0355, itemType=ELEMENT, level=5, text=5-Score Notation, description=Defined as 5 - Logmar, widely used in China. , comment=Part of the Chinese national standard GB11533-1989., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_QUANTITY, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0302], code=at0302, itemType=ELEMENT, level=5, text=Jaeger Font Size, description=Jaeger font size of the smallest recognized line or text. , comment=Strictly not a unit of Visual Acuity but a measure of symbol size commonly used in near vision testing. A known testing distance is required to estimate the visual angle, 30-40cm is typical for reading distances. , uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_QUANTITY, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0193], code=at0193, itemType=CLUSTER, level=5, text=Derived Result, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=1.., cardinalityText= (Cardinality: 1.., unordered), subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0193]/items[at0306], code=at0306, itemType=ELEMENT, level=6, text=Qualitative Measures, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0307::HM - Hand movement [The subject can perceive hand movement.] [SNOMED-CT::260295004 \| Sees hand movements] at0308::CF - Count fingers [The subject can count fingers.] [LOINC::LA24679-5] at0309::PL - Perceives Light [The subject can perceive light] [SNOMED-CT::260296003 \| Perceives light only] at0310::PLAP - Perceives Light, accurate Projection [The subject can percieve light and indicate the direction of its source] [SNOMED-CT::260297007 \| Perception of light - accurate projection] at0311::PLIP - Perceives Light, inaccurate Projection [The subject can perceive light, but inacurrately indicates the direction of its source] [SNOMED-CT::260298002 \| Perception of light - inaccurate projection] at0312::CSMF - Central Steady Maintained Fixation [The (pediatric) subject fixates centrally, steadily and is able to maintain this over time] [LOINC::LA25490-6] at0313::CUMF - Central Unsteady Maintained Fixation [The (pediatric) subject fixates centrally, unsteadily, and is able to maintain this over time] [LOINC::LA25491-4] at0314::FF - Fix and Follow [The (pediatric) subject is able to fix and follow and object.] [LOINC::LA25492-2] at0315::BFL - Blinks for Light [The (pediatric) subject blinks in reponse to light.] [LOINC::LA25493-0] at0316::NPL - No Light Perception [The subject does not perceive light] [SNOMED-CT::63063006 \| Visual acuity, no light perception] at0317::OtO - Objection to Occlusion [The (pediatric) subject objects to occlusion of the tested eye] at0318::NI - No Improvement [The performer only tested whether the specified, new correction allows the subject to reach a higher VA threshold, but this was not the cae] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0193]/items[at0319], code=at0319, itemType=ELEMENT, level=6, text=Decimal Notation, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_QUANTITY, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0193]/items[at0320], code=at0320, itemType=ELEMENT, level=6, text=Meter Snellen Ratio, description=Snellen Ratio in Meters, where the numerator is the (equivalent or real) desting distance in meters and the denominator is the distance in meters at which the spatial pattern would be separated by a visual angle of one minute of arc. This means the denominator is the distance in meters at which a person with 6/6 visual acuity could still read the line. , comment=Often used with the standard of 6 meters (6/x), which may or may not be the real testing distance. When M Notation is used, the nominator is also the real testing distance. , uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_PROPORTION, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0193]/items[at0321], code=at0321, itemType=ELEMENT, level=6, text=Feet Snellen Ratio, description=Snellen Ratio in feet, where the numerator is usually 20 feet and the denominator is the distance in meters at which the spatial pattern would be separated by a visual angle of one minute of arc. This means the denominator is the distance in feet at which a person with 20/20 visual acuity could still read the line. , comment=In terms of the definition of the snellen ratio, the numerator should be the testing distance in feet, but usually it is 20 as this is the equivalent testing distance in terms of which the ratios are compared. , uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_PROPORTION, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0193]/items[at0322], code=at0322, itemType=ELEMENT, level=6, text=logMAR, description=Base-10 Logarithm of the Minimum Angle of resolution, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_QUANTITY, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0193]/items[at0323], code=at0323, itemType=ELEMENT, level=6, text=Minmum Angle of Resolution, description=Minimum angle of resolution in arc minutes, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=C_DV_QUANTITY, bindings=null, values=Property: Angle, plane Units: ', extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0193]/items[at0324], code=at0324, itemType=ELEMENT, level=6, text=N Font Size Notation, description=N Font size of the smallest recognized line or text. , comment=Strictly not a unit of Visual Acuity but a measure of symbol size commonly used in near vision testing. A known testing distance is required to estimate the visual angle, 30-40cm is typical for reading distances. , uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_QUANTITY, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0193]/items[at0325], code=at0325, itemType=ELEMENT, level=6, text=Number of Recognized Optotypes, description=The Number of Optotypes correctly identified by the patient on the Chart., comment=Commonly reffered to as "Letters read", but can be used for optotypes that are not Letters. Strictly not a measure of VA in itself, but commonly used for VA documentation. Testing distance and Chart Type are required to estimate visual acuity. , uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_QUANTITY, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0193]/items[at0326], code=at0326, itemType=ELEMENT, level=6, text=Visual Acuity Score, description=Visual Acuity Score, defined as: 100 - 50 x logMAR, comment=Used for Intuitive description of logarithmic VA Values, where higher values indicates better vision and 100 = 20/20 Vision. Also called Visual Acuity Rating, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_QUANTITY, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0193]/items[at0332], code=at0332, itemType=ELEMENT, level=6, text=Description of Derivation, description=A Text description used to describe the manner in which the derived results were determined. , comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0193]/items[at0357], code=at0357, itemType=ELEMENT, level=6, text=1 Meter-baseline ETDRS Letter Score, description=The number of optotypes correctly identified by the patient on the chart, based on the definition on the ETDRS study. , comment=Used in study settings, this score describes either the number of optotypes identified (letters read): 1. Out of 30 at 1m distance. Or 2. Out of 70 at 4m distance. In which case the 30 letters from the 1m distance are added to the result. , uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_QUANTITY, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0055], code=at0055, itemType=ELEMENT, level=5, text=No test result, description=No visual acuity test result is available for the test eye., comment=Record as True if the clinician was unable to record a result for the test eye., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=Allowed values: {true}, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0053]/items[at0140], code=at0140, itemType=ELEMENT, level=5, text=Reason for no test result, description=Reason why no visual acuity test result is available for the test eye., comment=For example, patient was not cooperative; patient was not capable; ran out of time., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0040], code=at0040, itemType=ELEMENT, level=4, text=Comment, description=Narrative comment about the visual acuity test., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=[SNOMED-CT::117364006 \| Narrative value], values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0333], code=at0333, itemType=ELEMENT, level=4, text=Interpretation, description=Interpretation of the Results, comment=Not to be used for information about how the test was performed or patient circumstances affecting result., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=Choice of: Text Coded Text , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0258], code=at0258, itemType=ELEMENT, level=4, text=BCVA/BRVA Tag, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0259::BCVA [This tags the VA test as the Best Corrected Visual Acuity, so as to not displace information about the actual correction used.] at0358::BRVA [This tags the VA test as the Best Recorded Visual Acuity during a specific encounter] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/data[at0003]/items[at0141], code=at0141, itemType=SLOT, level=4, text=Test not done, description=Details to explicitly record that this test was not performed., comment=null, uncommonOntologyItems=null, occurencesFormal=0.., occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include:* openEHR-EHR-CLUSTER.exclusion_exam.v1 and specialisations, extendedValues=null]], protocol=[ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0262], code=at0262, itemType=CLUSTER, level=2, text=Position in front of right eye, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..4, occurencesText=Optional, cardinalityFormal=1.., cardinalityText= (Cardinality: 1.., unordered), subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=[LOINC::29073-4 \| Right eye Position], values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0262]/items[at0263], code=at0263, itemType=ELEMENT, level=3, text=Type of Correction, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0264::Autorefraction-based trial Lenses [Trial Lenses with values based on an Autorefraction observation.] at0265::Subjective Refraction-based trial Lenses [Trial Lenses with values based on a subjective refraction.] at0266::Own Glasses [The corrective lens values are those of the currently owned glasses.] at0267::Hard Contact Lens [A hard contact lens was worn during the observation.] at0268::Soft Contact Lens [A soft contact lens was worn during the observation.] at0269::Subjective Refraction without Cycloplegia-based Trial Lenses [Trial Lenses with values based on a subjective refraction without cycloplegia.] at0270::Subjective Refraction with Cycloplegia-based Trial Lenses [Trial Lenses with values based on a subjective refraction with cycloplegia.] at0271::Retinoscopy-Based Trial Lenses [Trial Lenses with values based on retinoscopy.] [SNOMED-CT::726675003 \| Structure of left eye region] at0272::Trial Lenses [Trial lenses without a specific origin of the values used.] [SNOMED-CT::726680007 \| Structure of right eye region] at0273::Fogging lens [A Lens used to intentionally blur the vision in that eye.] [SNOMED-CT::362508001 \| Both eyes, entire] at0274::Pinhole Occluder [A pinhole occluder.] at0275::Subjective Overrefraction-based Trial Lenses [Trial Lenses with values based on subjective overrefraction. Typically used together with the corrective device that was present during overrefraction.] at0276::None - Uncorrected [There is explicitely nothing in front of the eye during the visual acuity testing.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0262]/items[at0080], code=at0080, itemType=SLOT, level=3, text=Lens Specification, description=Details of the refraction applied to each eye., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: openEHR-EHR-CLUSTER.lens_specification.v0, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0336], code=at0336, itemType=CLUSTER, level=2, text=Position in front of left eye, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=1.., cardinalityText= (Cardinality: 1.., unordered), subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=[LOINC::29074-2 \| Left eye Position], values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0336]/items[at0337], code=at0337, itemType=ELEMENT, level=3, text=Type of Correction, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0338::Autorefraction-based trial Lenses [Trial Lenses with values based on an Autorefraction observation] at0339::Subjective Refraction-based trial Lenses [Trial Lenses with values based on a subjective refraction] at0340::Own Glasses [The corrective lens values are those of the currently owned glasses] at0341::Hard Contact Lens [A hard contact lens was worn during the observation] at0342::Soft Contact Lens [A soft contact lens was worn during the observation] at0343::Subjective Refraction without Cycloplegia-based Trial Lenses [Trial Lenses with values based on a subjective refraction without cycloplegia] at0344::Subjective Refraction with Cycloplegia-based Trial Lenses [Trial Lenses with values based on a subjective refraction with cycloplegia] at0345::Retinoscopy-Based Trial Lenses [Trial Lenses with values based on retinoscopy] [SNOMED-CT::726675003 \| Structure of left eye region] at0346::Trial Lenses [Trial lenses without a specific origin of the Values used] [SNOMED-CT::726680007 \| Structure of right eye region] at0347::Fogging lens [A Lens used to intentionally blur the vision in that eye] [SNOMED-CT::362508001 \| Both eyes, entire] at0348::Pinhole Occluder [A pinhole occluder] at0349::Subjective Overrefraction-based Trial Lenses [Trial Lenses with values based on subjective overrefraction. Typically used together with the corrective device that was present during overrefraction] at0350::None - Uncorrected [There is explicitely nothing in front of the eye during the visual acuity testing] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0336]/items[at0354], code=at0354, itemType=SLOT, level=3, text=Lens Specification, description=Details of the refraction applied to each eye., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: openEHR-EHR-CLUSTER.lens_specification.v0, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0081], code=at0081, itemType=ELEMENT, level=2, text=Testing Distance, description=The distance at which the subject's visual acuity was measured., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=[SNOMED-CT::252124009 \| Test distance], values=Choice of: Quantity Coded Text at0223::Near [The test was performed at near distance, which typically refers to a distance below 50cm. There is no generally agreed cutoff.] at0224::Intermediate [The test was performed at intermediate distance, which typically refers to distances between 50cm and 2 Meters. There are no generally agreed cutoffs.] at0225::Far [The test was performed at far distance, which typically refers to distances at or above 4 meters, without a generally accepted cutoff.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0226], code=at0226, itemType=ELEMENT, level=2, text=General Method, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0227::Laser Interferometer [A Laser interferometer Device used to estimate potential visual acuity.] at0228::Near Card [A card that is typically held a reading distance, may depict optotoypes or segments of text.] at0229::Guyton and Minkowski Potential Acuity Meter [A Device used to estimate potential visual acuity.] at0230::Handheld Retinometer [A Handheld device used to estimate potential visual acuity.] at0231::Visual Acuity Chart [A chart, which may be a printed physical objected, projected or digitally displayed, typically depicts optotypes.] at0232::Preferential Looking Test [A test based on an infants tendency to fixate high-contrast gratings.] at0233::Fixation Testing [An indirect assessment of visual acuity based on the fixation behaviour.] at0234::Optokinetic Nystagmus Test [A Test based on the patient's ability to follow objects in motion.] at0235::Boeck's Candy Test [A Test based on children's ability to pick up candy beads of different sizes.] at0236::Visual Evoked Potential [A Test to estimate the Visual acuity based on the visual evoked potentials at different spacial frequencies.] at0237::Cardiff Acuity Test [A Test based on the principle of vanishing optotypes.] at0257::Electronic Visual Acuity Testing [Automated VA testing, typically used for research.] at0334::Near Reading Card [A near card with segments of text that are read by the patient.] at0335::Near Card with Optotypes [A near card depicting optotypes similar to a typical visual acuity chart.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0023], code=at0023, itemType=ELEMENT, level=2, text=Chart/Card Type, description=The charting method used to measure visual acuity., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0082::logMar chart [A logMar chart was used to measure visual acuity.] at0083::Snellen chart [A Snellen chart was used to measure visual acuity.] [SNOMED-CT::400913005 \| Snellen chart] at0084::ETDRS chart [An ETDRS chart was used to measure visual acuity.] [SNOMED-CT::400914004 \| ETDRS visual acuity chart] at0109::ETDRS Original Series Chart 1 [An ETDRS Original Series Chart 1 was used to measure acuity.] at0096::ETDRS Original Series Chart 2 [An ETDRS Original Series Chart 2 was used to measure acuity.] at0097::ETDRS Original Series Chart R [An ETDRS Original Series Chart R was used to measure acuity.] [SNOMED-CT::422673001 \| Snellen visual acuity] at0098::ETDRS Revised Series Chart 1 [An ETDRS Revised Series Chart 1 was used to measure visual acuity.] at0099::ETDRS Revised Series Chart 2 [An ETDRS Revised Series Chart 2 was used to measure visual acuity.] at0238::ETDRS Revised Series Chart 3 [An ETDRS Revised Series Chart 3 was used to measure visual acuity.] at0239::Golovin-Sitsev table [A Golovin-Sitsev table was used to measure visual acuity.] at0240::Monoyer Visual Acuity chart [A Monoyer Visual Acuity chart was used to measure visual acuity.] at0241::Cardiff Acuity Cards [Cardiff Acuity Cards were used to measure visual acuity.] at0242::Keeler Acuity Cards [Keeler Acuity Cards were used to measure visual acuity.] at0243::Teller Acuity Cards [Teller Acuity Cards were used to measure visual acuity.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0021], code=at0021, itemType=ELEMENT, level=2, text=Optotype, description=The style of chart optotype used to assess visual acuity., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0108::Pictogramm [Picture optotypes were used.] at0107::Orientation-Type Optotypes [Orientation-Type optotypes were used.] at0106::Letters [Letter optotypes were used.] at0206::Lea Symbol [Lea Symbol optotypes were used.] at0207::Kay Picture [Kay Picture optotypes were used.] at0208::Allen Picture [Allen Picture optotypes were used.] at0209::Auckland [Auckland optotypes were used.] at0210::Amsterdam Picture [Amsterdam Picture optotypes were used.] at0211::Landolt C [Landolt C optotypes were used.] at0212::Tumbling E [Tumbling E optotypes were used.] at0213::Numbers [Number optotypes were used.] at0214::Precision Vision Numbers [Precision Vision Number optotypes were used.] at0215::Lea Numbers [Lea Number optotypes were used.] at0216::Sloan Letters [Sloan Letter optotypes were used.] at0217::Cyrillic Letters [Cyrillic Letter optotypes were used.] at0218::Snellen Letters [Snellen Letter optotypes were used.] at0219::HOTV Letters [HOTV Letter optotypes were used.] at0220::LRVC Letters [LRVC Letter optotypes were used.] at0221::British Letters (2003) [British Letter (2003) optotypes were used.] at0222::European-Wide Letters [European-Wide Letter optotypes were used.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0252], code=at0252, itemType=ELEMENT, level=2, text=Optotype Presentation Modifiers, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0253::Single Optotype Presentation [A single Optotype at a time was shown to the subject.] at0254::Crowded Optotype Presentation [Crowded Optotypes were shown to the subject.] at0261::Line Optotype Presentation [A whole line of optotypes of the same size were shown to the subject at the same time.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0022], code=at0022, itemType=ELEMENT, level=2, text=Chart Scoring Algorithm, description=The alogrithm used to determine the score., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0100::Single letter [A single letter algorithm was used to derive the visual acuity score.] at0101::Whole line [A whole line algorithm was used to derive the visual acuity score.] at0102::Last line single letter [A last line single letter algorithm was used to derive the visual acuity score.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0244], code=at0244, itemType=ELEMENT, level=2, text=Background Luminance, description=This should be Candela Per Square meter., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_QUANTITY, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0256], code=at0256, itemType=ELEMENT, level=2, text=Ambient Lighting, description=The ambient lighting in the room where the visual acuity testing ist taking place, comment=may be described either as Illuminance or Luminance, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, 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comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=1.., cardinalityText= (Cardinality: 1.., unordered), subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0247]/items[at0245], code=at0245, itemType=ELEMENT, level=3, text=Weber Contrast, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_PROPORTION, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0247]/items[at0248], code=at0248, itemType=ELEMENT, level=3, text=Michelson Contrast, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_PROPORTION, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0247]/items[at0249], code=at0249, itemType=ELEMENT, level=3, text=RMS Contrast, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_PROPORTION, bindings=null, values=, extendedValues=null]], source=[], capabilities=[], contacts=[], provider=[], details=[], items=[], credentials=[], state=[ResourceSimplifiedHierarchyItem [path=/data[at0001]/events[at0134]/state[at0041]/items[at0112], code=at0112, itemType=ELEMENT, level=4, text=Patient circumstances affecting result, description=Patient circumstances or actions which affect interpretation of the result. Often termed 'reliability' in opthalmological documentation. May include maneuvers aiming to mediate confounders., comment=Examples: 'Patient was confused', "Lid held open by hand" "Excentric Fixation" , uncommonOntologyItems=null, occurencesFormal=0.., occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=null, values=Choice of:* Text Coded Text at0195::Mydriasis [SNOMED-CT::37125009 \| Dilated pupil] at0196::Lid Swelling [SNOMED-CT::193967004 \| Swelling of eyelid] at0197::Blepharospasm [SNOMED-CT::59026006 \| Blepharospasm] at0198::Confusion [SNOMED-CT::40917007 \| Clouded consciousness] at0199::Excentric Fixation [SNOMED-CT::246630002 \| Eccentric viewing] at0200::Manually holding lid open at0201::Uncooperative [SNOMED-CT::248042003 \| Uncooperative behavior] at0202::After anaestheric eyedrop application at0203::Good cooperation at0204::Lying in Bed [SNOMED-CT::17535004 \| Lying in bed] , extendedValues=null]], activities=[], other_participations=[], context=[]}, topLevelItems={data=ResourceSimplifiedHierarchyItem [path=ROOT_/data[at0001]/events[at0134]/data[at0003], code=at0003, itemType=ITEM_TREE, level=2, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=0..1, cardinalityText=optional, subCardinalityFormal=0.., subCardinalityText=Minimum of 0 items (Cardinality: 0.., unordered), dataType=ITEM_TREE, bindings=null, values=null, extendedValues=null], protocol=ResourceSimplifiedHierarchyItem [path=ROOT_/protocol[at0020], code=at0020, itemType=ITEM_TREE, level=0, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=0..1, cardinalityText=optional, subCardinalityFormal=0.., subCardinalityText=Minimum of 0 items (Cardinality: 0.., unordered), dataType=ITEM_TREE, bindings=null, values=null, extendedValues=null], state=ResourceSimplifiedHierarchyItem [path=ROOT_/data[at0001]/events[at0134]/state[at0041], code=at0041, itemType=ITEM_TREE, level=2, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=0..1, cardinalityText=optional, subCardinalityFormal=0.., subCardinalityText=Minimum of 0 items (Cardinality: 0.., unordered), dataType=ITEM_TREE, bindings=null, values=null, extendedValues=null]}, addHierarchyItemsTo=protocol, currentHierarchyItemsForAdding=[ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0262], code=at0262, itemType=CLUSTER, level=2, text=Position in front of right eye, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..4, occurencesText=Optional, cardinalityFormal=1.., cardinalityText= (Cardinality: 1.., unordered), subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=[LOINC::29073-4 \| Right eye Position], values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0262]/items[at0263], code=at0263, itemType=ELEMENT, level=3, text=Type of Correction, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0264::Autorefraction-based trial Lenses [Trial Lenses with values based on an Autorefraction observation.] at0265::Subjective Refraction-based trial Lenses [Trial Lenses with values based on a subjective refraction.] at0266::Own Glasses [The corrective lens values are those of the currently owned glasses.] at0267::Hard Contact Lens [A hard contact lens was worn during the observation.] at0268::Soft Contact Lens [A soft contact lens was worn during the observation.] at0269::Subjective Refraction without Cycloplegia-based Trial Lenses [Trial Lenses with values based on a subjective refraction without cycloplegia.] at0270::Subjective Refraction with Cycloplegia-based Trial Lenses [Trial Lenses with values based on a subjective refraction with cycloplegia.] at0271::Retinoscopy-Based Trial Lenses [Trial Lenses with values based on retinoscopy.] [SNOMED-CT::726675003 \| Structure of left eye region] at0272::Trial Lenses [Trial lenses without a specific origin of the values used.] [SNOMED-CT::726680007 \| Structure of right eye region] at0273::Fogging lens [A Lens used to intentionally blur the vision in that eye.] [SNOMED-CT::362508001 \| Both eyes, entire] at0274::Pinhole Occluder [A pinhole occluder.] at0275::Subjective Overrefraction-based Trial Lenses [Trial Lenses with values based on subjective overrefraction. Typically used together with the corrective device that was present during overrefraction.] at0276::None - Uncorrected [There is explicitely nothing in front of the eye during the visual acuity testing.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0262]/items[at0080], code=at0080, itemType=SLOT, level=3, text=Lens Specification, description=Details of the refraction applied to each eye., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: openEHR-EHR-CLUSTER.lens_specification.v0, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0336], code=at0336, itemType=CLUSTER, level=2, text=Position in front of left eye, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=1.., cardinalityText= (Cardinality: 1.., unordered), subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=[LOINC::29074-2 \| Left eye Position], values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0336]/items[at0337], code=at0337, itemType=ELEMENT, level=3, text=Type of Correction, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0338::Autorefraction-based trial Lenses [Trial Lenses with values based on an Autorefraction observation] at0339::Subjective Refraction-based trial Lenses [Trial Lenses with values based on a subjective refraction] at0340::Own Glasses [The corrective lens values are those of the currently owned glasses] at0341::Hard Contact Lens [A hard contact lens was worn during the observation] at0342::Soft Contact Lens [A soft contact lens was worn during the observation] at0343::Subjective Refraction without Cycloplegia-based Trial Lenses [Trial Lenses with values based on a subjective refraction without cycloplegia] at0344::Subjective Refraction with Cycloplegia-based Trial Lenses [Trial Lenses with values based on a subjective refraction with cycloplegia] at0345::Retinoscopy-Based Trial Lenses [Trial Lenses with values based on retinoscopy] [SNOMED-CT::726675003 \| Structure of left eye region] at0346::Trial Lenses [Trial lenses without a specific origin of the Values used] [SNOMED-CT::726680007 \| Structure of right eye region] at0347::Fogging lens [A Lens used to intentionally blur the vision in that eye] [SNOMED-CT::362508001 \| Both eyes, entire] at0348::Pinhole Occluder [A pinhole occluder] at0349::Subjective Overrefraction-based Trial Lenses [Trial Lenses with values based on subjective overrefraction. Typically used together with the corrective device that was present during overrefraction] at0350::None - Uncorrected [There is explicitely nothing in front of the eye during the visual acuity testing] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0336]/items[at0354], code=at0354, itemType=SLOT, level=3, text=Lens Specification, description=Details of the refraction applied to each eye., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: openEHR-EHR-CLUSTER.lens_specification.v0, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0081], code=at0081, itemType=ELEMENT, level=2, text=Testing Distance, description=The distance at which the subject's visual acuity was measured., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CHOICE, bindings=[SNOMED-CT::252124009 \| Test distance], values=Choice of: Quantity Coded Text at0223::Near [The test was performed at near distance, which typically refers to a distance below 50cm. There is no generally agreed cutoff.] at0224::Intermediate [The test was performed at intermediate distance, which typically refers to distances between 50cm and 2 Meters. There are no generally agreed cutoffs.] at0225::Far [The test was performed at far distance, which typically refers to distances at or above 4 meters, without a generally accepted cutoff.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0226], code=at0226, itemType=ELEMENT, level=2, text=General Method, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0227::Laser Interferometer [A Laser interferometer Device used to estimate potential visual acuity.] at0228::Near Card [A card that is typically held a reading distance, may depict optotoypes or segments of text.] at0229::Guyton and Minkowski Potential Acuity Meter [A Device used to estimate potential visual acuity.] at0230::Handheld Retinometer [A Handheld device used to estimate potential visual acuity.] at0231::Visual Acuity Chart [A chart, which may be a printed physical objected, projected or digitally displayed, typically depicts optotypes.] at0232::Preferential Looking Test [A test based on an infants tendency to fixate high-contrast gratings.] at0233::Fixation Testing [An indirect assessment of visual acuity based on the fixation behaviour.] at0234::Optokinetic Nystagmus Test [A Test based on the patient's ability to follow objects in motion.] at0235::Boeck's Candy Test [A Test based on children's ability to pick up candy beads of different sizes.] at0236::Visual Evoked Potential [A Test to estimate the Visual acuity based on the visual evoked potentials at different spacial frequencies.] at0237::Cardiff Acuity Test [A Test based on the principle of vanishing optotypes.] at0257::Electronic Visual Acuity Testing [Automated VA testing, typically used for research.] at0334::Near Reading Card [A near card with segments of text that are read by the patient.] at0335::Near Card with Optotypes [A near card depicting optotypes similar to a typical visual acuity chart.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0023], code=at0023, itemType=ELEMENT, level=2, text=Chart/Card Type, description=The charting method used to measure visual acuity., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0082::logMar chart [A logMar chart was used to measure visual acuity.] at0083::Snellen chart [A Snellen chart was used to measure visual acuity.] [SNOMED-CT::400913005 \| Snellen chart] at0084::ETDRS chart [An ETDRS chart was used to measure visual acuity.] [SNOMED-CT::400914004 \| ETDRS visual acuity chart] at0109::ETDRS Original Series Chart 1 [An ETDRS Original Series Chart 1 was used to measure acuity.] at0096::ETDRS Original Series Chart 2 [An ETDRS Original Series Chart 2 was used to measure acuity.] at0097::ETDRS Original Series Chart R [An ETDRS Original Series Chart R was used to measure acuity.] [SNOMED-CT::422673001 \| Snellen visual acuity] at0098::ETDRS Revised Series Chart 1 [An ETDRS Revised Series Chart 1 was used to measure visual acuity.] at0099::ETDRS Revised Series Chart 2 [An ETDRS Revised Series Chart 2 was used to measure visual acuity.] at0238::ETDRS Revised Series Chart 3 [An ETDRS Revised Series Chart 3 was used to measure visual acuity.] at0239::Golovin-Sitsev table [A Golovin-Sitsev table was used to measure visual acuity.] at0240::Monoyer Visual Acuity chart [A Monoyer Visual Acuity chart was used to measure visual acuity.] at0241::Cardiff Acuity Cards [Cardiff Acuity Cards were used to measure visual acuity.] at0242::Keeler Acuity Cards [Keeler Acuity Cards were used to measure visual acuity.] at0243::Teller Acuity Cards [Teller Acuity Cards were used to measure visual acuity.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0021], code=at0021, itemType=ELEMENT, level=2, text=Optotype, description=The style of chart optotype used to assess visual acuity., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0108::Pictogramm [Picture optotypes were used.] at0107::Orientation-Type Optotypes [Orientation-Type optotypes were used.] at0106::Letters [Letter optotypes were used.] at0206::Lea Symbol [Lea Symbol optotypes were used.] at0207::Kay Picture [Kay Picture optotypes were used.] at0208::Allen Picture [Allen Picture optotypes were used.] at0209::Auckland [Auckland optotypes were used.] at0210::Amsterdam Picture [Amsterdam Picture optotypes were used.] at0211::Landolt C [Landolt C optotypes were used.] at0212::Tumbling E [Tumbling E optotypes were used.] at0213::Numbers [Number optotypes were used.] at0214::Precision Vision Numbers [Precision Vision Number optotypes were used.] at0215::Lea Numbers [Lea Number optotypes were used.] at0216::Sloan Letters [Sloan Letter optotypes were used.] at0217::Cyrillic Letters [Cyrillic Letter optotypes were used.] at0218::Snellen Letters [Snellen Letter optotypes were used.] at0219::HOTV Letters [HOTV Letter optotypes were used.] at0220::LRVC Letters [LRVC Letter optotypes were used.] at0221::British Letters (2003) [British Letter (2003) optotypes were used.] at0222::European-Wide Letters [European-Wide Letter optotypes were used.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0252], code=at0252, itemType=ELEMENT, level=2, text=Optotype Presentation Modifiers, description=, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0253::Single Optotype Presentation [A single Optotype at a time was shown to the subject.] at0254::Crowded Optotype Presentation [Crowded Optotypes were shown to the subject.] at0261::Line Optotype Presentation [A whole line of optotypes of the same size were shown to the subject at the same time.] , extendedValues=null], ResourceSimplifiedHierarchyItem [path=/protocol[at0020]/items[at0022], code=at0022, itemType=ELEMENT, level=2, text=Chart Scoring Algorithm, description=The alogrithm used to determine the score., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values= at0100::Single letter [A single letter algorithm was used to derive the visual acuity score.] at0101::Whole line [A whole line algorithm was used to derive the visual 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