Communicating Visual Acuity To Patients: Current Challenges And Proposed Streamlined Approach

Visual acuity (VA) assessment is integral to ophthalmic practice and effective communication of VA values to patients is essential to ensure they understand their visual status. Currently available standard VA systems: Snellen fractions (20/20 feet, 6/6 metres, and 4/4 metres), Decimal (Visus), and Minimum angle of resolution (LogMAR) notation may lack the meaning for laypersons. Although conversion of decimal to percentage seems an intuitive option but rarely adopted in practice. This study aims to evaluate current practices and perceptions of ophthalmologists & optometrists about communicating VA measurements to their patients, & to propose a novel optimised streamlined scale designed for patient comprehension.

Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia.

An online survey was distributed to a diverse sample of healthcare professionals (HCPs) worldwide. The survey consisted of multiple-choice and open-ended questions targeted practising ophthalmologists and optometrists, focusing on VA communication practices and perceptions, patients understanding of VA scores currently available in clinical practice, the need for further explanation, and the need for alternative systems. Responses were analysed to identify key areas for optimization. Based on the findings, a proposed novel VA scale was created.

A total of 179 responses were received from ophthalmologists and optometrists around the world, 89.8% were senior HCPs. 93.3% reported that patients often struggle to comprehend standard VA notations;p<0.01. Furthermore, 82.7% of HCPs believed that further clarification and providing additional context is necessary after communicating VA scores to patients;p<0.01. Notably, the majority (57.3%) of HCPs expressed a strong need for a new universal and simplified system that is easily understood by patients;p<0.01. Incorporating ophthalmologists and optometrists perspectives aided creation of a novel scale that fit with the standard VA charts with potential for improved patient-clinician discussions and informed decision making.

This study found variable practices and strong perceptions of limitations with the currently available standard VA systems, also it provided the potential into optimising and enhancing patient-clinician communication through a novel scale. Key themes included desires for simplification, familiarity, universal understanding and increased patient comprehension. Our proposed VA scale is a novel system which potentially addresses limitations of standard notation, fulfilling aforementioned desires. Further validation is recommended to assess usability, potential for standardisation, widespread adoption, and implementation of this scale in clinical practice, VA charts and digital VA systems.