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)
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 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: 1FE1C872230E16D59BA7AFABF76F4B72
- Build Uid: c15bd6f2-adf3-48da-8f5e-f4ccbbd1ece1
- 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
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.]
- Laser Interferometer [A laser interferometer device was used to estimate potential visual acuity.]
- Near Card [A card that is typically held a reading distance, may depict optotoypes or segments of text.]
- Guyton and Minkowski Potential Acuity Meter [A device used to estimate potential visual acuity.]
- Handheld Retinometer [A handheld device used to estimate potential visual acuity.]
- Visual acuity chart [A chart, which may be a printed physical objected, projected or digitally displayed, typically depicts optotypes.]
- Preferential looking test [A test based on an infants tendency to fixate high-contrast gratings.]
- Optokinetic nystagmus test [A test based on the patient's ability to follow objects in motion.]
- Visual evoked potential [A test to estimate the Visual acuity based on the visual evoked potentials at different spacial frequencies.]
- Cardiff Acuity Test [A Test based on the principle of vanishing optotypes.]
- Electronic visual acuity testing [Automated VA testing, typically used for research.]
- Near reading card [A near card with segments of text that are read by the patient.]
- Near card with optotypes [A near card depicting optotypes similar to a typical visual acuity chart.]
- Refractometer-integrated test [The stimulus is displayed in a refractometer device.]
- logMar chart [A logMar chart was used to measure visual acuity.]
- Snellen chart [A Snellen chart was used to measure visual acuity.]
[SNOMED-CT::400913005 | Snellen chart] - ETDRS chart [An ETDRS chart was used to measure visual acuity.]
[SNOMED-CT::400914004 | ETDRS visual acuity chart] - ETDRS Original Series Chart 1 [An ETDRS Original Series Chart 1 was used to measure acuity.]
- ETDRS Original Series Chart 2 [An ETDRS Original Series Chart 2 was used to measure acuity.]
- ETDRS Original Series Chart R [An ETDRS Original Series Chart R was used to measure acuity.]
[SNOMED-CT::422673001 | Snellen visual acuity] - ETDRS Revised Series Chart 1 [An ETDRS Revised Series Chart 1 was used to measure visual acuity.]
- ETDRS Revised Series Chart 2 [An ETDRS Revised Series Chart 2 was used to measure visual acuity.]
- ETDRS Revised Series Chart 3 [An ETDRS Revised Series Chart 3 was used to measure visual acuity.]
- Golovin-Sitsev table [A Golovin-Sitsev table was used to measure visual acuity.]
- Monoyer Visual Acuity chart [A Monoyer Visual Acuity chart was used to measure visual acuity.]
- Cardiff Acuity Cards [Cardiff Acuity Cards were used to measure visual acuity.]
- Keeler Acuity Cards [Keeler Acuity Cards were used to measure visual acuity.]
- Teller Acuity Cards [Teller Acuity Cards were used to measure visual acuity.]
- Pictogramm [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 ptotypes 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 arbitratry scale specific to the device used.
Choice of:
Quantity
Property: null
Units: arb. unit
Coded Text- Low
- Medium
- High
Include:
openEHR-EHR-CLUSTER.device.v1 and specialisations
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.
- Autorefraction-based lenses [Lenses with values based on an autorefraction test.]
- Subjective Refraction-based lenses [Lenses with values based on a subjective refraction.]
- Own Glasses [The corrective lens values are those of the currently owned glasses.]
- Hard Contact Lens [A hard contact lens.]
- Soft Contact Lens [A soft contact lens.]
- Subjective Refraction without cycloplegia-based lenses [Lenses with values based on a subjective refraction without cycloplegia.]
- Subjective Refraction with cycloplegia-based Trial Lenses [Lenses with values based on a subjective refraction with cycloplegia.]
- Retinoscopy based lenses [Lenses with values based on retinoscopy.]
[SNOMED-CT::726675003 | Structure of left eye region] - Corrected [Lenses without a specific origin of the values were used.]
[SNOMED-CT::726680007 | Structure of right eye region] - Fogging lens [A Lens used to intentionally blur the vision in that eye.]
[SNOMED-CT::362508001 | Both eyes, entire] - 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 Lenses [Lenses with values based on subjective overrefraction. Typically used together with the corrective device that was present during overrefraction.]
- None - Uncorrected [There is explicitely nothing in front of the eye during the visual acuity testing.]
Include:
openEHR-EHR-CLUSTER.lens_
Include:
openEHR-EHR-CLUSTER.device.v1 and specialisations
For monocular tests where the partner eye is fully occluded, this can be "The eye being tested". There may be exceptionns, 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.]
Examples: 'Patient was confused', "Lid held open by hand" "Excentric Fixation"
Choice of:
Text- Coded Text
- Mydriasis
[SNOMED-CT::37125009 | Dilated pupil] - Lid Swelling
[SNOMED-CT::193967004 | Swelling of eyelid] - Blepharospasm
[SNOMED-CT::59026006 | Blepharospasm] - Confusion
[SNOMED-CT::40917007 | Clouded consciousness] - Excentric Fixation
[SNOMED-CT::246630002 | Eccentric viewing] - Manually holding lid open
- Uncooperative
[SNOMED-CT::248042003 | Uncooperative behavior] - After anaestheric eyedrop application
- Good cooperation
- Lying in Bed
[SNOMED-CT::17535004 | Lying in bed]
- Mydriasis
Binding to SNOMED Eye region body Structure codes for coherence with other archetypes, and mappability to .BodySite in FHIR
- 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, reffering to a binocular vision test.]
[SNOMED-CT::362508001 | Both eyes, entire]
- HM - Hand movement [The subject can perceive hand movement.]
[SNOMED-CT::260295004 | Sees hand movements] - CF - Count fingers [The subject can count fingers.]
[LOINC::LA24679-5] - PL - Perceives Light [The subject can differentiate the absence or presence of light]
[SNOMED-CT::260296003 | Perceives light only] - 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] - 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] - NPL - No Light Perception [The subject can not perceive light.]
[SNOMED-CT::63063006 | Visual acuity, no light perception] - 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.]
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.
- Ratio
- Fraction
In terms of the definition of the snellen ratio, the numerator is may be 20 independent of the actual testing distance. as this is the equivalent testing distance in terms of which the ratios are compared. A 20 as denominator does not imply actual 20 ft desting distance.
- Ratio
- Fraction
This notation 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.
Can be calculating 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.
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 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.
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. 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.
Part of the Chinese national standard GB11533-1989.
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.
Line-based scoring means lines are scored in their entirety based on whether a certain threshhold (typically 50 or 60%) of their letters were read corretly. 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 persons and institutions 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 successully 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.]
Record as True if the clinician was unable to record a result for the test eye.
For example, patient was not cooperative; patient was not capable; ran out of time.
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.
- 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.
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 definied in different settings. These classifiers do not contain information on the actual correction used, which can be recorded within the right/left aid poisition clusters.
- BCVA [This result is classified as a Best Corrected Visual Acuity.]
- BRVA [This result is classified as a Best Recorded Visual Acuity.]
Include:
openEHR-EHR-CLUSTER.exclusion_
Ideally, this would include a description of the process how the lens powers of the best correction are determined.
This is typically a rectrospective comparison of visual acuity measures of the same eye on the same day or the same encounter. Ideally, this would include a description of the the comparison is performed. Specifically, whether measurements aided by pinhole occluder were excluded or not.
- Single letter [A single letter algorithm was used to derive the visual acuity score.]
- Whole line [A whole line algorithm was used to derive the visual acuity score.]
- Last line single letter [A last line single letter algorithm was used to derive the visual acuity score.]
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.]
Include:
openEHR-EHR-CLUSTER.device.v1 and specialisations
For example: local information requirements or additional metadata to align with FHIR or CIMI equivalents.
Include:
All not explicitly excluded archetypes
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, .