Implementation of a Novel Near Visual Acuity Chart in an Emergency Department Setting

Area of Science:

• Ophthalmology
• Emergency Medicine
• Diagnostic Tools

Background:

• Visual acuity (VA) measurement in emergency departments (EDs) is often inconsistent due to patient immobility and non-standardized conditions.
• Accurate VA assessment is crucial for timely diagnosis and treatment in ED settings.

Purpose of the Study:

• To evaluate the impact of implementing the Runge Sloan letter near card on the frequency and consistency of VA testing in a hospital ED.
• To assess the agreement of VA measurements between non-ophthalmic ED technicians and ophthalmology physicians-in-training.

Main Methods:

• A previously validated, novel VA chart, the Runge Sloan letter near card, was implemented in a hospital ED.
• Two hundred seventeen hospital ED ophthalmology consult records were retrospectively analyzed.
• Frequency of VA measurement and agreement between technicians and residents were assessed before and after implementation.

Main Results:

• Missed technician VA evaluations decreased significantly from 36% to 21% after implementing the Runge card (p = .01).
• The proportion of VA measurements differing by ≤2 lines between technicians and residents was 51%, improving to 64% with pinhole testing (p < .05).
• Pinhole testing significantly increased agreement in patients with good VA (>20/80) from 58% to 73% (p < .05).

Conclusions:

• Implementation of the Runge card improved the frequency of VA measurements in the ED.
• Combining the Runge card with pinhole testing enhanced the agreement rates of VA measurements.
• Training ED staff on the use of the Runge card shows utility for improving VA testing in emergency settings.