A need for standardization in visual acuity measurement

Patel, Hina; Congdon, Nathan; Strauss, Glenn; Lansingh, Charles

doi:10.5935/0004-2749.20170082

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Review Articles • Arq. Bras. Oftalmol. 80 (5) • Sep-Oct 2017 • https://doi.org/10.5935/0004-2749.20170082 copy

A need for standardization in visual acuity measurement

Medida da acuidade visual e necessidade de padronização

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Standardization of terminologies and methods is increasingly important in all fields including ophthalmology, especially currently when research and new technology are rapidly driving improvements in medicine. This review highlights the range of notations used by vision care professionals around the world for vision measurement, and the challenges resulting from this practice. The global community is urged to move toward a uniform standard.

Keywords:
Visual acuity; Vision screening; Vision tests; logMAR; ETDRS

	Other	20ft	10ft	5ft	2ft	6 m	5 m	4 m	3 m	1 m	Decimal	5 score	Decimal as x /10 fraction	logMAR ETDRS	Letter count	Read 1M at cm	Visual acuity score (VAS)	Visual acuity rating (VAR)	Visual angle/ Mar notation/minarc	VE% notation	spatial frequency cyc/ degree grating cpd	Line number	% central visual efficieny for distance vision	% central visual efficieny for near vision	0.40 mts	Reduced Snellen at 40 cm	Jaeger approximate 40 cm	Revised Jaeger standard	American point type	M notation/M-unit	N points *	x-height mm	40 cm UK	100 cm UK	Snellen at inches 14	Centimeters 35
Near total blind	NPL/NLP	NPL/LP
	PL/LP	PL/LP
	CF1/HM	CF1/HM
		20/6060									0.0033			2.48
		20/5020									0.0040			2.40
	CF2/HM	20/4000									0.0050			2.30
		20/3170									0.0063			2.20
	CF3/HM (20/2666)	20/2500									0.0080			2.10
	CF4	20/2000	10/1000			6/630 6/600	5/500	4/400	3/320	1/100	0.0100	3.0		2.00	0		0	0	100		0.30	20	0		0.40/40	20/2000				40.0	320	58.2			14/1400	35/3500
												3.1		1.98			01
														1.96			02
														1.94			03
														1.92			04
	CF5	20/1600	10/800			6/500 6/480	5/400	4/320	3/250	1/80	0.0125 0.0130			1.90	05		05	05	080		0.35 0.38				0.40/32	20/1600				32.0	250	46.5			14/1100
		20/1400									0.0140
	CF6 (20/1333)											3.2		1.88			06
														1.86			07
														1.84			08
														1.82			09
	CF7 (20/1143)	20/1250	10/630			6/400 6/380	5/320	4/250	3/200	1/63	0.0160			1.80	10		10	10	063						0.40/25	20/1250				25.0	200	36.4			14/880
		20/1200				6/360													060	0.48%	0.5 0.65
														1.78			11
														1.76			12
														1.74			13
														1.72			14
	CF8	20/1000	10/500			6/320 6/300	5/250	4/200	3/160	1/50	0.0200	3.3		1.70	15	2	15	15	050						0.40/20	20/1000				20.0	160	29.1			14/700
														1.68			16
														1.66			17
														1.64			18
														1.62			19
Profound visual impairment	CF10	20/800	10/400			6/250 6/240 6/192	5/200	4/160	3/125	1/40	0.0250 0.0300	3.4		1.60	20	2.5	20	20	040		0.75 0.95	16	5		0.40/16	20/800				16.0	125	23.3			14/560	35/1400
		20/640										3.5		1.50
														1.58			21
														1.56			22
														1.54			23
														1.52			24
		20/630	10/320			6/200 6/190 6/180	5/160	4/125	3/100 3/95	1/32	0.0320		2/60	1.50	25	3.2	25	25	032	0.40%					0.40/12.5	20/630				12.5	100	18.2			14/440
		20/600												1.50					030		1.00
														1.48			26
														1.46			27
														1.44			28
														1.42			29
		20/500	10/250			6/160 6/152 6/150	5/125	4/100	3/80 3/75	1/25	0.0400	3.6		1.40	30	4	30	30	025	1.40%	1.20				0.40/10	20/500				10.0	080	14.5			14/350
														1.38			31
														1.36			32
														1.34			33
														1.32			34

		20/400	10/200	20/1600	20/4000	6/126 6/120	5/100	4/80	3/63	1/20	0.050	3.7	3/60	1.30	35	05.0	35	35	20.00	03.3%	1.50	13	10		0.40/8	20/400				8.0	63	11.60	~N48		14/280	35/700
												3.8
														1.28			36
														1.26			37
														1.24			38
														1.22			39
		20/320	10/160			6/100 6/96 6/95 6/90	5/80	4/63	3/50 3/47	1/16	0.060 0.063			1.20	40	06.3	40	40	16.00	06.8%	1.88 1.90	12	15		0.40/6.3	20/320				6.4 6.3	50	09.16			14/ 224 14/220	35/560
Severe visual impairment		20/300									0.070			1.18			41		15.00		2.00		16							6.0			~N36		14/210	35/525
														1.16			42
														1.14			43
														1.12			44
		20/250	10/125			6/80 6/76 6/75	5/63	4/50	3/40 3/37	1/12.5	0.080	3.9		1.10	45	08.0	45	45	12.50	12.8%	2.40	11	17	0	0.40/5	20/250				5.0	40	07.27			14/175	35/437.5
														1.08			46
														1.06			47
														1.04			48
														1.02			49
		20/200	10/100	20/800	20/2000	6/63 6/60	5/50	4/40	3/32 3/30	1/10	0.100	4.0	1/10	1.00	50	10.0	50	50	10.00	20.0%	3.00	10	20	02	0.40/4	20/200	J15-J18	14	23	4.0	32	05.82	N24	N48	14/140	35/350
														0.98			51
														0.96			52
														0.94			53
														0.92			54
		20/160	10/80			6/50 6/48 6/45	5/40	4/32	3/25 3/24	1/8	0.125 0.130	4.1		0.90	55	12.5	55	55	08.00	28.6%	3.75 3.80	09	30	05	0.40/3.2	20/160	J10-J15	13	21	3.2	25	04.65			14/112 14/110	35/280
		20/150									0.130								07.50		4.00		32	06		20/150				3.0			~N18		14/105	35/262.5
														0.88			56
														0.86			57
														0.84			58
														0.82			59
Moderate visual impairment		20/125	10/63			6/40 6/38 6/37.5 6/34.2	5/ 32 5/30	4/25	3/20 3/19	1/6.3	0.160	4.2		0.80	60	16.0	60	60		38.8%	4.80	08	40	10	0.40/2.5	20/125	J9-J12	12	14	2.5	20	03.64		~N36	14/88 14/87.5	35/218.8
		20/120 20/114									0.180			0.76					05.10		5.26		44	12				11	13	2.3					14/79.8	35/199.5
														0.78			61
														0.76			62
														0.74			63
														0.72			64
		20/100	10/50	20/400	20/1000	6/32 6/30	5/25	4/20	3/16 3/15	1/5	0.200	4.3	2/10	0.70	65	20.0	65	65	05.01	48.9%	6.00	07	50	15	0.40/2.0	20/100	J8-J12	10	12	2.0	16	2.91	N14		14/70	35/175
														0.68			66
														0.66			67
														0.64			68
														0.62			69
		20/80	10/40	20/320	20/800	6/25 6/24	5/20	4/16	3/12.5 3/12	1/4	0.250	4.4		0.60	70	25.0	70	70	04.00	58.5%	7.50	06	60	20	0.40/1.60	20/80	J5-J9	09	11	1.6	12.5	2.33	N12	N24	14/56	35/140
		20/70		20/280	20/700	6/21					0.290								03.50		8.57		63	32						1.4					14/49	35/122.5
						6/20							3/10
														0.58			71
														0.56			72
														0.54			73

														0.52			74

Near normal vision		20/63	10/32			6/20 6/19 6/18.9 6/18	5/16	4/13 4/12.5	3/10 3/9	1/3.2	0.32	4.5	3/10	0.50	75	032	075	075	3.2/3.15	067.5%	9.5/9.52	5	065	040	0.40/1.25	20/63	J4-J7	8	10	1.30 1.25	10.0	1.82			14/44.1 14/44	35/110.3
		20/63		20/240	20/600	6/18	5/15				0.32 0.33		3/10	0.48			076		3.00		10		067	042				7	9	1.20			N10	N18	14/42	35/105
														0.46			077
														0.44			078
														0.42			079
		20/60 20/50	10/25	20/200	20/500	6/16 6/15	5/12.5	4/10	3/8 3/7	1/2.5	0.40	4.6	4/10	0.40	80	040	080	080	2.50	076.5%	12	4	075	050	0.40/1.0	20/50	J3-J6	6	8	10.9	08.0	1.45	~N8		14/35	35/87.5
														0.38			081
														0.36			082
														0.34			083
														0.32			084
		20/40	10/20	20/160	20/400	6/12.5 6/12	5/10	4/8	3/6.3 3/6	1/2	0.50	4.7	5/10	0.30	85	050	085	085	2.00	083.6%	15	3	085	090	0.40/0.8	20/40	J1-J5	5	7	0.8	06.3	1.16	N6	N14	14/28	35/70
														0.28			086
														0.26			087
														0.24			088
														0.22			089
		20/32	10/16			6/10 6/9.6 6/9.5	5/8	4/6.3	3/5	1/1.6	0.63	4.8	6/10	0.20	0.29	063	090	090	1.60	089.8%	18.75 19	2	090	094	0.40/0.63	20/32	J1-J3	4	6	0.64 0.63	05.0	0.92			14/22.4 14/22	35/56
		20/30	10/15			6/9	5/7.5 5/6.6				0.67 0.70		7/10	0.18							20		091	095				3	5	0.60			N5	N12	14/21	35/52.5
						6/8.5							7/10
														0.18			091
														0.16			092
														0.14			093
														0.12			094
		20/25	10/12.5			6/7.5 6/6.6 8	5/6.3	4/5	3/4	1/1.25	0.80	4.9	8/10	0.10	95	080	095	095	1.25	095.6%	24	1	095	100	0.40/0.5	20/25	J1-J2	2	4	0.50	04.0	0.73		N10	14/17.5	35/43.8
													9/10
														0.08			096
														0.06			097
														0.04			098
														0.02			099
Normal vision		20/20	10/10			6/6.3 6/6	5/5	4/4	3/3.2 3/3	1/1	1.00	5.0	10/10	0	100	100	100	100	1.00	100.0%	30	0	100	100	0.40/0.4	20/20	J1	1	3	0.40	03.2	0.58	N4.5	N8	14/14	35/35
														-0.02			101	101
														-0.04			102	102
														-0.06			103	103
														-0.08			104	104
		20/17 20/16 20/15	10/8			6 /5 6/4.8 6/4.5	5/4	4/3.2 4/3	3/2.5 3/2.4	1/.8	1.20 1.25 1.33	5.1	12/10	-0.10	105	125	105	105	0.80	103.6%	37.5 38	-1	100	100	0.40/0.32	20/16				0.32	02.5	0.47			14/11.2 14/11	35/28
														-0.12			106
														-0.14			107
														-0.16			108
														-0.18			109
		20/13 20/12.5 20/12	10/6.3			6/4 6/3.8 6/3.75	5/3.5 5/3.2	4/2.5	3/2 3/1.9	1/.63	1.50 1.60 1.63	5.2	15/10	-0.20	110	160	110	110	0.63	106.8%	48	-2	100	100	0.40/0.25	20/12.5				0.25	02.0	0.36			14/8.8	35/21.9
														-0.22			111
														-0.24			112
														-0.26			113
														-0.28			114
		20/10				6/3	5/3 5/2.5	4/2	3/1.5	1/0.5	2.00	5.3	20/10	-0.30			115	115	0.50	109.4%	60	-3	100	100	0.40/0.20	20/10				0.20	01.6	0.29			14/7	35/17.5
		20/8				6/2.4	5/2.0	4/1.6	3/1.2		2.50
References (key only)	21, 24	1, 2, 3, 7, 9, 10, 11, 13, 14, 16, 21, 24	9, 10	3	3	1, 2, 7, 9, 10, 11,13, 14, 16, 23	2, 3, 9, 10, 11	7, 9, 10	10	9, 10, 11	1, 2, 7, 9, 10, 11, 13, 14, 16, 21	personal communication	1, 11, 23	13	11	11	10, 13	7	7, 14	7	7, 14	14	14	14	7	7	7	14	14	7, 14	7	7	2	2	7, 14	14
References (key only)	20, 22	1, 2, 3, 4, 7, 10, 11, 12, 20, 21, , 22, 23	7, 11	21	21	1, 2, 3, 4, 7, 10, 11, 12, 23, 24	4, 7, 10, 11, 21	2, 7, 11,	7	7, 10, 11	1, 2, 3, 4, 7, 10, 11, 12, 20, 23	personal communication	3, 10, 24	23	10	10	7, 23	2	1, 2	2	1, 2	1	1	1	2	2	2	1	1	1 , 2	2	2	4	4	1 , 2	1

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[1] Corresponding author: Hina Patel. 20W 36^th Street, Floor 4 - New York - NY - 10018-8005 - USA - Email: hinaben@helpmesee.org