Visual acuity (VA) commonly refers to the clarity of vision, but technically rates an animal's ability to recognize small details with precision.
Causes of refractive errors include aberrations in the shape of the eye or the cornea, and reduced ability of the lens to focus light.
Other optical causes of low visual acuity include astigmatism, in which contours of a particular orientation are blurred, and more complex corneal irregularities.
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.
[10] 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.
Visual acuity is measured by a psychophysical procedure and as such relates the physical characteristics of a stimulus to a subject's percept and their resulting responses.
In later editions of his book, Snellen called the letters of his charts optotypes and advocated for standardized vision tests.
[4][20] Hugh Taylor uses these design principles for a "Tumbling E Chart" for illiterates, later used[21] to study the visual acuity of Australian Aboriginals.
[17] 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 Retinopathy Study (ETDRS).
There are no rods in the very center of the visual field (the foveola), and highest performance in low light is achieved in near peripheral vision.
6/6 vision is defined as the ability to resolve two points of light separated by a visual angle of one minute of arc, corresponding to 60 PPD, or about 290–350 pixels per inch for a display on a device held 250 to 300 mm from the eye.
[25] 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.
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.
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.
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.
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.
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.
Though the resolving power depends on the size and packing density of the photoreceptors, the neural system must interpret the receptors' information.
In the decimal system, acuity is defined as the reciprocal value of the size of the gap (measured in arc minutes) of the smallest Landolt C, the orientation of which can be reliably identified.
LogMAR is another commonly used scale, expressed as the (decadic) logarithm of the minimum angle of resolution (MAR), which is the reciprocal of the acuity number.
Distant visual acuity of count fingers and 6/17 with pinhole in the left eye will be: DscOS CF PH 6/17.
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.
Patients who are illiterate in the language whose letters and/or numbers appear on the chart will be registered as having very low visual acuity if this is not known.
A motor inability can make a person respond incorrectly to the optotype shown and negatively affect the visual acuity measurement.
[36] The measurement of visual acuity in infants, pre-verbal children and special populations (for instance, disabled individuals) is not always possible with a letter chart.
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.
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.
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).