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The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 2001 Apr;85(4):432–436. doi: 10.1136/bjo.85.4.432

The development of a "reduced logMAR" visual acuity chart for use in routine clinical practice

D Rosser 1, D Laidlaw 1, I Murdoch 1
PMCID: PMC1723918  PMID: 11264133

Abstract

BACKGROUND/AIMS—The advantages of logMAR acuity data over the Snellen fraction are well known, and yet existing logMAR charts have not been adopted into routine ophthalmic clinical use. As this may be due in part to the time required for a logMAR measurement, this study was performed to determine whether an abbreviated logMAR chart design could combine the advantages of existing charts with a clinically acceptable measurement time.
METHODS—The test-retest variability, agreement (with the gold standard), and time taken for "single letter" (interpolated) acuity measurements taken using three prototype "reduced logMAR" (RLM) charts and the Snellen chart were compared with those of the ETDRS chart which acted as the gold standard. The Snellen chart was also scored with the more familiar "line assignment" method. The subjects undergoing these measurements were drawn from a typical clinical outpatient population exhibiting a range of acuities.
RESULTS—The RLM A prototype chart achieved a test-retest variability of +/−0.24 logMAR compared with +/−0.18 for the ETDRS chart. Test-retest variability for the Snellen chart was +/−0.24 logMAR using clinically prohibitive "single letter" scoring increasing to +/−0.33 with the more usual "line assignment" method. All charts produced acuity data which agreed well with those of the ETDRS chart. "Single letter" acuity measurements using the prototype RLM charts were completed in approximately half the time of those taken using the ETDRS and Snellen charts. The duration of a Snellen "line assignment" measurement was not evaluated.
CONCLUSION—The RLM A chart offers an acceptable level of test-retest variability when compared with the gold standard ETDRS chart, while reducing the measurement time by half. Also, by allowing a faster, less variable acuity measurement than the Snellen chart, the RLM A chart can bring the benefits of logMAR acuity to routine clinical practice.



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Figure 1  .

Figure 1  

The RLM A chart.

Figure 2  .

Figure 2  

"Single letter" chart reading times.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arditi A., Cagenello R. On the statistical reliability of letter-chart visual acuity measurements. Invest Ophthalmol Vis Sci. 1993 Jan;34(1):120–129. [PubMed] [Google Scholar]
  2. Bailey I. L., Bullimore M. A., Raasch T. W., Taylor H. R. Clinical grading and the effects of scaling. Invest Ophthalmol Vis Sci. 1991 Feb;32(2):422–432. [PubMed] [Google Scholar]
  3. Bailey I. L., Lovie J. E. New design principles for visual acuity letter charts. Am J Optom Physiol Opt. 1976 Nov;53(11):740–745. doi: 10.1097/00006324-197611000-00006. [DOI] [PubMed] [Google Scholar]
  4. Bennett A. G. Ophthalmic test types. A review of previous work and discussions on some controversial questions. Br J Physiol Opt. 1965;22(4):238–271. [PubMed] [Google Scholar]
  5. Bland J. M., Altman D. G. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 Feb 8;1(8476):307–310. [PubMed] [Google Scholar]
  6. Elliott D. B., Sheridan M. The use of accurate visual acuity measurements in clinical anti-cataract formulation trials. Ophthalmic Physiol Opt. 1988;8(4):397–401. doi: 10.1111/j.1475-1313.1988.tb01176.x. [DOI] [PubMed] [Google Scholar]
  7. FLOM M. C., WEYMOUTH F. W., KAHNEMAN D. VISUAL RESOLUTION AND CONTOUR INTERACTION. J Opt Soc Am. 1963 Sep;53:1026–1032. doi: 10.1364/josa.53.001026. [DOI] [PubMed] [Google Scholar]
  8. Friendly D. S., Weiss I. P. An automated visual acuity testing computer program using the Apple II system. Am J Ophthalmol. 1985 Feb 15;99(2):188–192. doi: 10.1016/0002-9394(85)90231-4. [DOI] [PubMed] [Google Scholar]
  9. Lovie-Kitchin J. E. Validity and reliability of visual acuity measurements. Ophthalmic Physiol Opt. 1988;8(4):363–370. doi: 10.1111/j.1475-1313.1988.tb01170.x. [DOI] [PubMed] [Google Scholar]
  10. Reeves B. C., Wood J. M., Hill A. R. Vistech VCTS 6500 charts--within- and between-session reliability. Optom Vis Sci. 1991 Sep;68(9):728–737. doi: 10.1097/00006324-199109000-00010. [DOI] [PubMed] [Google Scholar]
  11. SLOAN L. L. New test charts for the measurement of visual acuity at far and near distances. Am J Ophthalmol. 1959 Dec;48:807–813. doi: 10.1016/0002-9394(59)90626-9. [DOI] [PubMed] [Google Scholar]
  12. Siderov J., Tiu A. L. Variability of measurements of visual acuity in a large eye clinic. Acta Ophthalmol Scand. 1999 Dec;77(6):673–676. doi: 10.1034/j.1600-0420.1999.770613.x. [DOI] [PubMed] [Google Scholar]
  13. Sloan L. L. Needs for precise measures of acuity. Equipment to meet these needs. Arch Ophthalmol. 1980 Feb;98(2):286–290. doi: 10.1001/archopht.1980.01020030282008. [DOI] [PubMed] [Google Scholar]
  14. Vanden Bosch M. E., Wall M. Visual acuity scored by the letter-by-letter or probit methods has lower retest variability than the line assignment method. Eye (Lond) 1997;11(Pt 3):411–417. doi: 10.1038/eye.1997.87. [DOI] [PubMed] [Google Scholar]
  15. Wick B., Schor C. M. A comparison of the Snellen chart and the S-chart for visual acuity assessment in amblyopia. J Am Optom Assoc. 1984 May;55(5):359–361. [PubMed] [Google Scholar]

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