VISION CHARTS AND VISION ASSESSMENT
SNELLEN CHART
It is the commonly used chart introduced by Dutch ophthalmologist Herman Snellen in 1862.
1. Chart Layout
The chart consists of rows of letters (optotypes) that progressively decrease in size from
top to bottom.
Each row represents a specific visual acuity level.
In Snellen chart, space between consequent rows is equal to the height of the lower row.
The distance between two letters of the same row is equal to the size of the letter.
2. Principle of the Snellen chart
The Snellen chart is based on the principle of minimum angle of resolution (MAR).
This principle determines the smallest detail that the eye can resolve and translates it into
a measurable visual acuity.
3. Optotype Design
Letter optotypes are available in two formats
1. Serif: In which short lines or blocks are added to the end of the letter.
2.Non Serif
o a)SLOAN optotype-5x5 grid
o b)British optotype-5x4 grid/5x5 grid
Letters are designed based on a 5x5 grid or 5x4 grid
The strokes of the letters (section of letter) subtend 1 minute of arc and the whole
optotype subtend 5 minutes of arc visual angle at the nodal point of the eye for a
given test distance.
4. Testing Distance
The standard testing distance is 6 meters (20 feet). This is considered as optical
infinity. A testing distance shorter than 6m causes activation of accommodation and a
longer distance result in poor legibility.
5. Visual Acuity Notation
Visual acuity is expressed as a fraction
Numerator: Testing distance (usually 6m or 20ft).
Denominator: Distance at which a person with normal vision can read the
line/Distance at which letter subtends 5 minutes of arc.
Example: 6/6 (or 20/20) means normal vision; 6/12 (20/40) means the person sees at
6 meters what a normal person can see at 12 meters.
6. Standard Chart Configuration
Metric system(6m) Feet system(20ft)
6/60 20/200
6/36 20/120
6/24 20/80
6/18 20/60
6/12 20/40
6/9 20/30
6/6 20/20
7. Illumination
Recommended Room illumination is 80-320cd/m2
Recommended chart illumination:160cd/m2
Snellen near Vision Chart
Printed Text or Optotypes: Letters, numbers, or paragraphs of text in different font
sizes.
Size Progression: The smallest readable line indicates the near visual acuity of the
patient.
Standard notations include N6, N8, N10, N12, N18, N24, N36 etc., where N6 is the
smallest print.
Testing Distance: Typically held at 33-40 cm (14-16 inches) from the eyes.
Tested with and without reading glasses to check for presbyopia or other near vision
issues.
Procedure of testing visual acuity
Patient is seated at a distance of 6m from the chart
Instruct the patient about the procedure
For measuring unaided monocular visual acuity ,ask the patient to occlude one eye with
palm or occluder.If the patient occlude eye with palm,make sure he/she might not be
looking through the gap between fingers.
Patient is asked to read the line from the top largest number to smallest number and
record notation corresponding to the smallest number which he/she can read.
If the patient is unable to read the topline ask the patient to come closer to the chart until
he/she can read.Then the distance at which the patient read the largest line is recorded as
the numerator of the snellen fraction(5/60,4/60,3/60,2/60,1/60 ).This step is not practiced
in the clinic.
If the patient is unable to read largest line, ask the patient to count fingers of the
examiner. The vision is recorded as CF with the distance at which patient counts finger.
(CF@1m, CF@2m,cf@3m etc).CFCF-counting finger close to face.
For a patient who fails to count the fingers, the examiner moves his/her hand from a
certain distance and note the patient’s ability to appreciate hand movement. It is recorded
as HM + or HM -
If the patient also fails to identify hand movement, the examiner flashes a penlight from
different quadrants and ask to identify direction of light. If the patient correctly
appreciates the direction of light from any of the quadrants, vision is recorded as PL
positive with the projection of rays (PL +, PR +).
Complete absence of perception of light is recorded as PL -.
Log MAR Chart
The Logarithm of the Minimum Angle of Resolution (LogMAR) chart is an advanced
visual acuity testing tool that provides a more precise and standardized assessment of
vision compared to traditional Snellen charts.
Developed by Bailey and Lovie in 1976 (hence also called the Bailey-Lovie chart).
Principle
LogMAR chart works on the principle of logarithmic scaling to measure vision more
accurately(each row is 1.26 times smaller than the one above it)
Logarithm of minimum angle of resolution
Types
1) Bailey Lovie Chart
First commercially available LogMAR chart
Testing Distance-6m with non-serif letters
2) Early treatment diabetic retinopathy study (ETDRS)
Ferris and colleagues
Testing Distance-4m
Features of LogMAR Chart
Optotypes (Letters)
Sloan letters (C, D, H, K, N, O, R, S, V, and Z) are used for uniform difficulty.
Rows
Typically, 14 lines, with 5 letters per line.
Spacing between two letters is the width of the single letter
The spacing between two lines is the height of the lower line letter.
Letter Size Progression
Decreases logarithmically from top to bottom.
Scoring System
Each correctly read letter reduces the LogMAR score by 0.02.
Equation to calculate LogMAR acuity
LogMAR=Base LogMAR + (0.02 X missed letter)
Base LogMAR LogMAR value of the row read (0.2, 0.3, 0.4 etc)
