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a. The external layer is the fibrous coat that supports the eye.
2. The middle layer, or uvea, is vascular and heavily pigmented. It consists of the
choroid, the ciliary body, and the iris.
a. The choroid is the dark brown membrane located between the sclera and
the retina, lines most of the sclera. The choroid lines most of the sclera and
is attached to the retina but can detach easily from the sclera. The choroid
contains many blood vessels and supplies nutrients to the retina.
b. The ciliary body connects the choroid with the iris and secretes aqueous
humor that helps give the eye its shape
c. The iris is the colored portion of the eye, is located in front of the lens, and
has a central circular opening called the pupil. The muscles of the iris
contract and relax to control pupil size and the amount of light entering the
eye. The pupils control the amount of light that enters the eye and reaches
the retina. Darkness produces dilation. Light produces constriction.
o The optic fundus is the area at the inside back of the eye that can
be seen with an ophthalmoscope. This area contains the optic
disk, is a creamy pink to white depressed area in the retina. The
optic nerve enters and exits the eyeball at this area. This area is
called the blind spot because it contains only nerve fibers, lacks
photoreceptor cells, and is insensitive to light.
• Macula Lutea
The vitreous body contains a gelatinous substance that occupies the vitreous
chamber, which is the space between the lens and the retina.
D. Vitreous
It is a jell-like substance that maintains the shape of the eye. It also provides
additional physical support to the retina.
E. Aqueous humor
It is a clear watery fluid that fills the anterior and posterior chambers of the eye.
The anterior chamber lies between the cornea and the iris while the posterior
chamber lies between the iris and the lens. The aqueous humor is produced by the
ciliary processes, and passes from the posterior chamber, through the pupil, and
into the anterior chamber. The fluid drains into the canal of Schlemm.
F. Canal of Schlemm
The canal of Schlemm is a passageway that extends completely around the eye.
The canal permits fluid to drain out of the eye into the systematic circulation so a
constant intraocular pressure is maintained.
G. Lens
It is a transparent circular, convex structure behind the iris and in front of the
vitreous body. It bends rays of light so that the light falls/focus properly on the
retina.
External Structure
H. Eyelids
The eyelids are thin, movable folds of skin that protect the eyes, shut out light
during sleep, and keep the cornea moist. The upper eyelid is larger than the lower
one. The canthus is the place where the two eyelids meet at the corner of the eye.
I. Conjunctivae
J. Lacrimal gland
It produces tears and is located in the upper part of each orbit. Tears flow across
the front of the eye, toward the nose, and into the inner canthus. They drain
through the punctum (an opening at the nasal side of the lid edges), into the
lacrimal duct and sac, and then into the nose through the nasolacrimal duct.
K. Eye Muscles
Six voluntary muscles rotate the eye and coordinate eye movements.
Rectus muscles exert their pull when the eye turns temporally
Oblique muscles exert their pull when the eye turns nasally.
Together with the medial rectus, this muscle moves the eye
diagonally upward toward the middle of the head
Contracting alone, the muscle turns the eye toward the side of the
head
Contracting alone, this muscle turns the eye toward the nose.
Together with the lateral rectus, this muscle moves the eye
diagonally downward toward the side of the head
Together with the medial rectus, this muscle moves the eye
diagonally downward toward the middle of the head
L. Nerves
Cranial nerve II: optic nerve (nerve of sight), connecting the optic disc to the brain
Cranial nerve V: trigeminal (stimulates the blink reflex when the cornea is
touched)
Cranial nerve VII: facial (innervates the lacrimal glands and muscles controlling lid
closure)
M. Blood vessels
1. Ophthalmic artery is the major artery supplying the structures in the eye. This
artery branches to supply blood to the retina. The ciliary arteries supply the
sclera, choroid, ciliary body and iris.
Functions
Four eye function that provides clear images of near and far objects:
A. Refraction
The different curved surfaces and refractive media of the eye allow light to pass
through to the retina. Each surface and media bends (refracts) light differently to
focus an image on the retina
Emmetropia is the perfect refraction of the eye: with the lens at rest, light rays
from a distant source (6m or more) are focused into a sharp image on the retina.
Errors of refraction:
Hyperopia (hypermetropia or farsightedness) occurs when the eye does not refract
light enough. As a result, images actually fall (converge) behind the retina. It is
corrected with a convex lens in eyeglasses or contact lenses.
Myopia (Nearsightedness) occurs when the eye overrefracts or overbends the
light. As a result, images are focused in front of the retina. It is corrected with a
biconcave lens in eyeglasses or contact lenses.
Astigmatism is a refractive error caused by unevenly curved surfaces on or in the
eye, especially of the cornea. These uneven surfaces distort vision.
B. Pupillary Constriction
The pupil controls the amount of light that enters the eye. If the level of light to
one of both eyes is increased, both pupils constrict (become smaller). The amount
of constriction depends on how much light is available and how well the retina can
adapt to light changes.
Pupillary constriction is called miosis, and papillary dilatation is called mydriasis.
C. Accommodation
The process of maintaining a clear visual image when the gaze is shifted from a
distant to a near object is known as accommodation. The eye is able to adjust its
focus by changing the curve of the lens.
D. Convergence
Ciliary body
Posterior chamber
Pupil
Anterior chamber
Canal of Schlemm
Blood
Assessment of Vision
A. Acuity
• Snellen’s chart (eye chart) – simple tool that measures distance vision. The
clients stands 20 feet from the chart and covers one eye and uses the other
eye to read the line that appears most clearly.
o Have the client stand 20 feet from the chart, cover an eye, and use
the other eye to read the line that appears most clear. If the client
can do this accurately, ask him/her to read the next lower line.
Repeat the procedure with the other eye. Record findings as a
comparison between what the client can read at 20 feet and the
distance at which a person with normal vision can read the same line.
For example, 20/50 means that the client is able to see at 20 feet
from the chart what a “healthy eye” can see at 50 feet.
• Near Vision Testing – is test for clients who have difficulty reading and n
clients over 40 years of age. Use a small, handled Snellen chart called a
Rosenbaum Pocket Vision Screener or a Jaeger card. Ask the client to hold
the card 14 inches away from his or her eyes and read the characters. Test
each eye separately and then together. Record the value of the lowest line
on which the client can identify more than half the characters.
• During the test, sit facing the client and ask him or her to look directly into
your eyes while you look into the client’s eyes. Cover your right eye, and
have the client cover hor or her left eye so that you both have the same
visual field. Then move a finger or an object from the nonvisible area into
the client’s line of vision. The client with normal peripheral vision should
notice the object at about the same time to you. Repeat this examination by
covering your left eye and the client covering his or her right eye.
1. Corneal light reflex – determines alignment of the eyes. Ask the client to stare
straight ahead, shine a penlight at both corneas from a distance of 12 to 15
inches. The bright dot of light reflected from the shiny surface of the cornea
should be in a symmetric position. An asymmetric reflex indicates a deviating
eye and possible muscle imbalance.
2. Six cardinal positions of gaze - client holds head still and is asked to move eyes
and to follow a small object
3. Cover-uncover test – ask the client to use both eyes to look at a specific fixed
point, such as your nose. Then place a card over one of the client’s eyes, and
observe the uncovered eye to see if it moves to fix on the object. If muscle
function is normal, the eye does not move.
D. Color vision
1. Tests for color vision involve picking numbers or letters out of a complex and
colourful picture
2. Ishihara chart consists of numbers that are composed of colored dots located
within a circle of colored dots. The test is sensitive for the diagnosis of red
E. Ophthalmoscopy
This is to examine the external structures and the interior of the eye.
Procedure
a. Performing ophthalmoscopy, hold the instrument with your right hand when
examining the right eye and with your left hand when the examining the
left. Stand on the same side as the eye being examined. Tell the client to
look straight ahead at an object on the wall behind you.
b. When using the ophthalmoscope, move towards the client’s eye from about
12 to 15 inches away and to the side of his or her line of vision. As you
direct the ophthalmoscope at the pupil, a red glare (red reflex) should be
seen in the pupil. The red reflex is a reflexion of the light of the retina. An
absent red reflex may indicate a lens opacity or cloudiness of the vitreous.
Intervention
a. Instruct the client that he or she will be positioned in a confined space and will
need to keep their heads still during the procedure
a. It has replaced CT in many settings for looking at the orbits and the optic
nerves.
4. Radioisotopic Scanning – are used to locate tumors and lesions in various body
organs. Isotope studies differentiate an intraocular tumor from a hemorrhage,
especially in the choroid layer.
Client preparation:
a. Informed consent. The client receives a tracer dose of the radioactive isotope,
either orally or by injection
Procedure:
a. The client is asked to lie still and breathe normally. The scanner measures the
radioactivity emitted by the radioactive atoms concentrated in the area being
studied. Clients who are anxious or agitated may require sedation
Postprocedure
a. Assure the client that the amount of radioisotope used is small and that he or
she is not radioactive. No other special follow-up care is required.
5. Slit lamp – it allows examination of the anterior ocular structures under
microscopic magnification. The client leans on a chin rest to stabilize the head
while a narrowed beam of light is aimed so that it illuminates only a narrow
segment of the eye is brightly lighted.
Intervention
a. Advise the client about the brightness of the light and the need to look forward
at point over the examiner’s ear
6. Corneal staining – a topical dye is instilled into the conjuctival sac to outline
irregularities of the corneal surface that are not easily visible. The eye is viewed
through a blue filter, and a bright green color indicates areas of a non-intact
corneal epithelium. Is used for corneal trauma, problems caused by contact lens,
or the presence of foreign bodies, abrasion, ulcers or other corneal disorders.
Procedure
a. Noninvasive and performed under aseptic conditions.
b. The dye is applied topically to the eye, and then viewed through a blue filter.
Nonintact areas of cornea stain a bright green color.
Interventions
b. The client is instructed to blink after the dye has been applied to distribute the
dye evenly across the cornea
Interventions
b. The client is asked to stare forward at a point above the examiner’s ear
e. The client must be instructed to avoid rubbing the eye following the
examination if the eye has been anesthetized because the potential for
scratching the cornea exists.
8. Ultrasonography – used to examine the orbit and eye with high-frequency sound
waves. This noninvasive test aids in the diagnosis of trauma, intraorbital tumors,
proptosis, and choriodal or retinal detachments/
Client Preparation:
a. Explain the test to the client and instill the anesthetic drops into the lower lid
b. Caution the client to avoid rubbing the eye.
c. Seat the client upright with his or her chin in the chin rest
Procedure
a. The probe is touched against the client’s anesthesized cornea and sound waves
are bounced through the eye.
b. The sound waves return to the transducer when they strike a non-fluid filled
structure. Structures that reflect sound waves are the cornea, anterior, and
posterior lens capsule, and retina.
c. When these reflected sound waves return to the transducer, a “spike” pattern
appears on the screen
Postprocedure
a. Remind the client not to rub or bump the eye until the effects of the anesthetic
drops have worn off
9. Electroretinography – is the process of graphing the retina’s response to light
stimulation. This test is helpful in detecting and evaluating blood vessel changes
from a disease or drugs. The graph is obtained by placing a contact lens electrode
on an anesthesized cornea. Lights at varying speeds and intensities are flashed,
and the neural response is graphed.
Preparation
a. Includes instilling an anesthetic into the eye
b. Remind the client to avoid rubbing the eye until the effects of the anesthetic
have disappeared.
3. Knowledge deficit
4. Grieving
5. Disturbed self-esteem
6. Hopelessness
2. To prevent overflow of medication into the nasal and pharyngeal passages, thus
reducing systemic absorption, instruct the client to apply pressure over the inner
canthus next to the nose for 30 seconds to 1 minute following administration of
the medication
3. If both an eye drop and an eye ointment are scheduled to be administered at the
same time, administer the eye drop first.
4. Wash hands before administering eye medications to avoid contaminating the eye
or medication dropper or applicator and after administering eye medications to
rinse off any residue
5. Use a separate bottle or tube of medication for each client to avoid accidental
cross-contamination
6. Place prescribed dose of eye medication in the lower conjunctival sac, never
directly onto the cornea
7. Avoid touching any part of the eye with the dropper or applicator
10.Instruct the client how to instill medication until the client can do it safely
11.Instruct the client to read the medication labels carefully to ensure administration
of the correct medication and strength.
14.Inform the client that he or she may be unable to drive home after eye
examinations when medications to dilate the pupil (mydriatics) or medications to
paralyze the ciliary muscle (cycloplegics) are used
15.If photophobia occurs, instruct the client to wear sunglasses and avoid bright lights
16.Instruct the client to administer a missed dose of the eye medication as soon as
remembered, unless the next dose is scheduled to be administered in 1 to 2 hours
17.Inform the client with glaucoma that the disorder cannot be cured, only controlled
19.Inform the client that medications used to treat glaucoma may cause pain and
blurred vision, especially when therapy is begun
21.Instruct the client using eye gel to store the gel at room temperature or in the
refrigerator but not to freeze it
22.Instruct the client to discard unused eye gel kept at room temperature after 8
weeks
23.Inform the client that soft contact lenses may absorb certain eye medications and
that preservatives in eye medications may discolour the contact lenses.
24.Advise the client wearing contact lenses to question the physician carefully about
special precautions to observe
25.In infants, inform the parents that atrophine sulphate eye drops may contribute to
abdominal distention
26.Instruct the parents to keep a record of the infant’s bowel movements of atrophine
sulphate eye drops are being administered
27.Auscultate bowel sounds of the infant or child receiving atrophine sulphate eye
drops
B. Side effects
Superinfection
2. Global irritation
C. Interventions
5. Advise the client that if improvement does not occur to notify the physician
ANTIBACTERIAL
Chloramphenicol
(Chloromycetin, Chloroptic)
Erythromycin (Ilotycin)
ANTIFUNGAL
Natamycin (Natacyn)
ANTIVIRAL
Idoxuridine (Stoxil, Herplex)
Trifluridine (Viroptic)
Vidarabine (Vira-A)
SULFONAMIDES
Sulfacetamide (Bleph-10,
Sulamyd)
Sulfisoxadole (Gantrisin)
A. Description
B. Side Effects
1. Cataracts
2. Increased IOP
3. Impaired healing
C. Interventions
2. Note that dexamethasone (Maxidex) should not be used for eye abrasions
and wounds
CORTICOSTERIODS
Betamethasone (Betnesol)
Dexamethasone (Maxidex)
Fluorometholene (FML-S Ophthalmic
Suspension, FML)
Medrysone (HMS Liquifilm)
Prednisolone (Pred-Forte, Predair-A)
NONSTEROIDAL ANTIINFLAMMATORY
AGENTS
Diclofenac (Voltaren)
Flurbiprofen sodium (Ocufen)
Ketorolac tromethamine (Acular)
A. Description
2. Topical anesthetics are used for anesthesia for eye examinations and
surgery or to remove foreign bodies from the eye
B. Side Effects
C. Interventions
2. Note that the medications should not be given to the client for home use
and are not to be self-administered by the client
3. Note that the blink reflex is lost temporarily and that corneal epithelium
needs to be protected
4. Provide an eye patch to protect the eye from injury until the corneal reflex
returns
Topical Anesthetics for the Eye
Proparacaine hydrochloride
(Ophthaine, Ophthetic)
Tetracaine hydrochloride
(Pontocaine)
EYE LUBRICANTS
A. Description
4. Eye lubricants are used for keratitis, during anesthesia, or in a disorder that
results in unconsciousness or decreased blinking
B. Side Effects
1. Burning on instillation
C. Interventions
Eye Lubricants
Hydroxypropyl methylcellulose (Lacril,
Isopto Plain)
Petroleum-based ointment (artificial
tears, Liquifilm Tears
MIOTICS
A. Description
2. Miotics open the anterior chamber angle and increase the outflow of
aqueous humor
B. Side Effects
1. Myopia
2. Headache
3. Eye pain
5. Local irritation
6. Systemic effects
a. Flushing
b. Diaphoresis
d. Frequent urination
e. Increased salivation
f. Muscle weakness
g. Respiratory difficulty
7. Toxicity
b. Bradycardia
c. Hypotension
d. Cardiac dysrhythmias
e. Tremors
f. Seizures
C. Interventions
11.Instruct the client to avoid activities such as driving while vision is impaired
Miotics
Carbachol (Carboptic)
Demecarium bromide
(Humorsol)
Echothiophate (Phospholine
Iodide)
Isoflurophate (Floropryl)
Pilocarpine hydrochloride
(Isopto Carpine
OCULAR SYSTEM
A. Description
B. Interventions
4. Inform the client that temporary stinging is expected but to notify the
physician of blurred vision or brow pain occurs
5. Instruct the client to check for the presence of the disk in the conjunctival
sac daily at bedtime and on arising
6. Because vision may change in the first few hours after the eye system is
inserted, instruct the client to replace the disk at bedtime
A. Description
4. Use these medications with caution in the client receiving oral β-blockers
B. Side Effects
1. Ocular irritation
2. Visual disturbances
3. Bradycardia
4. Hypotension
5. Bronchospasm
C. Interventions
8. Instruct the client to change positions slowly because of the potential for
orthostatic hypotension
D. Adrenergic medications
1. Adrenergic medications decrease the production of aqueous humor and lead
to a decrease in IOP
Adrenergic Medications
Epinephrine (Epifrin,
Glaucon)
Hydroxyamphetamine
(Paradrine)
Naphazoline (Allerest,
Vasoclear)
Oxymethazoline (OcuClear)
Phenylephrine (AK-Nephrin,
Prefin)
Tetrahydrozoline (Murine
Plus, Visine)
OSMOTIC MEDICATIONS
A. Description
B. Side Effects
1. Headache
3. Disorientation
4. Electrolyte imbalances
C. Interventions
5. Monitor weight
Osmotic Medications
for the Eye
Glycerin (Osmoglyn)
Mannitol (Osmitrol)
A. Functions
1. Hearing
2. Maintenance of balance
B. External Ear
a. The External ear is embedded in the temporal bone bilaterally at the level of
the eyes
b. The external ear extends from the auricle through the external canal to the
tympanic membrane or eardrum
c. The external ear includes the mastoid process, which is the bony ridge
located over the temporal bone
C. Middle Ear
a. The Middle ear consists of the medial side of the tympanic membrane
1. Malleus
2. Incus
3. Stapes
d. The middle ear is protected from the inner ear by the round and the oval
window membranes.
e. The Eustachian tube opens into the middle ear and allows for equalization of
pressure on both sides of the tympanic membrane
D. Inner Ear
a. The inner ear contains the semicircular canals, the cochlea, and the distal
end of the eighth cranial nerve
b. The semicircular canals contain fluid and hair cells connected to sensory
nerve fibers of the vestibular portion of the eighth cranial nerve
e. The organ of Corti (within the cochlea) is the receptor and organ of hearing
b. The middle ear, also called the tympanic cavity, conducts sound waves to
the inner ear
c. The middle ear is filled with air, which is kept at atmospheric pressure by
opening of the Eustachian tube
d. The inner ear contains sensory receptors for sound and for equilibrium
e. The receptors in the inner ear transmit sound waves and changes in body
position to the nerve impulses
A. Otoscopic examination
1. The speculum is never introduced blindly into the external canal because of the
risk of perforating the tympanic membrane
2. The client’s head is titled slightly away and the ostoscope is held upside down
as if it were a large pen, for this permits the examiner’s hand to lay against the
client’s head for support
3. Pull the pinna up and back to straighten the external canal in adult
5. The normal external canal is pink and intact without lesions and with various
amounts if cerumen and fine little hairs
6. Assess the tympanic membrane for intactness; the normal tympanic membrane
is intact, without perforations, and should be free from lesions.
B. Auditory assessment
C. Voice Test
D. Watch test
2. The examiner holds a ticking watch about 5 inches from each ear and asks the
client if the ticking is heard
c. The client is asked whether the sound is heard equally in both ears or
whether the sound is louder in one ear
e. If the client hears the sound louder in one ear, the term lateralization is
applied to the side hearing the loudest.
f. Such a finding may indicate that the client has a conductive hearing loss in
the ear to which the sound is lateralized or that sensorineural hearing loss
has occurred in the opposite ear
a. The test compares the client’s hearing by air conduction and bone
conduction.
c. The vibrating tuning fork stem is placed on the client’s mastoid process and
the client is asked to indicate when he or she no longer hears the sound
d. The examiner quickly brings the tuning fork in front of the pinna without
touching the client and asks the client to indicate if he or she still hears the
sound
e. The client normally continues to hear the sound 2 times longer in front of
pinna; such results are a positive Rinne Test
g. If the client is unable to hear the sound through the ear in front of the pinna,
the client may have a conductive hearing loss on the side tested; in this
situation, the bone conduction is greater than the air conduction (negative
Rinne test)
F. Vestibular assessment
a. The examiner asks the client to stand with the feet together
and arms hanging loosely at the side and eyes closed
b. The client closes the eyes and extends the arms on front,
pointing both index fingers at the examiner
c. The examiner holds and touches his or her own extended index
fingers under the extended index fingers of the client to give the client
a point of reference.
d. The client is instructed to raise both arms and then lower them,
attempting to return to the examiner’s extended index fingers
e. The normal test response is that the client can easily return to
the point of reference
j. Hallpike’s manuever
A. Tomography
1. Description
b. Tomography assesses the mastoid, middle ear, and inner ear structures
2. Interventions
b. Lead eye shields are used to cover the cornea to diminish the radiation
dose to the eyes
B. Audiometry
1. Description
a. Audiometry measures hearing acuity
2. Interventions
C. Electronystagmography
1. Description
2. Interventions
g. In addition, the client’s ears are irrigated with cool and warm water,
which may cause nausea and vomiting.
h. Following the procedure, the client begins taking clear fluids slowly and
cautiously because nausea and vomiting may occur
OTIC MEDICATIONS
Administration of drops
1. In an adult, pull the pinna up and back to straighten the external canal to instill ear
drops
2. Pull the pinna down and back for infants and children younger than 3 years of age;
up and back for older children
3. Warm irrigating solution to 98⁰F because solutions that are not close to the client’s
body temperature will cause ear injury, nausea, and vertigo
5. When irrigating, do not direct irrigation solution directly toward the eardrum
DIURETICS
Acetazolamide (Diamox)
Ethacrynic acid (Edecrin)
Furosemide (Lasix)
OTHERS
Cisplatin (Platinol, Platinol-AQ)
Nitrogen mustard
Quinine (Quinamm)
Quinidine (Cardioquin, Quinaglute, Quinidex)
A. Description
B. Side Effects
C. Interventions
5. Instruct the client to report dizziness, fatigue, fever, or sore throat, which
may indicate a superimposed infection
A. Description
B. Side Effects
1. Drowsiness
2. Blurred vision
C. Interventions
1. Inform the client that drowsiness, blurred vision, and a dry mouth may occur
2. Instruct the client to increase fluid intake unless contraindicated and to suck
on hard candy to alleviate dry mouth
Antihistamine and
Decongestants
Astemizole (Hismanal)
Brompheniramine (Bromphen,
Dimetan)
Cetirizine (Zyrtec)
Chlorpheniramine (Chlor-
Trimeton, Teldrin)
Clemastine (Tavist)
Naphazoline hydrochloride
(Allerest, Albalon)
Terfenadine (Seldane)
Triprolidine and
pseudoephedrine (Actifed)
LOCAL ANESTHETICS
A. Description
B. Side Effects
1. Allergic reaction
2. Irritation
C. Interventions
Local Anesthetic
Benzocaine (Americaine Otic,
Tympagesic)
CEREMINOLYTIC MEDICATIONS
A. Description
2. Used to loosen and removed impacted wax from the ear canal
B. Side Effects
1. Irritation
C. Interventions
1. Instruct the client not to use drops more often than prescribed
5. Thirty minutes after instillation, gently irrigate the ear as prescribed with
warm water using a soft rubber bulb ear syringe
7. For a chronic cerumen impaction, 1 to 2 drops of mineral oil will soften the
wax
Ceruminolytic Medications
Boric Acid (Ear-Dry)
Carbamide peroxide (Debrox)
Trolamine polypeptide oleate-
condensate (Cerumenex)
• The resolution of the human eye is equivalent to a 81 MP (megapixel) camera and a hawk's is 8 times better than that!
• The human eye actually sees everything upside-down and it's the brain that actually inverts the image right-way-up again
• The visual pathway contributes up to 65% of all brain pathways and is responsible for up to 85% of our knowledge
• The eye is the second most complex organ in the body after the brain
• The eye has over 2 million working parts and processes 36,000 bits of information every hour
In the term "20/20 vision", the numerator refers to the distance in feet between the subject and the chart. The denominator is the distance at which the lines that
make up those letters would be separated by a visual angle of 1 arc minute, which for the lowest line that is read by an eye with no refractive error (or the errors
corrected) is usually 20 feet. The metric equivalent is 6/6 vision where the distance is 6 metres. This means that at 20 feet or 6 metres, a typical human eye,
able to separate 1 arc minute, can resolve lines with a spacing of about 1.75mm. 20/20 vision can be considered nominal performance for human distance
vision; 20/40 vision can be considered half that acuity for distance vision and 20/10 vision would be twice normal acuity. The 20/x number does not directly relate
to the eyeglass prescription required to correct vision, because it does not specify the nature of the problem with the lens, only the resulting performance.
Instead an eye exam seeks to find the prescription that will provide at least 20/20 vision
Hermann Snellen
Vernier acuity measures the ability to align two line segments. Humans can do this with remarkable accuracy. Under optimal conditions of good illumination, high
contrast, and long line segments, the limit to vernier acuity is about 8 arc seconds or 0.13 arc minutes, compared to about 0.6 arc minutes (20/12) for normal
visual acuity or the 0.4 arc minute diameter of a foveal cone. Because the limit of vernier acuity is well below that imposed on regular visual acuity by the "retinal
grain" or size of the foveal cones, it is thought to be a process of the visual cortex rather than the retina.