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Test Questions and Referral Guide
Notes: All tests are given with both eyes open at all times. Subject to wear any glasses normally used for
driving.
Test #1 Quick Acuity at 20/40 Level
Ask your subject: “ Do you see three columns with numbers?” “Look at the first column, starting from top
to bottom, please read the digits to me.” “Now the second column, an the third column, please?”
Referral: If more than two digits in any column are missed
Test #2 Color Deficiency
Ask your subject: “ Do you see four blocks with multi-colored dots?” “Can you distinguish numbers within
the blocks?” “Please read them.”
Referral: If at least two numbers are misread.
Actual Test
Actual Test
COLOR
4163
BOTH RIGHT LEFT
1.
958 479 823
2.
347 563 268
3.
426 728 534
QUICK ACUITY TEST
5