Intended for healthcare professionals


Reliability of the Snellen chart

BMJ 1995; 310 doi: (Published 10 June 1995) Cite this as: BMJ 1995;310:1481
  1. Paul McGraw,
  2. Barry Winn,
  3. David Whitaker
  1. Research fellow Department of Vision Sciences, Glasgow Caledonian University, Glasgow G4 0BA
  2. Professor Senior lecturer Department of Optometry, University of Bradford, Bradford BD7 1DP

    Better charts are now available

    Historically, visual function has been assessed by determining the finest spatial detail that the visual system can discriminate. A letter acuity chart, such as the Snellen chart, is commonly used. This type of test is simple to perform and is sensitive to the most common sources of visual impairment, such as uncorrected refractive error, cataract, macular disease, and amblyopia. A recent article in the BMJ identified some of the factors reducing the Snellen chart's reliability, such as failure to test visual acuity at the right distance and under recommended levels of illumination.1 But other determinants inherent in the design of the Snellen chart also warrant consideration.

    During the measurement of visual acuity only the angular subtense of the letters should change as the subject reads down the chart, which is not the case with the Snellen chart. Variation in the number of letters on each line presents the subject with a task of increasing difficulty rather than providing an equivalent task at all …

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