You record 20/30, because J2 equals the 20/30 distance-equivalent line on the near card. Near cards print more than one scale beside each line of print. Jaeger notation gives each line an arbitrary number, such as J1 or J2. The distance equivalent gives the same line a Snellen fraction instead. His line carries both labels, so you simply write the one your office uses.
The near acuity test measures fine central vision at a normal reading distance. The card is held at the distance printed on it, usually 14 inches. If his reading glasses are made for another distance, test at that distance too and write the distance down. The Jaeger number is only a label and is not a measure of distance or of print size in inches. Other near systems exist, such as the point system and the Snellen M unit. Because the systems do not match each other, mixing them makes visits look different when vision has not changed. Near testing is done when a patient complains about reading or close work. It is also done when accommodation, the eye's focusing effort, may be weak. All children should have near vision tested, even with no complaint. Patients who wear distance glasses or contacts keep them on for the test. A contact lens wearer in monovision, with one eye set for distance, needs a plus lens of +1.25 to +2.50 held over that eye.
Learn your office's near notation and use it every time, and always note the testing distance. Knowing how Jaeger, distance-equivalent, and point notations line up is part of the COA visual assessment content area.
Incorrect Answers
- A. 20/20 is the smallest line on the near card. It sits below the J2 line, so recording it would overstate his reading vision.
- B. 20/25 is a different distance-equivalent line. It is a real line on the near card, but the J2 label belongs to the 20/30 line.
- D. 20/40 is a worse line than J2 and would make his near vision look poorer than the card shows. A wrong entry here can look like real change at his next visit.
Testing Pearls
- J2 = 20/30 on the near card's distance-equivalent scale.
- Hold the near card at the distance printed on it, usually 14 inches.
- Near notation systems include Jaeger, distance equivalent, point, and Snellen M unit.
- Test near vision with and without the reading correction on a first visit.
- Every child gets near vision tested, complaint or not.
References
- American Academy of Ophthalmology. Ophthalmic Medical Assisting: An Independent Study Course. Chapter 8, Comprehensive Medical Eye Examination.
