• 1990 (Vol.4)
  • 1989 (Vol.3)
  • 1988 (Vol.2)
  • 1987 (Vol.1)

An overview of the visual acuity assessment. 2. Theoretical and clinical requirements to the optotypes and chart designs

© 2022 G. I. Rozhkovaa, M. A. Grachevaa, A. A. Kazakovaa,b

aInstitute for Information Transmission Problems RAS, 127051 Moscow, B. Karetny, 19/1, Russia
bPirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, 117997 Moscow, Ostrovityanova st., 1, Russia

Received 17 Jul 2021

This paper presents analysis and discussion of the test images employed for the visual acuity (VA) assessment – the optotypes – and their distributions in the test charts. After brief description of the optotype early history and evolution, an attempt has been made to classify the existing optotypes and to analyze directions of their development. The following kinds of the optotypes are considered: letters, uniform configurations, periodic patterns, vanishing images, pictures, and embedded test stimuli. General theoretical and practical requirements to the optotypes are formulated. Specific advantages and disadvantages of certain popular optotypes are discussed in detail. The last section is devoted to the evolution of the charts for the VA assessment and their designs. A general conclusion is that there are no universal “golden standards” for the optotypes and the VA charts: their optimal structure depends on the purpose of investigation, characteristics of the contingent to be examined, and qualification of the examiners. In any case, the examiners have to understand advantages and disadvantages of the chosen tests and take them into account both in planning the procedure and interpretation of the results obtained.

Key words: variety of optotypes, optotype classification, improvement of optotypes, variety of visual acuity charts, visual acuity chart design guidelines

DOI: 10.31857/S0235009222010073

Cite: Rozhkova G. I., Gracheva M. A., Kazakova A. A. Otsenka ostroty zreniya. 2. teoreticheskie i klinicheskie trebovaniya k optotipam i dizainu tablits [An overview of the visual acuity assessment. 2. theoretical and clinical requirements to the optotypes and chart designs]. Sensornye sistemy [Sensory systems]. 2022. V. 36(1). P. 3–29 (in Russian). doi: 10.31857/S0235009222010073

References:

  • Allen H.F. A new picture series for preschool vision testing. American Journal of Ophthalmology. 1957. V. 44. P. 38–41. https://doi.org/10.1016/0002-9394(57)91953-0
  • Anderson R.S. Improving ophthalmic diagnosis in the clinic using the Moorfields Acuity Chart. Expert Review of Ophthalmology. 2017. V. 12 (6). P. 433–435. https://doi.org/10.1080/17469899.2017.1395696
  • Anderson R.S., Thibos L.N. Relationship between acuity for gratings and for tumbling-E letters in peripheral vision. Journal of the Optical Society of America A. 1999a. V. 16 (10). P. 2321–2333. https://doi.org/10.1364/josaa.16.002321
  • Anderson R.S., Thibos L.N. Sampling limits and critical bandwidth for letter discrimination in peripheral vision. Journal of the Optical Society of America A. 1999b. V. 16 (10). P. 2334–2342. https://doi.org/10.1364/josaa.16.002334
  • Anderson R.S., Evans D.W., Thibos L.N. Effect of window size on detection acuity and resolution acuity for sinusoidal gratings in central and peripheral vision. Journal of the Optical Society of America A. 1996. V. 13 (4). P. 697–706. https://doi.org/10.1364/josaa.13.000697
  • Atkinson J. The developing visual brain. N.Y.: Oxford Univ. Press. 2000. 211 p.
  • Bailey I.L., Lovie J.E. New design principles for visual acuity letter charts. American Journal of Optometry and Physiological Optics. 1976. V. 53 (11). P. 740–745. https://doi.org/10.1097/00006324-197611000-00006
  • Bailey I.L., Lovie-Kitchin J.E. Visual acuity testing. From the laboratory to the clinic. Vision Research. 2013. V. 90. P. 2–9. https://doi.org/10.1016/j.visres.2013.05.004
  • Bondarko V.M., Danilova M.V. What spatial frequency do we use to detect the orientation of a Landolt C? Vision Research. 1997. V. 37 (15). P. 2153–2156. https://doi.org/10.1016/S0042-6989(97)00024-2
  • Campbell F.W., Green D.G. Optical and retinal factors affecting visual resolution. The Journal of Physiology. 1965. V. 181. P. 576–593. https://doi.org/10.1113/jphysiol.1965.sp007784
  • Campbell F.W., Robson J.G. Application of Fourier analysis to the visibility of gratings. The Journal of Physiology. 1968. V. 197. P. 551–566. https://doi.org/10.1113/jphysiol.1968.sp008574
  • Caywood J., Nett J. Optometric assessment of the patient with mental retardation or special needs. College of Optometry. 2005. 1503. https://commons.pacificu.edu/opt/1503
  • Colenbrander A. Consilium Ophthalmologicum Universale Visual Functions Committee. Visual acuity measurement standard. Italian Journal of Ophthalmology. 1988. V. 2 (1). P. 1–15.
  • Colenbrander A. The historical evolution of visual acuity measurement. Visual Impairment Research. 2008. V. 10 (2–3). P. 57–66. https://doi.org/10.1080/1388235080263240
  • Curcio C.A., Sloan K.R., Kalina R.E., Hendrickson A.E. Human photoreceptor topography. The Journal of Comparative Neurology. 1990. V. 523 (292). P. 497–523. https://doi.org/10.1002/cne.902920402
  • Dennett W.S. Test type. Transactions of the American Ophthalmological Society. 1886. V. 4. P. 133–139.
  • Donders F.C. On the anomalies of accommodation and refraction. New Sydenham Society, London. 1864.
  • Doria C. À la recherche de la vision “normale” mesurer l’acuité visuelle au XIXe siècle. Canadian Bulletin of Medical History. 2020. V. 37 (1). P. 147–172. (in French) https://doi.org/10.3138/cbmh.312-012019
  • Doria C. Searching for the normal vision. Measuring visual acuity in the 19th century. Medicina Historica. 2021. V. 5 (2). P. e2021015. Available from: https://mattioli1885journals.com/index.php/MedHistor/article/view/90
  • Evans D.W., Wang Y., Haggerty K.M., & Thibos L.N. Effect of sampling array irregularity and window size on the discrimination of sampled gratings. Vision Research. 2010. V. 50 (1). P. 20–30. https://doi.org/10.1016/j.visres.2009.10.001
  • Fantz R.L., Ordy J.M., Udelf M.S. Maturation of pattern vision in infants during the first six months. Journal of Comparative and Physiological Psychology. 1962. V. 55. P. 907–917. https://doi.org/10.1037/h0044173
  • Fariza E., Kronheim J., Medina A., Katsumi O. Testing visual acuity of children using vanishing optotypes. Japanese journal of ophthalmology. 1990. V. 34 (3). P. 314–319.
  • Ferris F.L. III, Kassoff A., Bresnick G.H., Bailey I. New visual acuity charts for clinical research. American journal of ophthalmology. 1982. V. 94 (1). P. 91–96. https://doi.org/10.1016/0002-9394(82)90197-0
  • Ferris F.L. III, Freidlin V., Kassoff A., Green S.B., Milton R.C. Relative letter and position difficulty on visual acuity charts from the Early Treatment Diabetic Retinopathy Study. American Journal of Ophthalmology. 1993. V. 116 (6). P. 735–740. https://doi.org/10.1016/S0002-9394(14)73474-9
  • Filin V.A. Videoehkologiya [Videoecology]. Moscow, Videoehkologiya. 2006. 512 p. (in Russian)
  • Frisén L. Vanishing optotypes. New type of acuity test letters. Archives of Ophthalmology. 1986. V. 104 (8). P. 1194−1198. https://doi.org/10.1001/archopht.1986.01050200100060
  • Gräf M., Becker R. Determining visual acuity with LH symbols and Landolt rings. Klinische Monatsblatter fur Augenheilkunde. 2008. V. 215 (2). P. 86–90. https://doi.org/10.1055/s-2008-1034677
  • Green J. On a new series of test-letters for determining the acuteness of vision. Transactions of the American Ophthalmological Society. 1868. V. 1 (4–5). P. 68–71.
  • Hamm L.M., Anstice N.S., Black J.M., Dakin S.C. Recognition acuity in children measured using the Auckland Optotypes. Ophthalmic and Physiological Optics. 2018a. V. 38 (6). P. 596–608. https://doi.org/10.1111/opo.12590
  • Hamm L.M., Yeoman J.P., Anstice N.S., Dakin S.C. The Auckland Optotypes: an open-access pictogram set for measuring recognition acuity. Journal of Vision. 2018b. V. 18. P. 1–15. https://doi.org/10.1167/18.3.13
  • Hamm L.M., Langridge F., Black J.M., Anstice N.S., Vuki M., Fakakovikaetau T., Grant C.C., Dakin S.C. Evaluation of vision screening of 5–15-year-old children in three Tongan schools: comparison of The Auckland Optotypes and Lea symbols. Clinical and Experimental Optometry. 2019. V. 103 (3). P. 353–360. https://doi.org/10.1111/cxo.12958
  • Held R., Gwiazda J., Brill S., Mohindra I., Wolfe J. Infant visual acuity is underestimated because near threshold gratings are not preferentially fixated. Vision Research. 1979. V. 19 (12). P. 1377–1379. https://doi.org/10.1016/0042-6989(79)90210-4
  • Heinrich S.P., Bach M. Resolution acuity versus recognition acuity with Landolt-style optotypes. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2013. V. 251 (9). P. 2235–41. https://doi.org/10.1007/s00417-013-2404-6
  • Hyvärinen L., Näsänen R., Laurinen P. New visual acuity test for pre-school children. Acta Ophthalmologica. 1980. V. 58 (4). P. 507–511. https://doi.org/10.1111/j.1755-3768.1980.tb08291.x
  • ISO 8596. International Standard. Ophthalmic optics. Visual acuity testing. Standard optotype and its presentation. Geneve: International Standards Organization, 1994. (2nd edition: 2009).
  • ISO 8597. International Standard. Optics and optical instruments. Visual acuity testing. Method of correlating optotypes. Geneve: International Standards Organization, 1994.
  • ISO 5725-2. International Standard. Accuracy (trueness and precision) of measurement methods and results. Basic methods for the determination of repeatability and reproducibility of a standard measurement method. International Standards Organization, Geneva, 1994.
  • Jaeger E. Ueber die Pruefung des Sehvermoegens bei Gesunden wie Kranken in Ueber Staar und Staaroperationen. 1854. Wien.
  • Kay H. New method of assessing visual acuity with pictures. British Journal of Ophthalmology. 1983. V. 67. P. 131–133. https://doi.org/10.1136/bjo.67.2.131
  • Kazakova A., Gracheva M., Rozhkova G., Pokrovskiy D.F., Medvedev I.B. Novel visual acuity charts with modified 3-bar optotypes: approbation in cataract patients. Proc. of The 12th conference of the Lithuanian Neuroscience Association. 2020. P. 36.
  • Kholina A. Novaya tablitsa dlya issledovaniya ostroty zreniya [A new chart for visual acuity assessment]. Russkii oftal’mologicheskii zhurnal. 1930. V. 11 (1). P. 42–47. (in Russian).
  • Kniestedt C., Stamper R. L. Visual acuity and its measurement. Ophthalmology Clinics of North America. 2003. V. 16 (2). P. 155–170. https://doi.org/10.1016/s0896-1549(03)00013-0
  • Koskin S.A., Boiko É.V., Sobolev A.F. Shelepin Yu.E. Mechanisms of recognition of the outlines of “vanishing” optotypes. Neuroscience and Behavioral Physiology. 2007. V. 37. P. 59–65. https://doi.org/10.1007/s11055-007-0150-0
  • Koskin S.A. Sistema opredeleniya ostroty zreniya v tselyakh vrachebnoi ekspertizy [The systems of visual acuity measurements for medical examination]. MD diss, 2009. St Petersburg. (in Russian).
  • Landolt E. Méthode optométrique simple. Bulletins et Memoires de la Société Français d’Ophtalmologie. 1888. V. 6. P. 213–214.
  • Lebedev D.S., Belozerov A.E., Rozhkova G.I. Optotipy dlya tochnoi otsenki ostroty zreniya [Optotypes for an accurate assessment of visual acuity]. Patent RF. No. 2447826. 2012.
  • Lebedev D.S. Model mekhanizma raspoznavaniya orientatsii 3-polosnykh dvukhgradatsionnykh optotipov [A model of orientation recognition mechanisms for the 3-bar two-grade optotypes]. Sensornye sistemy [Sensory systems]. 2015. V. 29 (4). P. 309–320.
  • Lippmann O. Vision of young children. Archives of Ophthalmology. 1969. V. 81. P. 763– 775.
  • Lippmann O. Vision screening of young children. American journal of Public Health. 1971. V. 61. P. 1586–1601.
  • Linksz A., John Green, the AOS, and the reasonable notation of visual acuity measurements. Transactions of the American Ophthalmological Society. 1972. V. 70. P. 314–327.
  • Marg E., Freeman D.N. Visual acuity and sensitive period. Proceedings of the Fourth Symposium on Sensory Physiology. Leningrad, Academy of Sciences USSR IP Pavlov Institute of Physiology. 1976. P. 124–132.
  • Mayer D.L., Beiser A.S., Warner A.F., Pratt E.M., Kaye K.N., Lang J.M. Monocular acuity norms for the Teller acuity cards between ages one month and four years. Investigative Ophthalmology & Visual Science. 1995. V. 36 (3). P. 671–685.
  • Mayer D.L., Dobson V. Assessment of vision in young children: A new operant approach yields estimates of acuity. Investigative Ophthalmology & Visual Science. 1980. V. 19. P. 566–570.
  • Mayer D.L., Dobson V. Visual acuity development in infants and young children, as assessed by operant preferential looking. Vision Research. 1982. V. 22. P. 1141–1151. https://doi.org/10.1016/0042-6989(82)90079-7
  • Miller W.H., Bernard G.D. Averaging over the foveal receptor aperture curtails aliasing. Vision research. 1983. V. 23 (12). P. 1365–1369. https://doi.org/10.1016/0042-6989(83)90147-5
  • Moiseenko G.A., Pronin S.V., Zhil’chuk D.I., Koskin S.A., Shelepin Yu.E. Vanishing optotypes and objective measurement of human visual acuity. Journal of Optical Technology. 2020. V. 87 (12). P. 761–766. https://doi.org/10.1364/JOT.87.000761
  • Monoyer F. Echelle typographique d’ecimale pour mesurer l’acuit’e visuelle. Gaz. Med. Paris. 1875. V. 21. P. 258.
  • Norcia A.M., Tyler C.W. Spatial frequency sweep VEP: visual acuity during the first year of life. Vision Research. 1985. V. 25 (10). P. 1399–1408.
  • Plainis S., Tzatzala P., Orphanos Y., Tsilimbaris M.K. A modified ETDRS visual acuity chart for Europeanwide use. Optometry and Vision Science. 2007. V. 84 (7). P. 647–653.
  • Pugmire G.E., Sheridan M.D. Test types for very young or mentally backward children. Med Officer. 1930. V. 43. P. 133–134.
  • Pugmire G.E., Sheridan M.D. Revised vision screening chart for very young or retarded children. Med Officer. 1957. V. 98. P. 53–55.
  • Richman J.E., Petito G.T., Cron M.T. Brocken wheel acuity test: A new and valid test for preschool and exceptional children. Journal of the American Optometric Association. 1984. V. 55. P. 561–565.
  • Rozhkova G.I., Belozerov A.E., Lebedev D.S. Izmerenie ostroty zreniya: neodnoznachnost' vliyaniya nizkochastotnykh sostavlyayushchikh spektra Fur'e optotipov [Visual acuity measurement: uncertain effect of the low-frequency components of the optotype Fourierspectra]. Sensornye sistemy [Sensory systems]. 2012. V. 26 (2). V. 160–171. (in Russian).
  • Rozhkova G.I., Gracheva M., Lebedev D.S. Optimizatsiya testovyh znakov i tablits dlya izmereniya ostroty zreniya [Optimisation of the test symbols and charts for visual acuity measurements]. Nevskiye gorizonty. 2014. P. 563–567.
  • Rozhkova G.I., Lebedev D., Gracheva M., Rychkova S. Optimal optotype structure for monitoring visual acuity. Proceedings of the Latvian Academy of Sciences. Section B. 2017. V. 71 (5). P. 20–30. https://doi.org/10.1515/prolas-2017-0057
  • Rozhkova G.I., Gracheva M.A. Paramei G.V. An overview of the visual acuity assessment. 1.Primary measures and various notations. Sensornye sistemy [Sensory systems]. 2021. V. 35(3). P. 179–198. https://doi.org/10.318/SO235009221030033
  • Shah N., Dakin S.C., Anderson R. Effect of optical defocus on detection and recognition of vanishing optotype letters in the fovea and periphery. Investigative Ophthalmology & Visual Science. 1996. V. 53 (11). P. 7063–7070. https://doi.org/10.1167/iovs.12-9864
  • Shah N., Dakin S.C., Redmond T., Anderson R.S. Vanishing Optotype acuity: repeatability and effect of the number of alternatives. Ophthalmic and Physiological Optics. 2011. V. 31 (1). P. 17–22. https://doi.org/10.1111/j.1475-1313.2010.00806.x
  • Shah N., Laidlaw D.A.H., Brown G., Robson C. Effect of letter separation on computerised visual acuity measurements: Comparison with the gold standard Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Ophthalmic and Physiological Optics. 2010. V. 30 (2). P. 200–203. https://doi.org/10.1111/j.1475-1313.2009.00700.x
  • Shah N., Dakin S.C., Dobinson S., Tufail A., Egan C.A., Anderson R.S. Visual acuity loss in patients with agerelated macular degeneration measured using a novel high-pass letter chart. British Journal of Ophthalmology. 2016. V. 100 (10). P. 1346–1352. https://doi.org/10.1136/bjophthalmol-2015-307375
  • Shamshinova A.M., Volkov V.V. Funktsional’nye metody issledovaniya v oftal’mologii [Functional methods of diagnostics in ophthalmology]. Moscow, Meditsina. 1999. 416 p.
  • Sheridan M.D. Vision screening of very young or handicapped children. British medical journal. 1960. V. 2 (5196), 453–456. https://dx.doi.org/10.1136%2Fbmj.2.5196.453
  • Sloan L.L. New test charts for the measurement of visual acuity at far and near distances. American Journal of Ophthalmology. 1959. V. 48 (6). P. 807–813. https://doi.org/10.1016/0002-9394(59)90626-9
  • Snellen H. Test-types for the determination of the acuteness of vision. Utrecht: P. W. van de Weijer. 1862.
  • Snyder A.W., Miller W.H. Photoreceptor diameter and spacing for highest resolving power. Journal of the Optical Society of America. 1977. V. 67 (5). P. 696–698. https://doi.org/10.1364/JOSA.67.000696
  • Stiers P., Vanderkelen R., Vandenbussche E. Optotype and grating visual acuity in preschool children. Investigative Ophthalmology & Visual Science. 2003. V. 44 (9). P. 4123–4130. https://doi.org/10.1167/iovs.02-0739
  • Stiers P., Vanderkelen R., Vandenbussche E. Optotype and grating visual acuity in patients with ocular and cerebral visual impairment. Investigative ophthalmology & visual science. 2004. V. 45 (12). P. 4333–4339. https://doi.org/10.1167/iovs.03-0822
  • Taylor H.R. Applying new design principles to the construction of an illiterate E chart. 1978. American Journal of Optometry and Physiological Optics. 55: 348–351. https://doi.org/10.1097/00006324-197805000-00008
  • Teller D.The forced-choice preferential looking procedure: A psychophysical technique for use with human infants. Infant Behavior and Development. 1979. V. 2. P. 135–153. https://doi.org/10.1016/S0163-6383(79)80016-8
  • Teller D. Measurement of visual acuity in human and monkey infants: The interface between laboratory and clinic. Behavioural Brain Research. 1983. V. 10. P. 15–23. https://doi.org/10.1016/0166-4328(83)90146-8
  • Teller D. First glances: The vision of infants. Investigative Opgthalmology and Visual Science. 1997. V. 38. P. 2183–2203.
  • Teller D., Mayer D.L., Makous W.L., Allen J.L. Do preferential looking techniques underestimate infant visual acuity? Vision Research. 1982. V. 22 (8). P. 1017–1024. https://doi.org/10.1016/0042-6989(82)90038-4
  • USAF-1951. United States Air Force 3-bar resolution test chart.
  • Watson A.B., Ahumada A.J. Predicting visual acuity from wavefront aberrations. Journal of Vision. 2008. V. 8 (4). P. 1–19. https://doi.org/10.1167/8.4.17
  • Watson A.B., Ahumada A.J. Modeling acuity for optotypes varying in complexity. Journal of Vision. 2012. V. 12 (10). P. 1–19. https://doi.org/10.1167/12.10.19
  • Wen Y., Chen Z., Zuo C., Yang Y., Xu J., Kong Y, Cheng H., Yu M. Low-contrast high-pass visual acuity might help to detect glaucoma damage: a structure-function analysis. Frontiers in Medicine. 2021. V. 8. 680823. https://doi.org/10.3389/fmed.2021.680823
  • Westheimer G. Chapter 7: Visual acuity and spatial modulation thresholds. Handbook of sensory physiology. 1972. P. 170–187.
  • Wollman K. A brief history of optotype. 2020. URL: https://mattjensenmarketing.com/brief-history-optotype/ (accessed 23.06.2021).