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either crowding of the labels or making the sary to test visual acuity at nonstandard dis-
labels applying to those 3 rows smaller. It tances.
should, however,tle <lbviousthat continuingthe In order to maintain equivalenceto the stand-
chart to beyond the 616 (20/201 logically ard testing situation, the nonstandard viewing
requires the next 3 rows to have visual acuity distance should be chosen from a geometric
ratings of 6.418,6/3.8,and 6/3 (20/L6, 20/L2.5, progression which is based on the standard
and 20/10)on the Snellenscale,and .0.1, 0.2, distanceand which has the same multiplier or
and -0.3 on the logarithmic scale. ratio as the progressionof letter sizes.For this
Chart slze. The chart is approximately 80 cm chart, with its progression of letter sizes in
high and 75'cm wide. These charts have been 0.1-log unit steps, the sequenceof optional
lrrinted on matte white cards, and some have testing distances follows the progression in
been printed on translucent white plastic meters:6, 4.8,3.8,3.0,2.4,1.9,1.5,etc. (in feet:
sheets. 20, 16, 12.5,10,8, 6.3,5, etc.). It shouldbe noted
Fig. 1 showsthe Snellennotation scalebased that this sequenceis a factor of 10different from
on u testing distance of 6 m. I'or clinicians the letter size sequence(60, 48, 38, etc., or 200,
whose usual practice is to use the decimal 160,125,etc.) which is labeled on the chart and
notation or the Snellen notation in feet, the can thus serve as a remi4der to the clinician.
chart labeling can be converted according to When the testing distdnce is reduced from 6
Table 1. Where decimal notation is used, it is m (20 ft) to 4.8 m (16 ft), which is four-fifths of
advisableto have additional labeling so that the the standard distance, there is a 25% (almost
visual acuity ratings are given in both decimal exactly 0.1 log unit) increasein the angular size
and Snellen form. of all letters on the chart. This createsa l-row
shift so that the examineewill be able to read I
NONSTANDARD TESTING DISTAhICES additional row on the chart. Similarly, moving
Becausethe chart has essentially equivalent in a further step of four-fifths to 3.8 m (12.5ft)
test tasks and a logarithmic size progression,it allows reading of 2 rows of letters more than
has special advantageswhen it becomesneces- would have been read at the standard distance;
Nouember, 1976 New Visual Acuity Chart-Bailey snd Louie 743
Tenue l. Conversionof the IogMAR and &m Snellen the chart (6/6, 6n.5, etc., or 20/20,20/25,etc.).
notations, shown on the new chart, to 20-ft Snellen To provide a further example, a visual acuity
and decimal notations score of 2.41ffi $/?ffi') will be equivalent to
Snellen
6/150 (or 20/500).
Snellen
IogMAR (6 m) (20 fr ) Decimal
LOGARITHMIC SCAI.E
1.0 6/ffi 20/2M 0.10
0.9 6/48 20/rffi 0.r25 The adjustment of visual acuity scores to
0.8 6/38 20/126 0.16 account for the nonstandard viewing distance is
0.7 6/30 20/rN 0.20 very much simplified by working with the
0.6 6/24 20/N 0.25 logMAR scale.For each0.1-logunit reduction of
0.5 6/r9 20/63 0.32 viewing distance there is an 0.1-logunit increase
0.4 6/r5 20/3{J 0.40 in the angular subtense of all letters on the
0.3 6/12 n/40 0.50 chart. Consequently, it becomes necessaryto
o.2 6/e.5 20/32 0.63 adjust each of the logMAR ratings for rows of
0 .1 6n.5 20/25 0.80 the chart by 0.1. For erample, when viewing
0.0 6/6 20/20 1.00 from a distance of 2.4 m (8 ft), a correction
-0.r 6/4.8 n/rc L.25 factor of 0.4 log units must be added to each of
-o.2 6/3.8 20/12.5 r.60 the logMAR ratings as labeled on the chart; the
-0.3 6/3 wrc 2.00 row of letters labeled logMAR = 0.0 now
acquires a logMAR rating of 0.4, 0.1 becomes
at 3 m (10 ft), it is 3 extra rows; at 2.4 m (8 ft), 0.5, and so on, up to the largest row whose
it is 4 rows; at 1.9 m (6.3 ft), it is 5 rows;at 1.5 labeledlogMAR rating of 1.0is adjustedto 1.4.
m (5 lt), it is 6 rows; aL 1.2m (4 lt), it is 7 rows; When a logMAR rating of visual acuity of
and so on. grcater than 1.0 is obtained, it is dealt with by
Some clinicians prefer to denote visual acuity recalling that 1.0 log unit is equivalent to a
as the Snellen acuity scores expected at the factor of 10 times, and 2.0log units is equivalent
standard distance rather than Snellen "frac- to a factor of 100 times. As an example: a
tions" which have nonstandard "numerator€." subject reading the row labeled logMAR - 0.9
It is a relatively simple matter to make the when the chart is at a distance of 2.4 m
conversionfrom a nonstandard Snellen "frac- (correction factor 0.4 log units) will obtain a
tion" to the equivalent Snellen score for the visual acuity scoreof logMAR = 1.3; by refer-
standard distance. Consider an examineewho, ring to the standard labeling of rows on the
when tested at 2.4 m (8 ft), can read the row chart, it is seenthat logMAF[ = 0.3 is equivalent
labeled 6119(20/63);his visual acuity would be to Snellen 6/f2 (Snellen20/40or decimal 0.5);
recordedas2.4/19(8/63).The examiner is aware logMAR = 1.3 represents an acuity which is
that the testing distance is 4 incremental steps worseby a factor of 10times and so is equivalent
closerthan standard and that the examineewill to Snellen 6/L20 (20/400or 0.05).
therefore be able to read letters which are 4 When using the logMAR scale and reduced
incremental steps smaller t,han those which working distancesin this manner, it is particu-
would have beenread at the standarddistance. larly easy to convert back t<l the more familiar
Accordingly, the examiner counts up 4 steps Snellenor decimal notation. There is no needto
larger than the threshold row of letters and refer to tables, sinceall the relevant information
determinesthat, in this example,the equivalent is given by the scalelabeling on the chart. Some
acuity score for the standard distance is 6/48 examplesare presentedin Table 2.
(20/160).
When applying this method to measurevisual DISCUSSION
acuities which are less than 6/60 (201200),the
'l'he letter chart described here introduces
examiner rnust be aware that |,he sequenceol
visual acuity scores that are less than 6/60 new design principles. The most basic principle
(n/zCo) follow the pattern 6fi6,6/95, 6/120, is that the visual acuity task for all letter sizes
6/150, etc. (201250,20/ 320,20/ 400,20/ 600,etc.). should be practically the same and should
Again, it is not necessaryto commit this pro- remain so when nonstandard viewing distances
gressionto memory because,apart from being are used. Consequently,the only chart design
different by a factor 10, it follows the same parameter likely to influence the measured
sequenceas the visual acuity scoreslabeled on visual acuity score is letter size.
744 AM J OYTOM & PHYSIOL Of|TICS V ol .53,N o. 1I
Treta 2. Examples strowing application of a logarithmic distance "correction factor" arrd,conversion of the
conected logMAR score to Snellen or decimal notation
The "correction factor" f(rr a particular l,estingdistance indicates [he magnitude (in logarithmic units) of the
change in angular size resulting from the change from the standard test distance. When an eraminee reade to
hie threshold level on the chart, note is made of the logMAR label applied to the row of letterg which can just be
read. To this "chart score" ie added the "correction factor." The sum of the chart scoreand correction factor
is
the corrected VA Hcoroexprossodus the logaril,hm of the minimum angle of recolution. Using procedures
described in the text, the corrected IogMAR score can easily be converted to Snellen or decimal notation.
An advantagewhich derives from this princi- ensure adeqtrate focus; it might also become
ple is realized when a penpn attempting to read necessary to pay special attention to the ef-
a nowof near-threshold letters is not able to read fects of obliquity of viewing.
all letters correctly. In such situations, examin-
ers generally record such partial success by ACKNOWLEDGMENTS
recording a score such as 6/30 + | or 6/15 - 2. This work u)oa supported by the Natiorwl
Unlike the situation with existing charts (with Health and Medical Research Council of Aus-
different numbers and legibility of lettens on a trulb Gront 72/4719 owarded to lan L. fuilet
row), the addition of such a suffix to a visual ard by the Assocbtion for the Blind, Mel-
acuity score on the new chart carries the same b ourne, Austrulia Resq,r ch S cho larship ow arde d
meaning in terms of qualifying the visual score to Jon E. Louie.
at each level of the chart. With 5 letters in all
rows there is no need to use a suffix outside the REFERENCES
range -2 to +2. 1. Bennett A. G., Ophthalmic test types, Br. J.
The other major priniciple is that there Physiol. Opt., 22: 238-271,1965.
should be a logarithmic size progression in 2. Snellen, H., Letterproeven tot Bepaling der
conjunction with the standardizing of the test Gezigtsscherpte(P.W. van der Weijer, Utrecht,
task. It is only when these 2 features are 1862),cited in Bennett, A.G., Ophthalmic test
combined that it becomespossible to utilize a types, tsr. J. Phyriol. Opt., 22: 238-271,1965.
3. Green, J., Notes on the clinical determination of
wide variety of testing distanceswith the assur-
the acutcneesof vision including the construction
ance that valid and consistentacuity scoreswill and graduation of optotypes, Tlanb. Am.
be obtained. Reducing the testing distance is Ophthalmol. Soc., 10: 644-654,1905.
particularly useful in casesof low vision, where 4. Sloan, L. L., New charts for the measurement of
this new chart permits reliable grading of visual visual acuity at far and near distances, Am. J.
acuity in fine stepson scalesthat are continuous Ophthalmol., 48: 807-813,1959.
and consistent with the scaling that is used to 5. Ogle K. N., On the problem of an international
measurebetter visual acuities. Flexibility in the nomenclature for designating visual acuity, Am.
.J. Ophthalmol., 36: 909-921,1953.
choice of viewing distance provides a means of
6. Deutche Normen, Sehscharfebestimmung,DIN
validating scoresof visual acuity, and this can
ffi 2n Bl 1,3, Beuth-Vertrieb, Berlin, 19?4.
be useful in detecting nralingerert. In some 7. Coates, W. R., Visual acuity and test letters,
cases of unusually poor acuity, very small Ttans. Inst. Ophthalmic Opticians, lll, lggb,
testing distances becomenecessary,ind it may cited in Bennett, A. G., Ophthalmic test types,
be appropriate to introduce convex lenses to Br. J. Physiol. Opt., 22:238-2?1, 1965.
Nwember,Ino NcutVbwI Aeuity Chst ,Eailey arlldLoub 745
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f0. YourUron,R M., Anonrly invinralecuitytrtins Iut L. tuW
in children, Br. J. Ophtbrlmol., 50: 16E-U0, Sclroofof Optonpny
rfl6. Wril,elaity 4 Cdifntu
ll. Flom, M. C., F. W, Wcymouth,and D. Kehno- Mtchi, Calilarin Ufn