Report Of Eye Examination (Page 2 of 2) in pdf

Report Of Eye Examination Page 2

INSTRUCTIONS FOR EXAMINING DOCTOR

1. ACUITY:

Tested with standard, accurate, properly illuminated Snellen

Chart or Projection Chart at 20’ and 16’. Acuity, distance, and near vision

in each eye must be correctable to at least 20/30. If unaided acuity is at

least 20/30 in each eye, applicant will be encouraged (but not required) to

obtain corrective lenses if vision can be improved.

2. COLOR PERCEPTION:

Tested with Ishihara Charts or equivalent.

Applicant must be trichromatic and readily able to discern red, green, and

yellow. Failure to do so is disqualifying.

3. FUSION:

Tested with Worth 4-dot. Diplopia or suppression is

disqualifying.

Applicant must have single, simultaneous, binocular vision.

DEPTH PERCEPTION:

Tested with Howard-Dolman apparatus. N.B.:

This is the only acceptable test for depth perception. Stereopsis testing is

not a suitable substitute. Applicant must be tested at 20’ and able to align

pegs within ± 2 cm of each other.

5. E.O.M.:

ESO or exophoria greater than 15 prism diopters and/or

hyperphoria greater than 2 prism diopters is disqualifying. Strabismus of

any degree is disqualifying, as is nystagmus.

6. FIELD OF VISION:

Tested on any standard perimeter. Applicant must

have uninterrupted horizontal binocular field of at least

Any scotoma

1400.

other than physiologic is disqualifying.

OPTHALMOSCOPY:

Any degeneration of or active pathology of the

retina,

uveal tract, lens, or cornea that could adversely affect vision is

disqualifying.

HSMV 62042 (REV. 03/00)

Report Of Eye Examination Page 2