During eye examinations, I can remember to measure near reading visual acuity with both eyes together but forget to measure monocular reading visual acuity. The senior clinician in my practice has mentioned this to me several times and I have to get better at this. How can I remember to measure monocular reading visual acuity each and every examination?

When it comes to undertaking all the relevant tests and writing down the results good habits need to be formed. A well-established way of forming a good habit is habit stacking. A new habit can be built by identifying a current habit that is already done during an eye examination and then the new behaviour (test) stopped on top of the one that is already performed. The habit stacking formula is: After [CURRENT HABIT (or TEST)], I will [NEW HABIT (or TEST)].

This can be applied to any test in an eye examination. The problem here is with measuring monocular near visual acuity. So using the habit stacking formula:

After [CURRENT HABIT], give patient near reading card and ask them to read the smallest print they can manage with both eyes together, I will [FIRST NEW HABIT], pick up an occluder (e.g. a cover test paddle), then I will [SECOND NEW HABIT] cover over each eye in turn to determine monocular near print size, and then I will [THIRD NEW HABIT], pick up a tape measure and measure the distance from the plane of the patient’s face to the page of print.

Developing this habit will benefit the patient as conditions which affect the macular such as age-related macular degeneration sometimes cause a reduction in reading visual acuity while distance visual acuity remains in the normal range.


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