A 42-year-old woman presents to urgent care with bilateral red eyes for the past 2 days. She reports no pain or vision disturbance but complains of some itchiness and opaque discharge in both eyes throughout the day. She usually wears contact lenses but did not put them in today due to the discharge. The patient’s partner drove her to the appointment, and she forgot to bring her glasses. Which of the following statements regarding visual acuity testing for this patient is CORRECT?
a. Visual acuity testing is not possible for this patient because she needs corrective lenses but does not have them with her.
b. Visual acuity testing is not necessary because the patient did not report any problems with her vision.
c. Visual acuity testing is necessary and should be measured for this patient using the pinhole method or another strategy.
d. Visual acuity testing is not necessary in this case because it’s obvious that this patient has infectious conjunctivitis.
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Answer: C. Visual acuity should be considered a vital sign for any patient with an eye complaint. It should always be tested in each eye individually and in both eyes together. While it is ideal for the patient to be tested while wearing their prescribed glasses, other options are acceptable if the patient does not have their glasses. One option is to have the patient look through a pinhole created by using an 18-gauge needle or object of similar size to punch a small hole in a thick piece of paper. This method can correct some refractive errors and help compensate for missing glasses. The patient may also hold a handheld ophthalmoscope and adjust the dial up or down with the lens until the image is clear. If neither of these strategies is available, ask the patient to count fingers held up at a short distance or ask if they can see your hand motion while waving. Even asking a patient about their ability to perceive light will provide some data on their vision.
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