Telehealth Visual Acuity Test Instructions 1 Print the second page of this document 2 Select a well lighted room that is at least 10 feet long 3 Tape or pin the printed chart on a bare wa ID: 954259
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TO FIND AN EYE DOCTOR NEAR YOU VISIT VISIONSOURCE.COM/FIND Telehealth Visual Acuity Test Instructions: 1. Print the second page of this document . 2. Select a well - lighted room that is at least 10 feet long . 3. Tape or pin the printed chart on a bare wall, level with your eyes as you stand. 4. Measure 10 feet from the wall you have selected to tape or pin your chart. You will stand here during the testing. 5. If you wear glasses or contact lenses for distance vision, the glasses or contact lenses should be worn during the test . 6. While standing at your 10 - foot marker, cover one eye with your hand without applying any pressure.
Make sure you have your eye fully covered during testing. 7. Read the letters starting from the top. Continue to the bottom row or until the letters are too difficult to see . 8. Write down the number of the smallest line seen correctly (the line with the majority of the letters correctly identified). Example: If you were able to read 5 out of 8 letters on line 8, you would write 20/2 0. 9. Now repeat the test with the other eye covered and record the results. **Keep your results saved so they may be reported to your doctor during your telehealth evaluation. PLACE CHART 10 FEET AWAY TO FIND AN EYE DOCTOR NEAR YOU VISIT VISIONSOURCE.COM/FIND