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)
Organisation: Ocean Informatics, UK
Email: ian.mcnicoll@oceaninformatics.com
Date originally authored: 2012-07-18
Organisation: Ocean Informatics, UK
Email: ian.mcnicoll@oceaninformatics.com
Date originally authored: 2012-07-18
- 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 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: AEE2714D5EA0AA848757915F07A9D9DE
- Build Uid: 1bdc17b0-6f58-4e19-a4a7-4899bd5d255d
- 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
The physical examination of the eye will be recorded using the CLUSTER.exam-eye family of archetypes. Use the 'Clinical evidence' archetype nested within the 'Additional details' SLOT to record structured details about relevant eye examination findings. Coding with a terminology is recommended. Free text entry should only be permitted if no appropriate coded value is available.
Choice of:
Coded Text- Normal [The pupil is in its natural physiological state without pharmacological intervention or pathological changes.]
- Medically induced mydriasis [The pupil was dilated due to prior administration of mydriatic agents.]
- Medically induced miosis [The pupil was constricted due to prior administration of miotic agents.]
- Pathological pupil state [The pupil was in an unphysiological state due to disease, trauma, or structural abnormalities.]
Text
Examples: 'Patient was confused', "Lid held open by hand" "Excentric Fixation"
Choice of:
- Text
- Coded Text
- Lid Swelling [Swelling of the eyelid was present, potentially obscuring part of the visual field during testing.]
[SNOMED-CT::193967004 | Swelling of eyelid] - Blepharospasm [Involuntary spasm of the eyelid muscles was present during testing.]
[SNOMED-CT::59026006 | Blepharospasm] - Confusion [The individual was confused or disoriented during testing, affecting the reliability of responses.]
[SNOMED-CT::40917007 | Clouded consciousness] - Eccentric fixation [The individual used an area of the retina other than the fovea for fixation during testing.]
[SNOMED-CT::246630002 | Eccentric viewing] - Manually holding lid open [The eyelid required manual support to remain open during testing.]
- Uncooperative [The individual was unable or unwilling to cooperate with testing instructions.]
[SNOMED-CT::248042003 | Uncooperative behavior] - After anaesthetic eyedrop application [A topical anaesthetic agent had been applied to the eye prior to testing.]
- Lying in Bed [The test was performed with the individual in a supine or recumbent position.]
[SNOMED-CT::17535004 | Lying in bed]
- Lid Swelling [Swelling of the eyelid was present, potentially obscuring part of the visual field during testing.]
Where multiple devices are positioned in front of the same eye, this cluster is expected to be used once for each. Example: Pinhole occluder and phoropter lenses being used at the same time.
For monocular tests where the partner eye is fully occluded, this can be "The eye being tested". There may be exceptions, such as when the eye that is not being tested explicitely has a fogging lens in front of it to blur, but not block all vision. In binocular tests, this element is expected to occur once with "right eye" and once with "left eye" for each aid placed in front of the eyes.
- Left eye [The left eye was examined.]
[SNOMED-CT::726675003 | Structure of left eye region] - Right eye [The right eye was examined.]
[SNOMED-CT::726680007 | Structure of right eye region] - The eye being tested [The aid was in front of the eye being tested. For monocular test where the other eye is occluded, this is the default value.]
Which eye it is in front of depends on the value of the "In front of which eye" element. Note that this is not exclusive of devices that are not corrective, such as defocus or fogging lenses. Avoid using the generic value "Corrected" (at0382) where a more specific correction-origin code is applicable.
Choice of:
- Coded Text
- Autorefraction-based correction [A correction with powers based on an autorefraction test.]
- Subjective refraction-based correction [A correction with powers based on a subjective refraction.]
- Glasses [Glasses were used as an aid.]
- Rigid contact lens [A rigid contact lens correction was used. Sometimes called hard contact lens.]
- Soft contact lens [A soft contact lens.]
- Retinoscopy based correction [A correction with values based on retinoscopy.]
- Corrected [Lenses without a specific origin of the values were used.]
- Fogging lens [A lens used to intentionally blur the vision in that eye.]
- Pinhole occluder [A pinhole occluder was used which is a device with small holes that act as apertures. Sometimes used together with lenses.]
- Subjective overrefraction-based correction [A correction with values based on subjective overrefraction was used.]
- Unaided [There is explicitly nothing in front of the eye during the visual acuity testing.]
- Text
- Cycloplegic refraction [The correction used was based on a measurement of refractive error in a cycloplegic state.]
- Non-cycloplegic refraction [The correction used was based on a measurement of refractive error in a non-cycloplegic state.]
Property: Refractive power
Units: -100.0..100.0 dioptre
Limit decimal places: 2
Property: Refractive power
Units: -100.0..100.0 dioptre
Limit decimal places: 2
Property: Angle, plane
Units: 0.0..180.0 °
Limit decimal places: 1
Property: Refractive power
Units: dioptre
Include:
openEHR-EHR-CLUSTER.device.v1 and specialisations
Include:
All not explicitly excluded archetypes
Ideally, this would include a description of how the lens powers of the best correction are determined.
This is typically a retrospective comparison of visual acuity measures of the same eye on the same day or the same encounter. Ideally, this would include a description of how the comparison is performed. Specifically, whether measurements aided by pinhole occluder were excluded or not.
May be described either as Illuminance or Luminance.
Choice of:
Quantity
Property: Illuminance
Units: lx- Coded Text
- Photopic [Bright or Daylight conditions, where cone function dominates.]
- Mesopic [Twilight conditions, where both rods and cones are active.]
- Scotopic [Dark Conditions, where rod function dominates.]
For example: local information requirements or additional metadata to align with FHIR or CIMI equivalents.
Include:
All not explicitly excluded archetypes
- Left eye [The left eye was examined.]
[SNOMED-CT::726675003 | Structure of left eye region] - Right eye [The right eye was examined.]
[SNOMED-CT::726680007 | Structure of right eye region] - Both eyes simultaneously [Both eyes were examined simultaneously, typically to assess binocular visual acuity.]
[SNOMED-CT::362508001 | Both eyes, entire]
Light Projection testing is not a VA test, use OBSERVATION.light_projection_test.v0 instead.
- Hand movement [The individual perceived hand movements.]
[SNOMED-CT::260295004 | Sees hand movements] - Count fingers [The individual correctly counted fingers.]
[LOINC::LA24679-5] - Light perception [The individual correctly identified the absence or presence of light.]
[SNOMED-CT::260296003 | Perceives light only] - No light perception [The individual was unable to identify the absence or presence of light.]
[SNOMED-CT::63063006 | Visual acuity, no light perception]
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 numerator is also the real testing distance.
- Ratio
- Fraction
In terms of the definition of the snellen ratio, the numerator may be 20 independent of the actual testing distance. It is s the equivalent testing distance in terms of which the ratios are compared.
- Ratio
- Fraction
This notation is used in the majority of scientific publications. When users enter visual acuity test results using decimal numbers, such as 0.5, it needs to be ensured that the intended notation (decimal, logMAR or others) is known to both the user and the software, and the appropriate element is used.
Property: Qualified real
Units: 1{LogMAR}
Can be calculated by dividing the snellen ratio's numerator by its denominator. When users enter visual acuity test results using decimal numbers, such as 0.5, it needs to be ensured that the intended notation (decimal, logMAR or others) is known to both the user and the software, and the appropriate element is used.
Property: Qualified real
Units: 1{DecimalVA}
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.
Commonly referred 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.
min: >=0; max: <=400
Commonly 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 as they are presumed readable. An ETDRS letter score of 85 is equivalent to 20/20, 1.0 decimal, 0.0 logMAR. Conversion of this notation requires understanding of testing procedures and intended meaning.
min: >=0; max: <=100
Part of the Chinese national standard GB11533-1989.
Property: Qualified real
Units: 1{5PointVA}
The Jaeger font sizes denoted by the same number are known to vary from card to card.
1: J1 [Jaeger font size 1.]
2: J2 [Jaeger font size 2.]
3: J3 [Jaeger font size 3.]
4: J4 [Jaeger font size 4.]
5: J5 [Jaeger font size 5.]
6: J6 [Jaeger font size 6.]
7: J7 [Jaeger font size 7.]
8: J8 [Jaeger font size 8.]
9: J9 [Jaeger font size 9.]
10: J10 [Jaeger font size 10.]
11: J11 [Jaeger font size 11.]
12: J12 [Jaeger font size 12.]
13: J13 [Jaeger font size 13.]
14: J14 [Jaeger font size 14.]
15: J15 [Jaeger font size 15.]
16: J16 [Jaeger font size 16.]
17: J17 [Jaeger font size 17.]
18: J18 [Jaeger font size 18.]
19: J19 [Jaeger font size 19.]
20: J20 [Jaeger font size 20.]
Used in grating based tests such as teller acuity cards.
Property: null
Units: arb. unit
Used in grating based tests such as teller acuity cards.
Property: null
Units: arb. unit
Used in near visual acuity testing.
Line-based scoring means lines are scored in their entirety based on whether a certain threshold (typically 50 or 60%) of their letters were read correctly. Based on this scoring method, it is correct to note the smallest line where that threshold was reached as the visual acuity grade and that is what is expected based on ISO standards. Some practitioners additionally record the number of missed letters in the smallest scored line (negative count), the fact that there were missed letters in the smallest scored line (partial) or the number or letters read beyond the smallest scored line (positive count).
Choice of:
Count
min: >=-9; max: <=9- Coded Text
- partial [Some symbols were not read correctly in the smallest line that was scored as being successfully read, which is not unusual as the line being scored as correct requires 50 or 60% of symbols being identified correctly. Not actually part of line-based scoring, and a bit controversial but commonly used anyway.]
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 numerator is also the real testing distance.
- Ratio
- Fraction
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.
- Ratio
- Fraction
Typically 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 as they are presumed readable. Typically, an ETDRS letter score of 85 is equivalent to 20/20, 1.0 decimal, 0.0 logMAR. Conversion of this notation requires precise understanding of testing procedures and intended meaning.
Used in grating based tests such as teller acuity cards.
Property: null
Units: arb. unit
Ideally to be used in conjunction with the quantitative element for testing distance.
- Near [The test was performed at near distance, which typically refers to a distance below 50cm. There is no generally agreed cutoff.]
- Intermediate [The test was performed at intermediate distance, which typically refers to distances between 50cm and 2 Meters. There are no generally agreed cutoffs.]
- Far [The test was performed at far distance, which typically refers to distances at or above 4 meters, without a generally accepted cutoff.]
The stimulus may be a virtual image.
- Printed chart or card [A printed chart or card was used.]
- Electronic chart display [An electronic display was used.]
- Projected chart [A chart projector was used.]
- Physical object [Physical objects other than Charts or Cards were used,]
- Integrated virtual chart display [A chart presented as a virtual image inside a device, such as an autorefractor.]
Choice of:
- Coded Text
- logMAR chart [A logMAR chart was used.]
- Snellen chart [A Snellen chart was used.]
[SNOMED-CT::400913005 | Snellen chart] - ETDRS chart [An ETDRS chart was used.]
[SNOMED-CT::400914004 | ETDRS visual acuity chart] - ETDRS original series chart 1 [An ETDRS original series chart 1 was used.]
- ETDRS original series chart 2 [An ETDRS original series chart 2 was used.]
- ETDRS original series chart R [An ETDRS original series chart R was used.]
- ETDRS revised series chart 1 [An ETDRS revised series chart 1 was used.]
- ETDRS revised series chart 2 [An ETDRS revised series chart 2 was used.]
- ETDRS revised series chart 3 [An ETDRS revised series chart 3 was used.]
- Golovin-Sitsev table [A Golovin-Sitsev table was used.]
- Monoyer chart [A monoyer visual acuity chart was used.]
- Cardiff acuity cards [Cardiff acuity cards were used.]
- Keeler acuity cards [Keeler acuity cards were used.]
- Berkeley rudimentary vision test [Berkeley rudimentary vision test was used. Note that white field projection or black/white discrimination is not a measure of VA.]
- Near reading card [A near card with segments of text that are read by the individual was used.]
- LEA grating acuity test [LEA gratings, a type of preferential looking test was used.]
- Teller acuity cards [Teller acuity cards were used.]
- Cardiff acuity test [The Cardiff acuity test was used.]
- Allen picture test [The allen picture test was used.]
- Sheridan letter test [The Sheridan letter test was used.]
- Cambridge crowding cards [Cambridge crowding cards were used.]
- MNREAD chart [A MNREAD acuity chart was used.]
- Radner Reading Chart [A RADNER reading chart was used.]
- Freiburg visual acuity test [The Freiburg visual acuity test was used.]
- Sheridan gardiner test [The Sheridan Gardiner test was used.]
- Sonksen silver test [The Sonksen silver test was used]
- Text
Include:
openEHR-EHR-CLUSTER.device.v1 and specialisations
- Pictogram [Picture optotypes were used.]
- Orientation-Type Optotypes [Orientation-Type optotypes were used.]
- Letters [Letter optotypes were used.]
- Lea Symbol [Lea Symbol optotypes were used.]
- Kay Picture [Kay Picture optotypes were used.]
- Allen Picture [Allen Picture optotypes were used.]
- Auckland [Auckland optotypes were used.]
- Amsterdam Picture [Amsterdam Picture optotypes were used.]
- Landolt C [Landolt C optotypes were used.]
- Tumbling E [Tumbling E optotypes were used.]
- Numbers [Number optotypes were used.]
- Precision Vision Numbers [Precision Vision Number optotypes were used.]
- Lea Numbers [Lea Number optotypes were used.]
- Sloan Letters [Sloan Letter optotypes were used.]
- Cyrillic Letters [Cyrillic Letter optotypes were used.]
- Snellen Letters [Snellen Letter optotypes were used.]
- HOTV Letters [HOTV Letter optotypes were used.]
- LRVC Letters [LRVC Letter optotypes were used.]
- British Letters (2003) [British Letter (2003) optotypes were used.]
- European-wide letters [European-wide letter optotypes were used.]
Differentiating crowded from uncrowded optotypes is especially relevant in children and those with a suspicion of Amblyopia.
- Single Optotype Presentation [A single optotype at a time was displayed.]
- Crowded Optotype Presentation [Crowded optotypes were displayed.]
- Line Optotype Presentation [A whole line of optotypes of the same size were displayed at the same time.]
- Uncrowded Optotype Presentation [Uncrowded optotypes were displayed.]
This does not include the room lighting and the typical lighting of the stimulus. Optotype Projectors, Digital Chart Displays and Lightboxes all contain light sources, but these are not considered "ancillary".
- Glare Light [A light source was directed at the eye to induce glare.]
- Brightness Acuity Test [A handheld Ganzfeld illumination device was used to simulate environmental brightness.]
- None [No ancillary lighting was used.]
This does not refer to a physical measure of light intensity, but rather the setting used to produce it, which may be on an arbitrary scale specific to the device used.
Choice of:
- Quantity
Property: null
Units: arb. unit - Coded Text
- Low [The ancillary lighting source was set to its lowest intensity setting.]
- Medium [The ancillary lighting source was set to a medium intensity setting.]
- High [The ancillary lighting source was set to its highest intensity setting.]
Include:
openEHR-EHR-CLUSTER.device.v1 and specialisations
Used where a determination of the visual acuity with the additional aid was not deemed sufficiently important to warrant being performed.
Choice of:
- Coded Text
- No improvement with additional pinhole [No improvement beyond the recorded result was noted after addition of a pinhole.]
- No Improvement with subjective refraction-based correction [No improvement beyond the recorded result was noted using corrective lenses based on subjective refraction.]
- No improvement with autorefraction-based correction [No improvement beyond the recorded result was noted after addition of corrective lenses based on an autorefraction test.]
- No Improvement with retinoscopy-based correction [No improvement beyond the recorded result was noted after addition of corrective lenses based on retinoscopy.]
- No Improvement with glasses [No improvement beyond the recorded result was noted after the addition of corrective glasses.]
- No improvement with soft contact lens [No improvement beyond the recorded result was noted after the addition of a soft contact lens.]
- No improvement with rigid contact lens [No improvement beyond the recorded result was noted after the addition of a rigid or hard contact lens]
- No Improvement with further correction [No improvement beyond the recorded result was noted after the addition of an unspecified correction.]
- Text
It is a common but controversial practice to comment "partial" where the last line was not read entirely even in line-based scoring. This is covered by the "Letters missed or read in addition to scored line" element.
Choice of:
- Text
- Coded Text
Not to be used for information about how the test was performed or patient circumstances affecting result.
Choice of:
- Text
- Coded Text
There is significant variation to how these terms are defined in different settings. These classifiers do not contain information on the actual correction used, which can be recorded within the right/left aid position clusters.
Choice of:
- Coded Text
- BCVA [This result is classified as a Best Corrected Visual Acuity.]
- BRVA [This result is classified as a Best Recorded Visual Acuity.]
- Text
Include:
openEHR-EHR-CLUSTER.exclusion_
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)
- 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, .