What is the most important test in eye care? All you mad scientists are jumping in with fundus photography, OCT,  visual fields and on and on. After all, these help us enhance and protect our patients’ eye health. What’s more important than that? 

Well, after all the tests are run and you have destroyed your patient’s will to live with seemingly endless data collection, do you know what they really care about? Can they see.  

Seeing 20/Whatever Works

So, the most important test is good ol’ visual acuity (VA). I don’t know if Snellen and his buddies were vaping CBD or what, but they decided 20/20 is what a “normal” person should be able to see. Interestingly, with computers now running (or “ruining”) our lives, no one reads a black 20/20 on a white background in a dimly lit room. Thus, the goal of 20/20 has become 20/happy.  

My first eye exam as a kid didn’t even include a Snellen chart. Our family physician, Dr. Peck, figured if I could read the headlines of the Montgomery Herald taped on the wall, that would be good enough. He was right. 

 I have many patients who are, at best, 20/40 and correctable to 20/10 who would rather have a toenail removed by a lawnmower than have to wear glasses.  

I often ask this seemingly simple question (this is considered correct English where I come from): “Do you wanna see as good as you can see?”Of course 100% of patients immediately reply, “Yes!” Bull.  

I follow up with: “What if you had to swim across the Kanawha River when it’s 10 degrees outside and there’s 14 inches of snow on the ground? Still wanna see as good as you can see?” “No.” 

VA only means something to us. Patients just want to be 20 years younger, not to see as best they can. Our job is to convince them that they want to spot a bus before it slams into their car and it’s good to not feel like death warmed over after straining at a computer all day. 

Once I had been in practice for something like 25 years, I decided to finally listen to the patient. If they didn’t complain at all about their distance vision, even when measuring 20/60, unless they drove a church bus, I spent about 18 seconds planting a small seed about distance visual needs for future reference; I spent the rest of my time working on what they do gripe about.   

Handle VAs With Care

But, insurance companies love VAs and expect at least some attempt to record them. So we do. However, never, ever, allow a staff member to take a VA in these circumstances:

  1. A multifocal contact lens follow-up visit. A 20/happy patient doesn’t realize their left eye is only 20/30-2. Leave them in bliss.
  2. Myopia control children. If dad’s with them, you’ll have a lot of ’splaining to do if Suzi subjectively reports, “That looks fuzzy.” Avoid. 
  3. Any recheck in children. Just make a professional judgment and recheck their Rx with 20/40 or bigger. I’m not joking. 

You can do VAs, if you want, on any post-op patient, but stick them behind a foggy phoropter and start from known blur. Never burst their bubble with 20/20 off the bat. 

VA testing is, no doubt, the most important test we do; not because it helps the patient, but because it can make or break you if not handled with aplomb.