Snellen chart
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Snellen chart
Purpose Snellen chart is used to estimate visual acuity
A Snellen chart is an eye chart that can be used to measure visual acuity. Snellen
charts are named after the Dutch ophthalmologist Herman Snellen, who developed the
chart in 1862.[1] Many ophthalmologists and vision scientists now use an improved chart
known as the LogMAR chart
Description[edit]
The normal Snellen chart is printed with eleven lines of block letters. The first line consists of one
very large letter, which may be one of several letters, for example E, H, or N. Subsequent rows have
increasing numbers of letters that decrease in size. A person taking the test covers one eye from 6
metres or 20 feet away, and reads aloud the letters of each row, beginning at the top. The smallest
row that can be read accurately indicates the visual acuity in that specific eye. The symbols on an
acuity chart are formally known as "optotypes".
In the case of the traditional Snellen chart, the optotypes have the appearance of block letters, and
are intended to be seen and read as letters. They are not, however, letters from any ordinary
typographer's font. They have a particular, simple geometry in which:
the thickness of the lines equals thickness of the white spaces between lines
and the thickness of the gap in the letter "C"
the height and width of the optotype (letter) is five times the thickness of the
line.
Only the nine letters C, D, E, F, L, O, P, T, Z are used in the common Snellen chart. The perception
of five out of six letters (or similar ratio) is judged to be the Snellen fraction. [4] Wall-mounted Snellen
charts are inexpensive and are sometimes used for approximate assessment of vision, e.g. in a
primary-care physician's office. Whenever acuity must be assessed carefully (as in an eye doctor's
examination), or where there is a possibility that the examinee might attempt to deceive the
examiner (as in a motor vehicle license office), equipment is used that can present the letters in a
variety of randomized patterns. BS 4274-1:1968(British Standards Institution) "Specification for test
charts for determining distance visual acuity" was replaced by BS 4274-1:2003 "Test charts for
clinical determination of distance visual acuity — Specification". It states that "the luminance of the
presentation shall be uniform and not less than 120 cd/m2. Any variation across the test chart shall
not exceed 20 %." According to BS 4274-1:2003 only the letters C, D, E, F, H, K, N, P, R, U, V, and
Z should be used for the testing of vision based upon equal legibility of the letters. [citation needed]
Snellen fraction[edit]
Visual acuity = Distance at which test is made / distance at which the
smallest optotype identified subtends an angle of five arcminutes.[citation needed]
"6/6"(m) or "20/20"(ft) vision[edit]
Further information: Visual acuity § Expression
Snellen defined “standard vision” as the ability to recognize one of his optotypes when it subtended
5 minutes of arc. Thus the optotype can only be recognized if the person viewing it can discriminate
a spatial pattern separated by a visual angle of one minute of arc.
Outside the United States, the standard chart distance is 6 metres (20 ft), and normal acuity is
designated "6/6". Other acuities are expressed as ratios with a numerator of 6. Some clinics do not
have 6-metre eye lanes available, and either a half-size chart subtending the same angles at 3
metres (9.8 ft), or a reversed chart projected and viewed by a mirror is used to achieve the correct
sized letters.
In the most familiar acuity test, a Snellen chart is placed at a standard distance: 6 metres. At this
distance, the symbols on the line representing "normal" acuity subtend an angle of five minutes of
arc, and the thickness of the lines and of the spaces between the lines subtends one minute of arc.
This line, designated 6/6 (or 20/20), is the smallest line that a person with normal acuity can read at
a distance of 6 metres.
Three lines above, the letters have twice the height of those letters on the 6/6 (or 20/20 in the US)
line. If this is the smallest line a person can read, the person's acuity is "6/12" ("20/40"), meaning
that this person needs to approach to a distance of 6 metres (20 ft) to read letters that a person with
normal acuity could read at 12 metres (39 ft). In an even more approximate manner, this person
could be said to have "half" the normal acuity of 6/6.
At exactly 6 metres' distance from the patient, the letters on the 6/6 line shall subtend 5 minutes of
arc (such that the individual limbs of the letters subtend 1 minute of arc), which means that the chart
should be sized such that these letters are 8.73 mm tall and the topmost (6/60) "E" should be
87.3 mm tall. Putting it another way, the eye should be at a distance 68.76 times the height of the
top (6/60) letter.
