610800 Pediatric Near Contrast Score Sheet - PDF - Good-Lite ...
610800 Pediatric Near Contrast Score Sheet - PDF - Good-Lite ...
610800 Pediatric Near Contrast Score Sheet - PDF - Good-Lite ...
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<strong>Near</strong> <strong>Contrast</strong> Testing <strong>Score</strong> <strong>Sheet</strong><br />
Use this sheet to document the raw scores. Make copies as needed.<br />
Patient Name:______________________________ Date:________________<br />
OD:_________ OS:_________ Note: Use separate for for each eye<br />
The number of letters read correctly = the number of points<br />
Test<br />
Acuity Level-ETDRS<br />
Letters<br />
Snellen<br />
LogMAR<br />
# items<br />
per row<br />
<strong>Contrast</strong> Level - Letter Charts<br />
100% 25% 10%<br />
# items<br />
read in<br />
error<br />
calculate the<br />
# of items<br />
read<br />
correctly<br />
# items<br />
per row<br />
# items read<br />
in error<br />
calculate the<br />
# of items<br />
read<br />
correctly<br />
# items<br />
per row<br />
# items read<br />
in error<br />
calculate the<br />
# of items<br />
read<br />
correctly<br />
# items<br />
per row<br />
5%<br />
# items read<br />
in error<br />
calculate the<br />
# of items<br />
read<br />
correctly<br />
# items<br />
per row<br />
2.5%<br />
# items read<br />
in error<br />
calculate the<br />
# of items<br />
read<br />
correctly<br />
# items<br />
per row<br />
1.25%<br />
# items read<br />
in error<br />
calculate the<br />
# of items<br />
read<br />
correctly<br />
20/400 1.3 5 5 5 5 5 5<br />
20/320 1.2 5 5 5 5 5 5<br />
20/250 1.1 5 5 5 5 5 5<br />
20/200 1 5 5 5 5 5 5<br />
20/160 0.9 5 5 5 5 5 5<br />
20/125 0.8 5 5 5 5 5 5<br />
20/100 0.7 5 5 5 5 5 5<br />
20/80 0.6 5 5 5 5 5 5<br />
20/63 0.5 5 5 5 5 5 5<br />
20/50 0.4 5 5 5 5 5 5<br />
20/40 0.3 5 5 5 5 5 5<br />
20/32 0.2 5 5 5 5 5 5<br />
20/25 0.1 5 5 5 5 5 5<br />
20/20 0 5 5 5 5 5 5<br />
20/16 -0.1 5 5 5 5 5 5<br />
20/12.5 -0.2 5 5 5 5 5 5<br />
20/10 -0.3 5 5 5 5 5 5<br />
Total Points<br />
85 85 85 85 85 85<br />
Richmond Products 4400 Silver Ave SE Albuquerque, NM 87108 USA<br />
Part Number 911633<br />
1.800.362.3860<br />
www.good-lite.com 1.888.362.2576 Fax 1
<strong>Near</strong> <strong>Contrast</strong> Testing Continuous Reading <strong>Score</strong> <strong>Sheet</strong><br />
Use this sheet to document the raw scores. Make copies as needed. Not used with <strong>Pediatric</strong> <strong>Near</strong> <strong>Contrast</strong> Booklet.<br />
Patient Name:______________________________<br />
Date:________________<br />
OD:_________ OS:_________ Note: Use separate for for each eye<br />
Test<br />
The number of letters read correctly = the number of points<br />
Continuous<br />
Reading<br />
Examples<br />
# words<br />
per<br />
paragraph<br />
Snellen LogMAR<br />
<strong>Contrast</strong> Level - Continuous Reading<br />
100% 25% 10%<br />
#<br />
words<br />
read<br />
correctl<br />
# words<br />
per<br />
paragraph<br />
# words<br />
read<br />
correctly<br />
#<br />
words<br />
per<br />
paragr<br />
# words<br />
read<br />
correctly<br />
# words<br />
per<br />
paragraph<br />
5% 2.5%<br />
# # words<br />
words per<br />
read paragraph<br />
correct<br />
20/100 0.7 25 20 20 28 29<br />
20/80 0.6 24 22 19 17 22<br />
20/63 0.5 27 22 22 20 27<br />
20/50 0.4 24 21 20 15 28<br />
20/40 0.3 32 23 23 25 24<br />
# words<br />
read<br />
correctly<br />
20/32 0.2 25 23 23 23 26<br />
20/20 0 24 20 20 23 25<br />
Total Correct<br />
Words 181 151 147 151 181<br />
Richmond Products 4400 Silver Ave SE Albuquerque, NM 87108 USA<br />
Part Number 911633<br />
1.800.362.3860<br />
www.good-lite.com 1.888.362.2576 Fax 2
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