Far/Near Hart Facility Monocular (1 eye)

Far/Near Hart Chart performed with dynamic near target (activity 2) (1 eye)

What equipment is needed to perform Far/Near Hart Facility Monocular?

• Large Hart Chart for distance or GTVT Large

• Small Hart Chart for near (or GTVT) near

• Eye patch/occlude for monocular

What are the goal/objectives of Far-Near hart chart monocular?

• Normalize monocular accommodative amplitude

• Normalize monocular accommodative facility

How is Far/Near Hart Facility Monocular set up?

• Occlude one eye with the eye patch if working on monocular accommodation. (Keep both eyes open if working on binocular accommodation)

• Large chart @ 3m/10ft

• Patient holds small chart @ 40cm/ near working distance (Level 1&2)

  • Level 3 is to hold the near chart 1-2 inches further than blur point.

How is Level 1 Far-Near Hart Chart performed?

Quick summary bc this is not tested. Only Levels 2 and 3 are tested in the practical. Have pt read ½ letters of first line on near, then the rest of the first line on the far chart. Repeat until all 10 lines have been completed. Then repeat with the other eye.

How is Level 2 Far-Near Hart Chart performed?

• Pt reads the letters on first line of the near chart while slowly moving the small Hart Chart closer

• When near target blurs, switch to the second line of the distant chart

• On the large distance Hart Chart, have the ptr read the second line of the target and complete the entire second line

• Then go to the 3rd line on the near chart and repeat moving in slowly until the chart blurs

• Repeat the earlier steps until all 10 lines have been completed

• Then repeat with the other eye

How is Level 3 Far-Near Hart Chart performed?

• Patient moves the near chart into blur point, then moves it back ~2.5cm/1inch

  • The near card distance does not change

• Pt reads ½ of the letters on the first line of the near chart

• Pt changes their focus to the large distance Hart Chart and read the second half of the line, complete the entire line

• Pt changes focus to the small chart in their hands and reads the first half of the second line

• Repeat until all 10 lines have been completed

• Repeat with other eye

For the practical, what needs to be coached and questioned?

• Coached and questioned patient-kinesthetic awareness

• Coached and questioned patient-image clarity

What are distractions/loading that can be done for monocular far-near hart chart?

• Decrease size of print

• Increase the distance between charts

• Switch charts more often (like every letter)

• Read 1 chart top to bottom, other chart bottom to top/diagonals/inside to out

• Add metronome

What are supports that can be done for monocular far-near hart chart?

• Increase print size

• Decrease the distance between charts

  • Pt walks away from distance chart to blur, then takes step closer to clear

• Kinesthetic awareness coaching

• Use lenses to assist with clearing