Visual acuity

Visual acuity
Visual acuity (VA) commonly refers to the clarity of vision. Visual
acuity is dependent on optical and neural factors, i.e., (i) the sharpness of Medical diagnostics
the retinal focus within the eye, (ii) the health and functioning of the
[1]
retina, and (iii) the sensitivity of the interpretative faculty of the brain.

A common cause of low visual acuity is refractive error (ametropia), or

errors in how the light is refracted in the eyeball. Causes of refractive
errors include aberrations in the shape of the eyeball or the cornea, and
reduced flexibility of the lens. Too high or too low refractive error (in
relation to the length of the eyeball) is the cause of nearsightedness
(myopia) or farsightedness (hyperopia) (normal refractive status is
referred to as emmetropia). Other optical causes are astigmatism or more
complex corneal irregularities. These anomalies can mostly be corrected
by optical means (such aseyeglasses, contact lenses, laser surgery, etc.).

Neural factors that limit acuity are located in the retina or the brain (or
the pathway leading there). Examples for the first are a detached retina
and macular degeneration, to name just two. Another common
impairment, amblyopia, is caused by the visual brain not having
developed properly in early childhood. In some cases, low visual acuity
is caused by brain damage, such as from traumatic brain injury or stroke. A typical Snellen chart that is frequently used
When optical factors are corrected for, acuity can be considered a for visual acuity testing.
measure of neural well-functioning. MeSH D014792

Visual acuity is typically measured while fixating, i.e. as a measure of MedlinePlus 003396
central (or foveal) vision, for the reason that it is highest there. However, LOINC 28631-0
acuity in peripheral vision can be of equal (or sometimes higher)
importance in everyday life. Acuity declines towards the periphery in an inverse-linear fashion (i.e. the decline follows a
hyperbola).[2][3]

Contents
Definition
Measurement
History
Physiology
Optical aspects
Expression
Legal definitions
Measurement considerations
Testing in children
"Normal" visual acuity
Other measures
Motion acuity
 Subtended angular velocity detection threshold (SA
VT)
Lateral motion
Radial motion
See also
References
Further reading
External links

Definition
Visual acuity is a measure of the spatial resolution of the visual processing system. VA, as it is sometimes referred to by optical
professionals, is tested by requiring the person whose vision is being tested to identify so-called optotypes – stylized letters, Landolt
rings, pediatric symbols, symbols for the illiterate, standardized Cyrillic letters in the Golovin–Sivtsev table, or other patterns – on a
printed chart (or some other means) from a set viewing distance. Optotypes are represented as black symbols against a white
background (i.e. at maximum contrast). The distance between the person's eyes and the testing chart is set so as to approximate
"optical infinity" in the way the lens attempts to focus (far acuity), or at a defined reading distance (near acuity).

A reference value above which visual acuity is considered normal is called 6/6 vision, the USC equivalent of which is 20/20 vision:
At 6 meters or 20 feet, a human eye with that performance is able to separate contours that are approximately 1.75 mm apart.[4]
Vision of 6/12 corresponds to lower, vision of 6/3 to better performance. Normal individuals have an acuity of 6/4 or better
(depending on age and other factors).

In the expression 6/x vision, the numerator (6) is the distance in meters between the subject and the chart and the denominator (x) the
distance at which a person with 6/6 acuity would discern the same optotype. Thus, 6/12 means that a person with 6/6 vision would
discern the same optotype from 12 meters away (i.e. at twice the distance). This is equivalent to saying that with 6/12 vision, the
person possesses half the spatial resolution and needs twice the size to discern the optotype.

A simple and efficient way to state acuity is by solving the fraction to a decimal number. 6/6 then corresponds to an acuity (or a
Visus) of 1.0 (see Expression below). 6/3 corresponds to 2.0, which is often attained by well-corrected healthy young subjects with
binocular vision. Stating acuity as a decimal number is the standard in European countries, as required by the European norm (EN
ISO 8596, previously DIN 58220).

The precise distance at which acuity is measured is not important as long as it is sufficiently far away and the size of the optotype on
the retina is the same. That size is specified as a visual angle, which is the angle, at the eye, under which the optotype appears. For
6/6 = 1.0 acuity, the size of a letter on the Snellen chart or Landolt C chart is a visual angle of 5 arc minutes (1 arc min = 1/60 of a
degree). By the design of a typical optotype (like a Snellen E or a Landolt C), the critical gap that needs to be resolved is 1/5 this
value, i.e., 1 arc min. The latter is the value used in theinternational definitionof visual acuity:

Acuity = gap size1[arc min]

Acuity is a measure of visual performance and does not relate to the eyeglass prescription required to correct vision. Instead, an eye
exam seeks to find the prescription that will provide the best corrected visual performance achievable. The resulting acuity may be
greater or less than 6/6 = 1.0. Indeed, a subject diagnosed as having 6/6 vision will often actually have higher visual acuity because,
once this standard is attained, the subject is considered to have normal (in the sense of undisturbed) vision and smaller optotypes are
not tested. Emmetropic subjects with 6/6 vision or "better" (20/15, 20/10, etc.), may still benefit from an eyeglass correction for other
problems related to the visual system, such asastigmatism, ocular injuries, or presbyopia.

Measurement
Visual acuity is measured by a psychophysical procedure and as such relates the physical characteristics of a stimulus to a subject's
percept and his/her resulting responses. Measurement can be by using an eye chart invented by Ferdinand Monoyer, by optical
instruments, or by computerized tests[5] like the FrACT.[6]

Care must be taken that viewing conditions correspond to the standard,[7] such as correct illumination of the room and the eye chart,
correct viewing distance, enough time for responding, error allowance, and so forth. In European countries, these conditions are
standardized by the European norm (EN ISO 8596, previouslyDIN 58220).

History
Year Event
Vision test types are invented in 1843 by theGerman ophthalmologistHeinrich Kuechler (1811–1873), in
1843 Darmstadt, Germany. He argues for need to standardize vision tests and produces three reading charts to
avoid memorization.
Eduard Jäger von Jaxtthal, a Vienna oculist, makes improvements to eye chart test types that were developed
by Heinrich Kuechler. He publishes, in German, French, English and other languages, a set of reading
1854 samples to document functional vision. He uses fonts that were available in the State Printing House in
Vienna in 1854 and labels them with the numbers from that printing house catalogue, currently known as
Jaeger numbers.
Herman Snellen, a Dutch ophthalmologist, publishes inUtrecht his "Optotypi ad visum determinandum"
("Probebuchstaben zur Bestimmung der Sehschärfe"), the first visual chart based on "Optotypes", advocating
1862
the need for standardized vision tests. Snellen's Optotypes are not identical to the test letters used today
.
' gyptian Paragon' font (i.e. usingserifs).[8][9]
They were printed in an E
Edmund Landolt introduces the broken ring, now known as the Landolt ring, which later becomes an
1888
international standard.[10][11]

1894 Theodor Wertheim in Berlin presents detailedmeasurements of acuity inperipheral vision.[2][12]

Hugh Taylor uses these design principles for a "Tumbling E Chart" for illiterates, later used[13] to study the
1978
visual acuity of Australian Aborigines.[9]

Rick Ferris et al. of the National Eye Institute chooses the LogMAR chart layout, implemented with Sloan
letters, to establish a standardized method of visual acuity measurement for the Early Treatment of Diabetic
1982 Retinopathy Study (ETDRS). These charts are used in all subsequent clinical studies, and did much to
familiarize the profession with the new layout and progression. Data from the ETDRS were used to select
letter combinations that give each line the same average dif
ficulty, without using all letters on each line.

The International Council of Ophthalmology approves a new 'Visual Acuity Measurement Standard', also
1984
incorporating the above features.

Antonio Medina and Bradford Howland of the Massachusetts Institute of Technology develop a novel eye
testing chart using letters that become invisible with decreasing acuity, rather than blurred as in standard
1988
charts. They demonstrate the arbitrary nature of the Snellen fraction and warn about the accuracy of visual
acuity determined by using charts of different letter types, calibrated by Snellen's system.[14]

Physiology
Daylight vision (i.e. photopic vision) is subserved by cone receptor cells which have high spatial density (in the central fovea) and
allow high acuity of 6/6 or better. In low light (i.e., scotopic) vision, cones do not have sufficient sensitivity and vision is subserved
by rods. Spatial resolution is then much lower. This is due to spatial summation of rods, i.e. a number of rods merge into a bipolar
cell, in turn connecting to aganglion cell, and the resulting unit for resolution is large, and acuity small. Note that there are no rods in
the very center of the visual field (the foveola), and highest performance in low light is achieved innear peripheral vision[2]

The maximum angular resolution of the human eye at a distance of 1 km is typically 30 to 60 cm. This gives an angular resolution of
between 0.02 and 0.03 degrees, which is roughly 1.2–1.8 arc minutes per line pair, which implies a pixel spacing of 0.6–0.9 arc
minutes.[15][16] 6/6 vision is defined as the ability to resolve two points of light separated by a visual angle of one minute of arc, or
[17]
about 320–386 pixels per inch for a display on a device held 25 to 30 cm from the eye.

Thus, visual acuity, or resolving power (in daylight, central vision), is the property of cones.[18] To resolve detail, the eye's optical
system has to project a focused image on the fovea, a region inside the macula having the highest density of cone photoreceptor cells
(the only kind of photoreceptors existing in the fovea's very center of 300 μm diameter), thus having the highest resolution and best
color vision. Acuity and color vision, despite being mediated by the same cells, are different physiologic functions that do not
interrelate except by position. Acuity and color vision can be af
fected independently.

The grain of a photographic mosaic has just as limited resolving power as

The diagram shows the relative acuity of the
human eye on the horizontal meridian in
degrees visual angle from foveal vision.[19]
The blind spot is at about 18° in the outside
direction (e.g. in the left visual field for the left
eye).
the "grain" of the retinal mosaic. In order to see detail, two sets of
receptors must be intervened by a middle set. The maximum resolution is
that 30 seconds of arc, corresponding to the foveal cone diameter or the
angle subtended at the nodal point of the eye. In order to get reception
from each cone, as it would be if vision was on a mosaic basis, the "local
sign" must be obtained from a single cone via a chain of one bipolar,
ganglion, and lateral geniculate cell each. A key factor of obtaining
detailed vision, however, is inhibition. This is mediated by neurons such as
the amacrine and horizontal cells, which functionally render the spread or
convergence of signals inactive. This tendency to one-to-one shuttle of
signals is powered by brightening of the center and its surroundings, which
triggers the inhibition leading to a one-to-one wiring. This scenario,
however, is rare, as cones may connect to both midget and flat (diffuse)
bipolars, and amacrine and horizontal cells can merge messages just as
easily as inhibit them.[4]

Light travels from the fixation object to the fovea through an imaginary
path called the visual axis. The eye's tissues and structures that are in the visual axis (and also the tissues adjacent to it) affect the
quality of the image. These structures are: tear film, cornea, anterior chamber, pupil, lens, vitreous, and finally the retina. The
posterior part of the retina, called the retinal pigment epithelium (RPE) is responsible for, among many other things, absorbing light
that crosses the retina so it cannot bounce to other parts of the retina. In many vertebrates, such as cats, where high visual acuity is
not a priority, there is a reflecting tapetum layer that gives the photoreceptors a "second chance" to absorb the light, thus improving
the ability to see in the dark. This is what causes an animal's eyes to seemingly glow in the dark when a light is shone on them. The
RPE also has a vital function of recycling the chemicals used by the rods and cones in photon detection. If the RPE is damaged and
does not clean up this "shed" blindness can result.

As in a photographic lens, visual acuity is affected by the size of the pupil. Optical aberrations of the eye that decrease visual acuity
are at a maximum when the pupil is largest (about 8 mm), which occurs in low-light conditions. When the pupil is small (1–2 mm),
image sharpness may be limited by diffraction of light by the pupil (see diffraction limit). Between these extremes is the pupil
diameter that is generally best for visual acuity in normal, healthy eyes; this tends to be around 3 or 4 mm.

If the optics of the eye were otherwise perfect, theoretically, acuity would be limited by pupil diffraction, which would be a
diffraction-limited acuity of 0.4 minutes of arc (minarc) or 6/2.6 acuity. The smallest cone cells in the fovea have sizes corresponding
to 0.4 minarc of the visual field, which also places a lower limit on acuity. The optimal acuity of 0.4 minarc or 6/2.6 can be
demonstrated using a laser interferometer that bypasses any defects in the eye's optics and projects a pattern of dark and light bands
directly on the retina. Laser interferometers are now used routinely in patients with optical problems, such as cataracts, to assess the
health of the retina before subjecting them to surgery.

The visual cortex is the part of the cerebral cortex in the posterior part of the brain responsible for processing visual stimuli, called
the occipital lobe. The central 10° of field (approximately the extension of the macula) is represented by at least 60% of the visual
cortex. Many of these neurons are believed to be involved directly in visual acuity processing.

Proper development of normal visual acuity depends on a human or an animal having normal visual input when it is very young. Any
visual deprivation, that is, anything interfering with such input over a prolonged period of time, such as a cataract, severe eye turn or
strabismus, anisometropia (unequal refractive error between the two eyes), or covering or patching the eye during medical treatment,
will usually result in a severe and permanent decrease in visual acuity and pattern recognition in the affected eye if not treated early
in life, a condition known as amblyopia. The decreased acuity is reflected in various abnormalities in cell properties in the visual
cortex. These changes include a marked decrease in the number of cells connected to the affected eye as well as cells connected to
both eyes in cortical area V1, resulting in a loss of stereopsis, i.e. depth perception by binocular vision (colloquially: "3D vision").
The period of time over which an animal is highly sensitive to such visual deprivation is referred to as the
critical period.

The eye is connected to the visual cortex by the optic nerve coming out of the back of the eye. The two optic nerves come together
behind the eyes at the optic chiasm, where about half of the fibers from each eye cross over to the opposite side and join fibers from
the other eye representing the corresponding visual field, the combined nerve fibers from both eyes forming the optic tract. This
ultimately forms the physiological basis of binocular vision. The tracts project to a relay station in the midbrain called the lateral
geniculate nucleus, part of the thalamus, and then to the visual cortex along a collection of nerve fibers called theoptic radiation.

Any pathological process in the visual system, even in older humans beyond the critical period, will often cause decreases in visual
acuity. Thus measuring visual acuity is a simple test in accessing the health of the eyes, the visual brain, or pathway to the brain. Any
relatively sudden decrease in visual acuity is always a cause for concern. Common causes of decreases in visual acuity are cataracts
and scarred corneas, which affect the optical path, diseases that affect the retina, such as macular degeneration and diabetes, diseases
affecting the optic pathway to the brain such as tumors and multiple sclerosis, and diseases affecting the visual cortex such as tumors
and strokes.

Though the resolving power depends on the size and packing density of the photoreceptors, the neural system must interpret the
receptors’ information. As determined from single-cell experiments on the cat and primate, different ganglion cells in the retina are
tuned to different spatial frequencies, so some ganglion cells at each location have better acuity than others. Ultimately, however, it
appears that the size of a patch of cortical tissue in visual area V1 that processes a given location in the visual field (a concept known
as cortical magnification) is equally important in determining visual acuity. In particular, that size is largest in the fovea’s center, and
decreases with increasing distance from there.[2]

Optical aspects
Besides the neural connections of the receptors, the optical system is an equally key player in retinal resolution. In the ideal eye, the
image of a diffraction grating can subtend 0.5 micrometre on the retina. This is certainly not the case, however, and furthermore the
pupil can cause diffraction of the light. Thus, black lines on a grating will be mixed with the intervening white lines to make a gray
appearance. Defective optical issues (such as uncorrected myopia) can render it worse, but suitable lenses can help. Images (such as
gratings) can be sharpened by lateral inhibition, i.e., more highly excited cells inhibiting the less excited cells. A similar reaction is in
.[4]
the case of chromatic aberrations, in which the color fringes around black-and-white objects are inhibited similarly

Expression
Visual acuity is often measured according to the isze of letters viewed on aSnellen chart or the size of other symbols, such as Landolt
Cs or the E Chart.

In some countries, acuity is expressed as avulgar fraction, and in some as a decimal number.
Using the meter as a unit of measurement, (fractional) visual acuity is expressed
relative to 6/6. Otherwise, using the foot, visual acuity is expressed relative to 20/20. Visual acuity scales[20]
For all practical purposes, 20/20 vision is equivalent to 6/6. In the decimal system, Foot Metre Decimal LogMAR
acuity is defined as the reciprocal value of the size of the gap (measured in arc 20/200 6/60 0.10 1.00
minutes) of the smallest Landolt C, the orientation of which can be reliably
20/160 6/48 0.125 0.90
identified. A value of 1.0 is equal to 6/6.
20/125 6/38 0.16 0.80
LogMAR is another commonly used scale, expressed as the (decadic) logarithm of
20/100 6/30 0.20 0.70
the minimum angle of resolution (MAR). The LogMAR scale converts the geometric
20/80 6/24 0.25 0.60
sequence of a traditional chart to a linear scale. It measures visual acuity loss:
positive values indicate vision loss, while negative values denote normal or better 20/63 6/19 0.32 0.50
visual acuity. This scale is rarely used clinically; it is more frequently used in 20/50 6/15 0.40 0.40
statistical calculations because it provides a more scientific equivalent for the
20/40 6/12 0.50 0.30
traditional clinical statement of “lines lost” or “lines gained”, which is valid only
20/32 6/9.5 0.63 0.20
when all steps between lines are equal, which is not usually the case.
20/25 6/7.5 0.80 0.10
A visual acuity of 6/6 is frequently described as meaning that a person can see detail
20/20 6/6.0 1.00 0.00
from 6 metres (20 ft) away the same as a person with "normal" eyesight would see
20/16 6/4.8 1.25 −0.10
from 6 metres. If a person has a visual acuity of 6/12, he is said to see detail from 6
metres (20 ft) away the same as a person with "normal" eyesight would see it from 20/12.5 6/3.8 1.60 −0.20
12 metres (39 ft) away. 20/10 6/3.0 2.00 −0.30

Healthy young observers may have a binocular acuity superior to 6/6; the limit of 20/8 6/2.4 2.50 −0.40

acuity in the unaided human eye is around 6/3–6/2.4 (20/10–20/8), although 6/3 was
[21] Some birds of prey, such as hawks, are believed to have an
the highest score recorded in a study of some US professional athletes.
acuity of around 20/2;[22] in this respect, their vision is much better than human eyesight.

When visual acuity is below the largest optotype on the chart, the reading distance is reduced until the patient can read it. Once the
patient is able to read the chart, the letter size and test distance are noted. If the patient is unable to read the chart at any distance, he
or she is tested as follows:
 Name Abbreviation Definition
Ability to count fingers at a given distance. This test method is only utilized after it has
been determined that the patient is not able to make out any of the letters, rings, or
images on the acuity chart. The letters CF , and the testing distance, would represent
the patient's acuity.
For example, the recording CF 5' would mean the patient was able to count the
Counting examiner's fingers from a maximum distance of 5 feet directly in front of the examiner
.
CF
Fingers
(The results of this test, on the same patient, may vary from examiner to examiner.
This is due more so to the size differences of the various examiner's hands and
fingers, than fluctuating vision.)

Ability to distinguish whether or not there is movement of the examiner's hand directly
in front of the patient's eyes. This test method is only utilized after a patient shows little
or no success with the Counting Fingers test. The letters HM, and the testing distance,
would represent the patient's acuity.
For example, the recording HM 2' would mean that the patient was able to distinguish
movement of the examiner's hand from a maximum distance of 2 feet directly in front
Hand of the examiner.
HM
Motion
(The results of the Hand Motion test are often recorded without the testing distance.
This is due to the fact that this test is performed after the patient cannot "pass" the
Counting Fingers test. At this point, the examiner is usually directly in front of the
patient, and it is assumed that the Hand Motion test is performed at a testing distance
of 1 foot or less.)

Ability to perceive any light. This test method is utilized only after a patient shows little
or no success with the Hand Motion test. In this test, an examiner shines a pen light at
the patient's pupil and asks the patient to either, point to the light source, or, describe
the direction that the light is coming from (up, out, straight ahead, down and out, etc.).
Light
LP If the patient is able to perceive light, the letters LP are recorded to represent the
Perception
patient's acuity. If the patient is unable to perceive any light, the letters NLP N( o Light
Perception) are recorded. A patient with no light perception in one eye is considered
blind in the respective eye. If NLP is recorded in both eyes, the patient is described as
having total blindness.

Legal definitions
Various countries have defined statutory limits for poor visual acuity that qualifies as a disability. For example, in Australia, the
Social Security Act defines blindness as:

A person meets the criteria for permanent blindness under section 95 of the Social Security Act if the corrected visual
acuity is less than 6/60 on the Snellen Scale in both eyes or there is a combination of visual defects resulting in the
same degree of permanent visual loss.[23]

[24]
In the USA, the relevant federal statute defines blindness as follows:

[T]he term "blindness" means central visual acuity of 20/200 or less in the better eye with the use of a correcting lens.
An eye that is accompanied by a limitation in the fields of vision such that the widest diameter of the visual field
subtends an angle no greater than 20 degrees shall be considered for purposes in this paragraph as having a central
visual acuity of 20/200 or less.
A person's visual acuity is registered documenting the following: whether the test was for distant or near vision, the eye(s) evaluated
and whether corrective lenses (i.e. glasses or contact lenses) were used:

Distance from the chart

D (distant) for the evaluation done at 20 feet (6.1 m).

N (near) for the evaluation done at 15.7 inches (40 cm).
Eye evaluated

OD (Latin oculus dexter) for the right eye.

OS (Latin oculus sinister) for the left eye.
OU (Latin oculi uterque) for both eyes.
Usage of spectacles during the test

cc (Latin cum correctore) with correctors.

sc: (Latin sine correctore) without correctors.
Pinhole occluder

The abbreviation PH is followed by the visual acuity as measured with a pinhole occluder
, which temporarily
corrects for refractive errors such as myopia or astigmatism.

So, distant visual acuity of 6/10 and 6/8 with pinhole in the right eye will be: DscOD 6/20 PH 6/8. Distant visual acuity of count
fingers and 6/17 with pinhole in the left eye will be: DscOS CF PH 16/17. Near visual acuity of 6/8 with pinhole remaining at 6/8 in
both eyes with spectacles will be: NccOU 6/8 PH 6/8.

"Dynamic visual acuity" defines the ability of the eye to visually discern fine detail in a moving object.

Measurement considerations
Visual acuity measurement involves more than being able to see the optotypes. The patient should be cooperative, understand the
optotypes, be able to communicate with the physician, and many more factors. If any of these factors is missing, then the
measurement will not represent the patient's real visual acuity
.

Visual acuity is a subjective test meaning that if the patient is unwilling or unable to cooperate, the test cannot be done. A patient who
is sleepy, intoxicated, or has any disease that can alter their consciousness or mental status, may not achieve their maximum possible
acuity.

Illiterate patients who cannot read letters and/or numbers will be registered as having very low visual acuity if this is not known.
Some patients will not tell the examiner that they don't know the optotypes, unless asked directly about it. Brain damage can result in
a patient not being able to recognize printed letters, or being unable to spell them.

A motor inability can make a person respond incorrectly to the optotype shown and negatively fect
af the visual acuity measurement.

Variables such as pupil size, background adaptation luminance, duration of presentation, type of optotype used, interaction effects
from adjacent visual contours (or “crowding") can all af
fect visual acuity measurement.

Testing in children
The newborn’s visual acuity is approximately 6/133, developing to 6/6 well after the age of six months in most children, according to
a study published in 2009.[25]

The measurement of visual acuity in infants, pre-verbal children and special populations (for instance, handicapped individuals) is
not always possible with a letter chart. For these populations, specialised testing is necessary. As a basic examination step, one must
check whether visual stimuli can be fixated, centered and followed.
More formal testing usingpreferential looking techniques use Teller acuity cards (presented by a technician from behind a window in
the wall) to check whether the child is more visually attentive to a random presentation of vertical or horizontal gratings on one side
compared with a blank page on the other side — the bars become progressively finer or closer together, and the endpoint is noted
when the child in its adult carer's lap equally prefers the two sides.

Another popular technique is electro-physiologic testing using visual evoked (cortical) potentials (VEPs or VECPs), which can be
used to estimate visual acuity in doubtful cases and expected severe vision loss cases like
Leber's congenital amaurosis.

VEP testing of acuity is somewhat similar to preferential looking in using a series of black and white stripes (sine wave gratings) or
checkerboard patterns (which produce larger responses than stripes). Behavioral responses are not required and brain waves created
by the presentation of the patterns are recorded instead. The patterns become finer and finer until the evoked brain wave just
disappears, which is considered to be the endpoint measure of visual acuity. In adults and older, verbal children capable of paying
attention and following instructions, the endpoint provided by the VEP corresponds very well to the psychophysical measure in the
standard measurement (i.e. the perceptual endpoint determined by asking the subject when they can no longer see the pattern). There
is an assumption that this correspondence also applies to much younger children and infants, though this does not necessarily have to
be the case. Studies do show the evoked brain waves, as well as derived acuities, are very adult-like by one year of age.

For reasons not totally understood, until a child is several years old, visual acuities from behavioral preferential looking techniques
typically lag behind those determined using the VEP, a direct physiological measure of early visual processing in the brain. Possibly
it takes longer for more complex behavioral and attentional responses, involving brain areas not directly involved in processing
vision, to mature. Thus the visual brain may detect the presence of a finer pattern (reflected in the evoked brain wave), but the
"behavioral brain" of a small child may not find it salient enough to pay special attention to.

A simple but less-used technique is checking oculomotor responses with an optokinetic nystagmus drum, where the subject is placed
inside the drum and surrounded by rotating black and white stripes. This creates involuntary abrupt eye movements (nystagmus) as
the brain attempts to track the moving stripes. There is a good correspondence between the optokinetic and usual eye-chart acuities in
adults. A potentially serious problem with this technique is that the process is reflexive and mediated in the low-level brain stem, not
in the visual cortex. Thus someone can have a normal optokinetic response and yet be cortically blind with no conscious visual
sensation.

"Normal" visual acuity

Visual acuity depends upon how accurately light is focused on the retina, the integrity of the eye's neural elements, and the
interpretative faculty of the brain.[26] "Normal" visual acuity (in central, i.e. foveal vision) is frequently considered to be what was
defined by Herman Snellen as the ability to recognize an optotype when it subtended 5 minutes of arc, that is Snellen's chart 6/6
meter, 20/20 feet, 1.00 decimal or 0.0 logMAR. In young humans, the average visual acuity of a healthy, emmetropic eye (or
ametropic eye with correction) is approximately 6/5 to 6/4, so it is inaccurate to refer to 6/6 visual acuity as "perfect" vision. 6/6 is
the visual acuity needed to discriminate two contours separated by 1 arc minute- 1.75 mm at 6 meters. This is because a 6/6 letter, E
for example, has three limbs and two spaces in between them, giving 5 different detailed areas. The ability to resolve this therefore
requires 1/5 of the letter's total size, which in this case would be 1 minute (visual angle). The significance of the 6/6 standard can best
be thought of as the lower limit of normal or as a screening cutoff. When used as a screening test, subjects that reach this level need
no further investigation, even though the average visual acuity with a healthy visual system is typically better
.

Some people may suffer from other visual problems, such as color blindness, reduced contrast, mild amblyopia, cerebral visual
impairments, inability to track fast-moving objects, or one of many other visual impairments and still have "normal" visual acuity.
Thus, "normal" visual acuity by no means implies normal vision. The reason visual acuity is very widely used is that it is easily
measured, its reduction (after correction) often indicates some disturbance, and that it often corresponds with the normal daily
activities a person can handle, and evaluates their impairment to do them (even though there is heavy debate over that relationship).

Other measures
Normally, visual acuity refers to the ability to resolve two separated points or lines, but there are other measures of the ability of the
visual system to discern spatial differences.

Vernier acuity measures the ability to align two line segments. Humans can do this with remarkable accuracy. This success is
sometimes regarded ashyperacuity. Under optimal conditions of good illumination, high contrast, and long line segments, the limit to
vernier acuity is about 8 arc seconds or 0.13 arc minutes, compared to about 0.6 arc minutes (6/4) for normal visual acuity or the 0.4
arc minute diameter of a foveal cone. Because the limit of vernier acuity is well below that imposed on regular visual acuity by the
"retinal grain" or size of the foveal cones, it is thought to be a process of the visual cortex rather than the retina. Supporting this idea,
vernier acuity seems to correspond very closely (and may have the same underlying mechanism) enabling one to discern very slight
differences in the orientations of two lines, whereorientation is known to be processed in the visual cortex.

The smallest detectable visual angle produced by a single fine dark line against a uniformly illuminated background is also much less
than foveal cone size or regular visual acuity. In this case, under optimal conditions, the limit is about 0.5 arc seconds or only about
2% of the diameter of a foveal cone. This produces a contrast of about 1% with the illumination of surrounding cones. The
mechanism of detection is the ability to detect such small differences in contrast or illumination, and does not depend on the angular
width of the bar, which cannot be discerned. Thus as the line gets finer
, it appears to get fainter but not thinner.

Stereoscopic acuity is the ability to detect differences in depth with the two eyes. For more complex targets, stereoacuity is similar to
normal monocular visual acuity, or around 0.6–1.0 arc minutes, but for much simpler targets, such as vertical rods, may be as low as
only 2 arc seconds. Although stereoacuity normally corresponds very well with monocular acuity, it may be very poor, or absent,
even in subjects with normal monocular acuities. Such individuals typically have abnormal visual development when they are very
young, such as an alternating strabismus, or eye turn, where both eyes rarely, or never, point in the same direction and therefore do
not function together.

Motion acuity
The eye has acuity limits for detecting motion.[27] Forward motion is limited by the subtended angular velocity detection threshold
(SAVT), and horizontal and vertical motion acuity are limited by lateral motion thresholds. The lateral motion limit is generally
below the looming motion limit, and for an object of a given size, lateral motion becomes the more insightful of the two, once the
observer moves sufficiently far away from the path of travel. Below these thresholds subjective constancy is experienced in
accordance with the Stevens' power law and Weber–Fechner law.

Subtended angular velocity detection threshold (SA

VT)
There is a specific acuity limit in detecting an approaching object's looming motion.[28][29] This is regarded as the subtended angular
velocity detection threshold (SAVT) limit of visual acuity.[30] It has a practical value of 0.0275 rad/s.[31] For a person with SAVT
limit of , the looming motion of a directly approaching object of size S, moving at velocity v, is not delectable until its distance D
is[28]

where the S2/4 term is omitted for small objects relative to great distances bysmall-angle approximation.

In order to exceed the SVAT, an object of size S moving as velocity v must be closer than D; beyond that distance, subjective
constancy is experienced. The SVAT can be measured from the distance at which a looming object is first detected:

where the S2 term is omitted for small objects relative to great distances bysmall-angle approximation.
The SAVT has the same kind of importance to driving safety and sports as the static limit. The formula is derived from taking the
derivative of the visual angle with respect to distance, and then multiplying by velocity to obtain the time rate of visual expansion
(dθ/dt = dθ/dx · dx/dt).

Lateral motion
There are acuity limits ( ) of horizontal and vertical motion as well.[27] They can be measured and defined by the threshold
detection of movement of an object traveling at distance D and velocity v orthogonal to the direction of view, from a set-back
distance B with the formula

Because the tangent of the subtended angle is the ratio of the orthogonal distance to the set-back distance, the angular time rate
(rad/s) of lateral motion is simply the derivative of the inverse tangent multiplied by the velocity (dθ/dt = dθ/dx · dx/dt). In
application this means that an orthogonally traveling object will not be discernible as moving until it has reached the distance

where for lateral motion is generally ≥ 0.0087 rad/s with probable dependence on deviation from the fovia and movement
orientation,[27] velocity is in terms of the distance units, and zero distance is straight ahead. Far object distances, close set-backs, and
low velocities generally lower the salience of lateral motion. Detection with close or null set-back can be accomplished through the
pure scale changes of looming motion.[29]

Radial motion
The motion acuity limit affects radial motion in accordance to its definition, hence the ratio of the velocity v to the radius R must
exceed :

Radial motion is encountered in clinical and research environments, indome theaters, and in virtual-reality headsets.

See also
Angular diameter Pediatric ophthalmology
Dioptre Psychophysics
Eye examination Refractive error
Fovea centralis Retinal summation
Hyperacuity (scientific term) Strabismus
Landolt ring Troxler's fading
Optical resolution Golovin–Sivtsev table, for testing visual acuity

References
1. Cline D, Hofstetter HW, Griffin J (1997). Dictionary of Visual Science (4th ed.). Boston: Butterworth-Heinemann.
ISBN 0-7506-9895-0.
2. Strasburger, Rentschler, Jüttner (2011). "Peripheral vision and pattern recognition: a review"(http://www.journalofvisi
on.org/content/11/5/13). Journal of Vision. 11 (5): 13, 1–82. doi:10.1167/11.5.13 (https://doi.org/10.1167/11.5.13).
 3. Barghout-Stein L (1999).On differences between peripheral and foveal pattern masking(Thesis). University of
California, Berkeley.
4. "eye, human". Encyclopædia Britannica 2006 Ultimate Reference Suite DVD
. Encyclopædia Britannica. 2008.
5. Strasburger H (2014). "Software for visual psychophysics: an overview"(http://www.visionscience.com/documents/st
rasburger/strasburger.html). VisionScience.com.
6. Bach M (2016). "The Freiburg Visual Acuity Test" (http://michaelbach.de/fract/).
7. Visual Functions Committee (25 May 1984)."Visual acuity measurement standard"(http://www.icoph.org/dynamic/att
achments/resources/icovisualacuity1984.pdf)(PDF). International Council of Ophthalmology. Retrieved 29 May
2015.
8. Enerson, Ole Daniel (2017)."Herman Snellen" (http://www.whonamedit.com/doctor.cfm/2075.html). Whonamedit?.
9. Colenbrander A (2001)."Measuring Vision and Vision Loss" (https://web.archive.org/web/20141204193231/http://ww
w.ski.org/Colenbrander/Images/Measuring_Vis_Duane01.pdf) (PDF). Archived from the original (http://www.ski.org/C
olenbrander/Images/Measuring_Vis_Duane01.pdf) (PDF) on 4 December 2014.
10. Landolt E (1888). "Méthode optométrique simple" [A simple optometric method].
Bulletins et Memoires De La
Societe Francaise D'Ophtalmologie(in French) (6): 213–214.
11. Grimm, Rassow, Wesemann, Saur, Hilz (1994). "Correlation of optotypes with the Landolt Ring – a fresh look at the
comparability of optotypes".Optometry and Vision Science. 71 (1): 6–13. doi:10.1097/00006324-199401000-00002
(https://doi.org/10.1097/00006324-199401000-00002) . PMID 8146001 (https://www.ncbi.nlm.nih.gov/pubmed/81460
01).
12. Wertheim T (1894). "Über die indirekte Sehschärfe" [On indirect visual acuity].Zeitschrift für Psychologie und
Physiologie der Sinnesorgane(in German) (7): 172–187.
13. Taylor H (1981). "Racial Variations in Vision". Am. J. Epidemiol. 113 (1): 62–80.
doi:10.1093/oxfordjournals.aje.a113067(https://doi.org/10.1093/oxfordjournals.aje.a113067)
. PMID 7457480 (http
s://www.ncbi.nlm.nih.gov/pubmed/7457480).
14. Medina A, Howland B (1988). "A novel high-frequency visual acuity chart".
Ophthalmic Physiol Opt. 8 (1): 14–8.
doi:10.1016/0275-5408(88)90083-x(https://doi.org/10.1016/0275-5408%2888%2990083-x) . PMID 3419824 (https://
www.ncbi.nlm.nih.gov/pubmed/3419824).
15. Clark RN (31 January 2016)."Notes on the Resolution and Other Details of the Human Eye"(http://www.clarkvision.
com/articles/eye-resolution.html). ClarkVision.com.
16. Deering MF. "The Limits of Human Vision" (http://www.swift.ac.uk/about/files/vision.pdf)(PDF)..
17. "Visual Acuity of the Human Eye"(http://www.ndt-ed.org/EducationResources/CommunityCollege/PenetrantTest/Intr
oduction/visualacuity.htm). NDT Resource Center.
18. Ali MA, Klyne M (1985).Vision in Vertebrates. New York: Plenum Press. p. 28.ISBN 0-306-42065-1.
19. Hans-Werner H (2006). Im Auge des Lesers: foveale und periphere W ahrnehmung - vom Buchstabieren zur
Lesefreude [The eye of the reader: foveal and peripheral perception - from letter recognition to the joy of reading
] (in
German). Zürich: Transmedia Stäubli Verlag. ISBN 978-3-7266-0068-6.
20. "Contrast sensitivity" (http://www.lea-test.fi/en/vistests/instruct/contrast/lowsymbo/Snellen.pdf)(PDF). LEA-Test Ltd.
Retrieved 21 July 2018.
21. Kirschen DG, Laby DM (1 May 2006)."Sports Vision Testing: An Innovative Approach To Increase Revenues" (http://
www.optometricmanagement.com/articleviewer.aspx?articleid=71635). Optometric Management.
22. Kirschbaum K. "Family Accipitridae" (http://animaldiversity.ummz.umich.edu/site/accounts/information/Accipitridae.ht
ml). Animal Diversity Web. University of Michigan Museum of Zoology. Retrieved 30 January 2010.
23. Social Security Act 1991 (Cth) "Table 13, Schedule 1B" (https://www.legislation.gov.au/Details/C2011C00765/Html/V
olume_3#_Toc304376657). as at 20 September 2011.
24. 42 U.S.C. § 416(i)(1)(B) (Supp. IV 1986). Cited in"SSR 90-5c: Sections 216(i)(1)(B) and 223(c)(1) and (d)(1)(B) of
the Social Security Act (42 U.S.C. 416(i)(1)(B) and 423(c)(1) and (d)(1)(B)) Disability insurance benefits --
Interpreting the statutory blindness provision"(https://www.law.cornell.edu/socsec/rulings/ssr/SSR90-05.html) .9
November 1990.
25. Pan Y, Tarczy-Hornoch K, Cotter SA (June 2009). "Visual acuity norms in pre-school children: the Multi-Ethnic
Pediatric Eye Disease Study"(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742505). Optom Vis Sci. 86 (6): 607–
12. doi:10.1097/OPX.0b013e3181a76e55(https://doi.org/10.1097/OPX.0b013e3181a76e55) . PMC 2742505 (https://
www.ncbi.nlm.nih.gov/pmc/articles/PMC2742505) . PMID 19430325 (https://www.ncbi.nlm.nih.gov/pubmed/194303
25).
26. Carlson N, Kurtz D, Heath D, Hines C (1990).Clinical Procedures for Ocular Examination. Norwalk, CT: Appleton &
Lange. ISBN 0071849203.
27. Lappin JS, Tadin D, Nyquist JB, Corn AL (January 2009). "Spatial and temporal limits of motion perception across
variations in speed, eccentricity, and low vision" (http://jov.arvojournals.org/article.aspx?articleid=2122525). Journal
of Vision. 9 (30): 1–14. doi:10.1167/9.1.30 (https://doi.org/10.1167/9.1.30). "Displacement thresholds for peripheral
motion were affected by acuity limits for speeds below 0.5 degrees/s. [0.0087 radians/s]"
28. Weinberger H (19 February 1971)."Conjecture on the Visual Estimation of Relative Radial Motion" (http://www.natur
e.com/nature/journal/v229/n5286/pdf/229562a0.pdf)(PDF). Nature. 229 (5286): 562. Bibcode:1971Natur.229..562W
(http://adsabs.harvard.edu/abs/1971Natur
.229..562W). doi:10.1038/229562a0 (https://doi.org/10.1038/229562a0).
29. Schrater PR, Knill DC, Simoncelli EP (12 April 2001)."Perceiving visual expansion without optic flow"(http://www.nat
ure.com/nature/journal/v410/n6830/full/410816a0.html) . Nature. 410 (6830): 816–819. doi:10.1038/35071075 (http
s://doi.org/10.1038/35071075). "When an observer moves forward in the environment, the image on his or her retina
expands. The rate of this expansion conveys information about the observer's speed and the time to collision... this
rate might also be estimated from changes in the size (or scale) of image features... we show
, ... observers can
estimate expansion rates from scale-change information alone, and that pure scale changes can produce motion
after-effects. These two findings suggest thatthe visual system contains mechanisms that are explicitly
sensitive to changes in scale."
30. Hoffmann ER, Mortimer RG (July 1996)."Scaling of relative velocity between vehicles"(http://www.sciencedirect.co
m/science/article/pii/000145759600005X). Accident Analysis & Prevention. 28 (4): 415–421. doi:10.1016/0001-
4575(96)00005-X (https://doi.org/10.1016/0001-4575%2896%2900005-X) . ISSN 0001-4575 (https://www.worldcat.or
g/issn/0001-4575). "Only when the subtended angular velocity of the lead vehicle exceeded about 0.003 rad/s were
the subjects able to scale the relative velocity"
31. Maddox ME, Kiefer A (September 2012)."Looming Threshold Limits and Their Use in Forensic Practice"(http://pro.s
agepub.com/content/56/1/700). Proceedings of the Human Factors and Ergonomics Society Annual Meeting . 50 (1):
700–704. doi:10.1177/1071181312561146(https://doi.org/10.1177/1071181312561146). "A number of laboratory
researchers have reported values of the looming threshold to be in the range of 0.003 radian/sec. Forensic
practitioners routinely use elevated values of the looming threshold, e.g., 0.005–0.008, to account for the complexity
of real-world driving tasks. However, only one source has used data from actual vehicle accidents to arrive at a
looming threshold – and that value, 0.0275 rad/sec, is an order of magnitude larger than that derived from laboratory
studies. In this study, we examine a much broader range of real-world accident data to obtain an estimate of the
reasonable upper end of the looming threshold. The results show a range of 0.0397 to 0.0117 rad/sec... "

Further reading
Duane's Clinical Ophthalmology. Lippincott Williams & Wilkins. 2004. V
.1 C.5, V.1 C.33, V.2 C.2, V.2 C.4, V.5 C.49,
V.5 C.51, V.8 C.17.
Golovin SS, Sivtsev DA (1927).Таблица для исследования остроты зрения [Table for the study of visual acuity]
(in Russian) (3rd ed.).
Carlson, Kurtz (2004).Clinical Procedures for the Ocular Examination(3rd ed.). McGraw Hill.ISBN 0071370781.

External links
How Visual Acuity is Measuredat Prevent Blindness
Visual Acuity Measurement Standard, International Council of Ophthalmology
, 1984
Visual Acuity of the Human Eye
Visual Acuity Chapter from the Webvision reference, University of Utah
The Freiburg Visual Acuity Test (FrACT)

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