Keystone 1157 Test Questions and Referral Guide, Test #1 Quick Acuity at 20/40 Level, Color

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

Actual Test

	QUICK ACUITY TEST
	BOTH	RIGHT	LEFT
1.	958	479	823
2.	347	563	268
3.	426	728	534

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

Actual Test

COLOR

4163

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.

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