ATTACHMENT C - Kentucky Slide Images.pdf
PDF 151 KB Posted
- Attached to
- DDL Vision Testing Equipment
- Solicitation number
- RFB 758 2500000457 2
- Issued by
- Elliott County, Kentucky
About this file
This is a technical specification document for the OPTEC Vision Tester Slide 1000-75, a standardized vision screening instrument used by the Kentucky Department of Motor Vehicles. The document provides the record form and test procedures for conducting comprehensive vision assessments, including multiple components designed to evaluate visual capability for driver licensing purposes.
The vision tester consists of five primary test modules: Test #1 measures visual acuity for the right eye, left eye, and both eyes simultaneously at the 20/40 level using numbered slides in red, amber, and green colors; Test #2 evaluates road sign recognition and depth perception using traffic sign identification at 323 and 145 seconds of arc; Test #3 reassesses visual acuity across multiple levels (20/100, 20/60, 20/50, 20/40, and 20/30) for each eye and binocularly; Test #4 assesses muscle balance and binocular coordination using nasal and temporal positioning at varying distances (85, 70, 55, 45 degrees); and Test #5 measures peripheral vision for both left and right eyes. The document includes specific pass/fail criteria, noting that two or more incorrect responses in any group constitutes failure for that particular acuity level and eye. The form is dated July 2017 and is designated as the official DMV 1000-75 record form for Kentucky vision testing procedures.
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Text version
1000-75 RECORD FORM FOR THE OPTEC® VISION TESTER
NAME: DATE:
20/40 1 RED 6 2 6 5 3 6 8 9 3 9 62653 68939 85923 6 8 9 3 9 8 5 9 2 3
20/40 2 AMBER 9 8 3 6 2 9 3 8 2 5 98362 93825 59862 9 3 8 2 5 5 9 8 6 2
20/40 3 GREEN 2 5 9 3 8 2 5 2 9 6 25938 25296 68238 2 5 2 9 6 6 8 2 3 8
20/40 4 RED 3 9 2 6 8 3 2 5 8 5 39268 32585 36598 3 2 5 8 5 3 6 5 9 8
5 INFORMATION SIGN
6 (323 Seconds of Arc)
7 REGULATORY SIGN
8 DO NOT ENTER SIGN
9 STOP SIGN
10 RAILROAD SIGN
11 (145 Seconds of Arc)
12 NO PASSING ZONE SIGN
Which of the Road Signs appear to be closer to you?
BOTH CORRECT IS ACCEPTABLE DEPTH PERCEPTION.
20/100 1 GREEN 3 9 5 8 5 2 395 852 628 8 5 2 6 2 8
20/60 2 AMBER 9 3 2 8 5 6 8 3 9328 5683 2965 5 6 8 3 2 9 6 5
20/50 3 RED 3 5 9 6 2 6 3 8 2 9 35962 63829 85293 6 3 8 2 9 8 5 2 9 3
20/40 4 GREEN 8 9 2 3 5 9 3 5 2 8 89235 93528 65939 9 3 5 2 8 6 5 9 3 9
20/30 5 AMBER 9 2 3 5 6 5 6 8 6 9 92356 56869 26953 5 6 8 6 9 2 6 9 5 3
LEFT EYE = 20/ ____ BOTH EYES = 20/ ____ RIGHT EYE = 20/ ____
Step 1 Occlude LEFT Eye Ball Box = PASS Step 2 Ask subject if they see the box? Ball of Box = FAIL Step 3 Illuminate LEFT Eye Step 4 Ask subject if the RED ball falls IN or OUT of the box?
RIGHT PERIPHERAL TEST
LEFT PERIPHERAL TEST
Use line # (both eyes column) numbers from test # as fixation point.
TEST #1:
Two or more incorrect in any group = FAIL for that particular acuity and eye.
TEST #2:
(#6 & #11)
TEST #3:
Two or more incorrect in any group = FAIL for that particular acuity and eye.
TEST #4:
TEST #5: ° ° ° °
1000-75
VISUAL ACUITY- BINOCULAR
ACUITY LINE COLOR BOTH EYES RIGHT EYE
ROAD SIGN AND DEPTH RECOGNITION
YIELD SIGN
SCHOOL ZONE SIGN
VISUAL ACUITY- BINOCULAR
ACUITY LINE BOTH EYES RIGHT EYE
MUSCLE BALANCE - Binocular
IN
OUT
85 70 55 NASAL 45
85 70 55 NASAL 45
6 8 9 3 9 1
LEFT EYE
LEFT EYE
PASS
PASS
Denotes Stereo Depth
OPTEC VISION TESTER SLIDE 1000-75
Test #1 Visual Acuity Number Right Eye, Left Eye Monocular and Both Eyes Simultaneously (20/40)
Test #2 Road Sign and Depth Recognition Traffic Sign Identification and Depth Perception of (323 and 145 Seconds of ARC)
Test #3 Visual Acuity Number Right Eye, Left Eye Monocular and Both Eyes Simultaneously (20/100,20/60,20/50,20/40,20/30) ri Li
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396 952
9329 E93
S 3525
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0 9993 2965
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S 3929
Nasas
95293
Test #4 Muscle Balance
| DMV 1000-75 record form 07.2017 |
| 1000-75 KY Test Slide Image |
File details come from the government source that posted it. Updated .