REVIEW

Reading charts in logarithmic scale: why the Jaeger test

is obsolete in the present?
Rodrigo M. Torres, Juan S. Rivero, Pablo Daponte
Argentine Council of Ophthalmology (CAO), Buenos Aires, Argentina.

Received: September 7th, 2023. Abstract

Approved: November 12nd, 2023. Seeing clearly from a distance close to our nose,
to the end of our outstretched arms, is relevant
Corresponsal author during a large part of a human being’s day. Being
Dr. Rodrigo M. Torres able to read is a frequent activity for most people.
ROMAT Creator Center, Colonia Avellaneda, Entre Ríos. Assessing near vision is part of the daily work of an
Consejo Argentino de Oftalmología ophthalmologist. Knowing what is the maximum
Tte. Gral. Juan Domingo Perón 1479 performance of a patient’s near visual capacity al-
(C1037 ACA) Buenos Aires lows us not only to detect ocular pathologies, but
Argentina. also aspects related to neurodegenerative process-
+54 (911) 5199-3372 es. Nowadays, the correct measurement of near
romator7@[Link] vision requires the use of charts developed on a
logarithmic scale, which are standardized at inter-
Oftalmol Clin Exp (ISSNe 1851-2658) national level. In this paper some historical aspects
2023; 16(4): e332-e341. will be reviewed and the current characteristics of
logarithmic scale reading charts will be described,
with the aim of stimulating their use in the daily
clinical practice, also explaining the existing dif-
ferences between the use of the Jaeger test and the
new Byromat reading char.
Keywords: reading charts, reading performance,
Byromat chart, near visión, intermediate vision.

Introduction
Near vision has always been relevant in the
Acknowledgments different stages of a person’s life.
To all the members of the board of directors of the Argentine After birth, an infant’s developing vision, in
Council of Ophthalmology, who supported this task of conjunction with other senses, are fundamental
research, development and scientific innovation. guides to feeding1, touching and exploring the
To all the great team of high executive performance that world at their fingertips2. Throughout childhood,
the CAO has: the non-medical staff, who take care of us and while distant vision increases, near vision allows
protect us by facilitating the environment to be able to create. the acquisition and perfection of psychomotor

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skills3 and the first steps to begin creative tasks, ways of measuring vision: one based on opto-
the basis for later learning to draw, write and types (Snellen’s), proposed as more reliable and
read4. The eyes are a window to the brain where accurate, and the other based on texts (Jaeger’s),
vision is also a constant neurosensory develop- proposed as more useful and user-friendly, based
ment pathway5. Near vision is necessary and on the concept that in daily life people read texts.
indispensable throughout life, with a prominent The review performed by Martín-Moro et al.
role in the processes of neuroplasticity that even raises a very interesting aspect to understand the
persist into old age; these constitute new areas of race to standardize the measurement of vision at
research due to their relevance in neurodegener- that time12. Jaeger conceptualized visual acuity
ative diseases such as Alzheimer’s disease6. as a spatial frequency and introduced the pos-
Two aspects are being analyzed in the evolution sibility of summarizing the visual function to a
of the vision: 1) the impact that the confinement numerical value. However, Snellen, in applying
that occurred during the coronavirus pandemic the theoretical concept of the separable minimum
may have on a large part of the population in to reading, developed optotypes that assigned an
future generations; and 2) the popularization of angular value of one minute of arc to each letter
the digital world mediated by screens, and facil- detail. This design ensured that, when an individ-
itated by electronic social networks7 beyond its ual was placed 20 feet away, each visual element
obvious effect on myopia8. had a specific angular measurement, proposing a
Therefore, understanding that near vision is reproducible system as Jaeger’s, but which would
used most of the day in different activities of most be superior from a practical approach to visual
people —regardless of their age—, it is necessary acuity acquisition. In fact, both won the race,
to emphasize the relevance of its proper assess- because thanks to their coexistence, awareness
ment in our current context. This is the aim of the was raised of the relevance of standardizing vision
present narrative review, which will also describe measurement, where both concepts were success-
the limitations of the current Jaeger chart and the ful and endured over time, but one of them was
characteristics of logarithmic scale charts, includ- used to measure distance vision (Snellen), and
ing the Byromat chart of the Argentine Council the other to measure near vision (Jaeger).
of Ophthalmology (CAO). It is clear then that Jaeger’s primer was a great
contribution for the time, made with the knowl-
edge and resources available in those years, at
The Jaeger test: historical overview a time when near vision was used in activities
different from those of today. If we consider
Dr. Eduard Jaeger Ritter von Jaxtthaln was the limitations they had in the manufacturing
born in Vienna, Austria, in 1818 and died in the tools, the limited knowledge of the physiology of
same city in 1884. Although we remember him vision and the technological limitations to be able
mainly for having developed the reading chart methodologically to evaluate the reproducibility
that bears his name and is still used in some parts of the tests produced, several of the aspects that
of the world9, he was also a pioneer in describing will be discussed below are explained and moti-
what diabetes produces in the back of the eye10 vate us to support what others have previously
and the alteration generated by glaucoma in the analyzed: Jaeger’s test is obsolete today14-16. We
appearance of the optic nerve11. must understand that ophthalmology is one of
Those years were times of many revolutions in the most device-dependent specialties in med-
the vision sciences. A contemporary of his was icine, which has come a long way since Jaeger
Dr. Herman Snellen, who published his opto- created his chart. Think of the growth of science
types in 186212-13, but Jaeger had preceded him and technology in the last two to three decades in
(1854) with the development of a test to measure association with the development of new imag-
vision using text. Since then, a stage of compe- ing methods, new neurological insights and
tition began between the two colleagues for two new therapeutics to improve and correct visual

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problems, with the rise of artificial intelligence deviation of no more than 0.03 millimeters, which
applied to this area and a wide range of options is relevant to ensure the legibility of the smallest
proposed by implanto-refractive surgery, from text.
the from excimer lasers, femtosecond lasers to Of the above five items, the Jaeger chart only
new designs of intraocular lenses, not to men- fulfills item “d” (which is also an optional item).
tion pharmacological advances for the control The following are the main weaknesses of Jaeger:
of myopia and for the treatment of presbyopia, 1. Discrepancy between different Jaeger prim-
whose worldwide innovation was and continues ers in terms of the print size of the optotypes
to be led by an Argentine development more than of different circulating versions. Therefore,
a decade ago17-22. saying that a patient has “J1” as it is usually
done in one place in Argentina is not neces-
sarily equivalent to expressing the same thing
Why did Jaeger become obsolete and what when measured with another Jaeger chart.
are the current options? This not only happens in Argentina but is
global. Jaeger is currently not reproducible.
The main reason is due to its current lack 2. In most Jaeger primers the distance of use is
of global standardization. Whoever measures not stated. It is “common usage” that it is used
near vision using Jaeger cannot provide repro- at 30 to 40 cm at best.
ducible information because they do not have a 3. Paragraph size does not follow a logarithmic
valid scale and the test currently lacks a rigorous scale.
method of production and standardization. We This is mainly due to the fact that when Jaeger
cannot say that what is measured with Jaeger in created his chart the smallest optotypes (equiv-
one region of the world is equivalent to another. alent to LogMAR 0.0, -0.1 and -0.2, under test
Maybe yes, maybe no. That is why the issue of conditions at 40 cm distance).
unifying criteria for measuring near vision was But there is another interesting aspect to high-
widely discussed by the International Council of light that has caused the loss of reproducibility of
Ophthalmology (ICO) on the basis of the fun- the data obtained with the Jaeger chart, and that
damentals set forth in an international standard is due to its growing popularity, many activities
(ISO 8596), defining briefly the following main related to the vision sciences began to print ver-
following main aspects23: sions without any type of control, appearing in a
a. By analogy with the standards for measuring great variety of medical marketing material, even
visual acuity visual acuity, print sizes should inadvertently leading to problems of confusion
progress logarithmically. and lack of standardization in doctors who took
b. Calibration and standardization of optotypes (and continue to take) this material to measure
and design. their patients. This does not mean that they can-
c. The conditions necessary to perform the test not use it to prescribe eyeglasses. You could also
must be specified (conditions of use), includ- do this by giving a newspaper, a magazine or by
ing the test distance and the minimum illu- making the patient read from a cell phone. But in
mination required. none of these situations I would be able to score
d. It is suggested that the text materials (opto- on a true and internationally reproducible scale
types) be continuous. the degree of a person’s near visual acuity.
e. The typography is constituted based on the At the present time, the following printed
height “x” of the body of the character (con- reading charts are the options we recommend
sidering the height of lowercase letters such to replace the measurements made with the Jaeger
as “o”, “m” or “x”), which is subtended by five test, as they are in accordance with the ICO rec-
minutes of arc. ommendations: the Sloan chart, the Bailey-Lovie
It is also established that this type of chart must word chart, the MNREAD chart, the Radner
be printed with a technique that allows obtaining a chart, the Colenbrander continuous text chart,

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the Smith-Kettlewell Reading test (SKread), the like measuring macular thickness, blood glucose
Oculus II Reading chart, the C-Read chart, the levels, or intraocular pressure. It should be carried
Arabic-BAL chart and recently the Byromat chart, out in a reproducible and standardized manner
from the Argentine Council of Ophthalmology. to gather accurate information.
Any medical data is relevant until proven oth-
erwise because it might not be significant at a
Measuring near vision is a medical act that given moment, but it could become so over time
should not be underestimated and in the course of evolution. It is clear that
accurately assessing near vision is crucial not only
In the ophthalmological consultation, in a rou- for prescribing glasses correctly but also because
tine way and especially in people over 40 years we need to precisely and reproducibly know a
of age, the evaluation of near vision is included. piece of information that represents a part of the
Usually, almost by tradition and custom, mainly functioning of an individual’s visual system.
in most of Latin America, we use the Jaeger chart.
We give the chart to the patient and tell him/her
to try to read the smallest part. Generally when So, why does the Jaeger chart continue to
we see that the patient begins to read the begin- be used in some places?
ning of the sentence, he/she says for example the
following (Spanish version of Jaeger): “Bóvedas In reality, there is no scientific justification,
y estos miles de columnas ...” We tell the patient and, in fact, we have already expressed the rea-
that it is okay. sons why it should not be used. However, there
This is the beginning of one of the smallest is a simple, concrete, and common-sense answer
sentences found in the majority of Jaeger charts based on the points mentioned below:
used in Argentina. In this case, we annotate it • Habit: The Jaeger chart continues to be
as J1 (although the correct notation should be used “out of tradition and habit”, although
V = 0.50). We are reassured that the patient can its use is becoming distorted with each
read the smallest text we are measuring with this new generation of ophthalmologists. This is
chart, unaware that there are actually people mainly because there are prints and repro-
who can see LogMAR -0.2 at 40 cm. The exam- ductions of the Jaeger chart that are widely
ple described is very common and has several available. Some physicians mistakenly be-
issues. Firstly, we are not specifying an exact lieve that by copying, pasting and printing
distance. Remember that we are measuring near them they possess a medical measuring de-
visual acuity. Therefore, the distance between the vice, and many others mistake it for what is
optical system (patient’s eyes) and the object to essentially just promotional material. More-
be visually resolved (optotypes printed on the over, not all doctors use the chart as Jaeger
chart) is crucial and should be explicitly defined. specified under the conditions existing in
Measuring vision at 32 cm is not the same as at 1854. It is logical not to adhere to the con-
40 cm. Secondly, there is a crucial aspect, which ditions of 1854, as we are approaching the
is the lighting. Our optical system is designed to end of 2023. However, the most logical step
operate at its maximum efficiency under certain would be to no longer use Jaeger except to
lighting conditions24: to evaluate near vision with highlight its place in the history of ophthal-
logarithmic charts, it should be 80 to 100 candelas mology. There is also no “habit” of teaching
per square meter (cd/m2)14-16. Additionally, it is new doctors this type of logarithmic scale
important to consider the issue of contrast, which visual acuity measurement (near or far), and
should be optimal25-26. that has been part of the motivation to create
It is important to emphasize that measuring the Byromat reading chart of the Argentine
near vision involves obtaining medical data that Council of Ophthalmology, as well as to pro-
will be recorded for future comparisons, much duce this review article specifically for His-

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panoamerica. optotype to ensure their equivalence, regardless

• Availability: Until March 2023, there was of the meaning of the words. In Byromat, each
no standardized logarithmic scale reading sentence optotype has the following characteris-
chart option developed from its origin in the tics (summarized):
Spanish language. • Each sentence optotype is arranged in
• Costs: The available options that meet the three lines.
standards described by the ICO (Interna- • It always consists of an identical structure
tional Council of Ophthalmology) have a in terms of the number of syllables, words,
current approximate global cost ranging be- and characters per line, including spaces.
tween 150 to 170 dollars. Additionally, the • The developed optotypes are interchange-
existing options were originally developed in able measurement products, regardless of
another language (English or German) and their size.
were later translated or adapted to Spanish.
In summary, using the Jaeger chart is easy and
convenient, even though it is not entirely accurate, Byromat: logarithmic reading chart with
and since 1988, the reasons for its obsolescence sentence optotypes and letters
have been specified. We can no longer ignore that
using it does not align with current international Currently, Byromat stands as the only test
standards for measuring near vision. that has the capability to assess near vision using
sentence optotypes that meet international stan-
dards. Additionally, it features an original devel-
Concept of sentence optotype: a reading opment—the rounded letter optotypes. This
chart is not just any text achievement resulted from various studies, cul-
minating in the definition and selection of 7 low-
Modern reading charts that adhere to inter- ercase letters: a-e-o-u-c-n-s. These letters differ
national standards contain text developed using from the so-called Sloan letters, which are the 10
the concept of “sentence optotypes”. This concept letters used in the ETDRS test29-30. Sloan letters
was well explained by another Austrian physician, have some that are simpler to distinguish from
Dr. Wolfgang Radner, who stated that each sen- each other (such as k from o). If there are letters
tence optotype constitutes a measurement tool that are easier to differentiate, visual acuity may
in itself15, 27-28. Each sentence optotype, in turn, be underestimated (the patient identifies them by
arises from considerations of the language of their differences and deduces rather than seeing
origin, taking into account factors such as word them). In Byromat, 7 rounded lowercase letters
difficulty, grammatical rules, and even auditory were selected that proved more challenging to
aspects. Dr. Radner is actually leading the revalu- identify. This is crucial for achieving maximum
ation of this type of chart through his own devel- precision when specifically measuring near visual
opment, which has been translated into multi- acuity (the resolution capacity of our visual sys-
ple languages. Additionally, he is recognized for tem): if the person can correctly identify them, it
being one of those who currently emphasize the means they have perceived them adequately. This
importance of considering other parameters that ensures that we measure what we truly want to
can be obtained through this type of tests, related measure, reducing the possibility of identifying
to reading performance15, as we will see later in letters based on their differences and deduction.
this paper. Each letter “counts” as 0.02 LogMAR, so simi-
The creation of sentence optotypes involves lar to the ETDRS test, an exact score of vision (in
various stages of development. After their design, this case, near vision) can be obtained. This allows
they undergo evaluation and selection following the use of the rounded letter optotype section as
different scientific tests. It is crucial to consider a reliable and reproducible measuring instru-
the reproducibility and reliability of each sentence ment in research, including clinical studies on

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Logarithmic scale
(calibrated at 40 and 32 cm)

OPTOTYPE of rounded letters

Each of these parts

constitutes a measurement
tool, known as a PHRASE
OPTOTYPE Each letter equals 0.02
LogMAR, so an accurate visual
acuity score can be obtained
(suitable for clinical trials)

A B C
Details of instructions and Accessory information:
conditions of use LogMAR conversion ruler, for
measuring at different
distances
Three defined areas

A. LogMAR scale in relation to B. Test with optotypes of C. Test with optotypes of rounded
distance sentences letters

Figure 1. A CAO Byromat chart is shown in the center and its most relevant elements are detailed and described on the sides.

outcomes in implant-refractive surgery or assess- the logarithm of the minimum angle of resolu-
ing the progress and response to treatments (such tion. In near vision, there is not truly an equiv-
as diabetic retinopathy or age-related macular alent between the LogMAR scale and what can
degeneration). Figure 1 describes the main ele- be measured with Jaeger.
ments present in the Byromat chart, TS12 model,
of the Argentine Council of Ophthalmology Is it good to have 0.0 vision in LogMAR?
(CAO). Yes, and it’s necessary to change our way of rea-
Based on the aforementioned points, the soning when assigning scores since in this notation
Byromat test can be used for both daily clini- format, zero is good, and if the result is negative,
cal activities, prescribing glasses for near vision, it’s even better (indicating higher visual resolution
and for rigorous research studies. Below are ques- capacity). Perhaps that’s why the LogMAR scale
tions and answers regarding general and practical initially causes confusion because the value of 0.0
aspects to consider in logarithmic scale charts. in LogMAR would potentially be equivalent to 1.0
in decimal notation (10/10) or 20/20 in distant
What is LogMAR? vision. Saying that zero is a good result can be
It is a scale that, in turn, involves a notation sys- culturally challenging to understand (generally,
tem. Its name comes from an acronym meaning getting a 10 is considered good, and 0 is bad).

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How far is it considered normal for my patient to see The measurement of near vision is a medical
on this type of chart? act in which we must assess the maximum capac-
We are accustomed to wanting the patient to ity, record the data, and track its evolution over
read the smallest letter, and typically with Jaeger, time. Currently, when we use the Jaeger scale, we
we provide the chart to the patient and ask them to can never measure beyond LogMAR 0.1 up close
read down to the smallest letter. We aim for them (at 40 cm). As Jaeger doesn’t measure beyond
to always reach the smallest letter on the Jaeger that, a change detected in Jaeger could poten-
chart. Moreover, the patient themselves will consis- tially have been detected much earlier. This is
tently attempt to read the smallest text, and if they clinically relevant, and taking near vision with a
can’t, they become concerned or frustrated. This Jaeger test undermines this. Using a logarithmic
is something that needs to change. In any stan- scale reading chart is, in fact, an early detection
dardized international logarithmic scale reading method for many eye diseases, such as age-related
chart (whether it be Byromat, Radner, MNREAD, macular degeneration31-32.
etc.), at a distance of 40 cm, few people will be able
to read LogMAR 0.0, and very few will achieve How to transition from Jaeger to logarithmic scale
LogMAR -0.1 or -0.2. The majority of healthy indi- reading charts?
viduals can read between LogMAR 0.1 and 0.2. We need to change how we ask the patient to
This concept is relevant because Jaeger 1 can cor- read the chart. It’s crucial to explain that they
relate very inaccurately, as previously mentioned, should read as far as they can, but not worry
between LogMAR 0.1 and 0.3 (there is consider- about seeing the smallest text. This is because
able discrepancy among Jaeger charts) if both tests most healthy, normal, well-prescribed, and/or
are conducted at a 40 cm distance. well-operated individuals fall within the range
To explain to our patients the approximate sizes of 0.1 to 0.2 LogMAR at 40 cm. Additionally, a
of texts in daily activities, we can use the follow- person reading LogMAR 0.3 or 0.4 at 40 cm may
ing practical references measured at 40 cm on still have visual capability suitable for most daily
the LogMAR scale: activities, except for reading a medical leaflet or
• Text on digital newspapers: 0.5 LogMAR information about food composition presented
• Text in printed newspapers, books, or ma- on packaging, which is typically in sizes equiva-
gazines: between 0.3 and 0.5 LogMAR lent to LogMAR ranging from -0.2 to 0.1.
• Text on digital phone or tablet screens: be- The reality is that information on food labels
tween 0.2 and 0.3 LogMAR can sometimes be indecipherable due to defects
• Text on medical leaflets, food products, in printing on packaging, curved surfaces, poor
cosmetics, or similar items: can range from contrasts, and wear and tear inherent in each
-0.2 LogMAR (those seen by very few peo- product’s handling from production, distribution,
ple) to 0.1 LogMAR. and storage in a supermarket. It is crucial for the
physician to understand all of the above so that
Why measure something so small that not everyone the patient can grasp it later on.
can see?
It’s a reasonable question when we’re used to Can anything other more than near visual acuity be
measuring with Jaeger. However, physiologically measured with this type of chart?
or after refractive surgical procedures, there are Yes, when we use reading charts with sentence
individuals who can even see up to LogMAR optotypes, we can measure the time it takes to
-0.2 up close at 40 cm. If we don’t evaluate a per- read. For this, we ask the patient to start reading
son with a logarithmic scale test, we will never aloud, and we time how many seconds it takes
know their maximum visual potential at a given until they can no longer read a complete sen-
moment, and therefore, we won’t know if they are tence-level optotype. We record the visual acu-
losing vision over time, whether due to normal ity in LogMAR of the optotype they managed to
wear and tear or some pathology. read and note the time. With these visual acuity

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and time data, we can determine the number of the smallest text. However, you may very well
words per minute and obtain much more infor- encounter patients who have undergone surgery
mation related to reading performance. This, in with new corneal ablation systems or implantable
turn, can be associated with characterizing both optical devices that can see up close better than
ophthalmological and neurological/cognitive you. You must measure and record the maximum
conditions33-36. potential for near vision to accurately track your
patient’s progress over time. Moreover, consider it
Are there limitations for these tests such as age, contradictory —and even scientifically unfair—
literacy level, and/or low vision? to perform treatments with techniques and mate-
This type of test evaluates reading, and from rials from 2023 and measure their results using
this, near visual acuity and other data are deter- a test from 1854.
mined, which are transformed into indices that If you invest a lot of financial resources in
mark the performance of the visual system and, acquiring new and expensive measurement
in turn, neurosensory cognitive aspects. However, equipment to be more surgically precise, if you
there are logarithmic scale near vision tests also undergo training to learn how to use this
designed for illiterate individuals and children technology and pay for maintenance services,
who cannot read but can identify figures and surely you can acquire and use a modern loga-
symbols. There are also tests specifically designed rithmic scale chart considering all the previously
for people with low vision. The CAO is in the final explained reasons.
stages of validating tests tailored to this segment However, none of this limits us from recogniz-
of the population. ing that the most important verdict is ultimately
expressed by the patient when subjectively telling
Does it make sense to measure near vision in people us if they are satisfied or not, something for which
without presbyopia? we still don’t have such an exact measurement
Yes, and it is a practice that is currently underuti- tool, let alone a way to make accurate predic-
lized. As we have expressed earlier, with this type tions. This is one of the reasons why empathy
of test, we can assess a person’s maximum visual should be practiced, and preoperative expecta-
capacity at close distances. Measuring near vision tions should be managed with postoperative facts
in a young person allows us to have not only the and evidence.
data on near visual acuity but also aspects related
to visual performance. This information can be In this review, we have explored the topic of printed
compared over time and will help us detect not charts, but what about digital visual tests?
only potential ophthalmological alterations but This is a growing trend, but it still faces lim-
also issues that may affect the cognitive system. itations in terms of widespread use, as technol-
It becomes an additional data point in the eval- ogy, while highly beneficial, still has challenges
uation of neurodegenerative diseases. to overcome in unifying conditions37-39. However,
the potential is significant, and it is likely that in
Is it correct not to use this type of tests on patients the short term, an international consensus may
who have undergone refractive and/or cataract be reached to standardize the features that digital
surgery due to fear that they won’t see the smallest vision tests should have. What is clear at the time
text? of writing this study is that great caution should
It is a conceptual error not to measure results be exercised when using visual tests on screens,
accurately, and we have already explained why especially those from applications installed on
using Jaeger is not valid today. You should not be smartphones and/or tablets. It is important to
afraid that your patient cannot see LogMAR -0.2 inquire about the developer, carefully read the
at 40 cm. To prevent both you and your patient terms of use, limitations, and instructions for
from feeling frustrated, you should learn to assess proper use. Nevertheless, the suggestion is to
vision by explaining that most people cannot see compare this information with what is currently

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considered the gold standard: printed logarithmic 6. Snyder PJ, Alber J, Alt C et al. Retinal imaging
scale reading charts. in Alzheimer’s and neurodegenerative diseases.
Alzheimers Dement 2021; 17: 103-111.
7. Bracci S, Op de Beeck HP. Understanding hu-
Conclusions man object vision: a picture is worth a thousand
representations. Annu Rev Psychol 2023; 74: 113-
The Jaeger test, developed in 1854, allowed 135.
for the measurement of near vision, but it is no 8. Foreman J, Salim AT, Praveen A et al. Associa-
longer valid today due to its general lack of stan- tion between digital smart device use and myo-
dardization and non-compliance with the inter- pia: a systematic review and meta-analysis. Lancet
national consensus established in 1988. During Digit Health 2021; 3: e806-e818.
this consensus, standards and features of current 9. Runge PE. Eduard Jaeger’s test-types
reading charts were determined, emphasizing (Schrift-Scalen) and the historical development
the need for logarithmic scale representation. of vision tests. Trans Am Ophthalmol Soc 2000;
Although its use is common in many parts of the 98: 375-438.
world, there are still regions, particularly in cer- 10. Wolfensberger TJ, Hamilton AM. Diabetic
tain countries in Hispanoamerica, that have not retinopathy: an historical review. Semin Ophthal-
adopted these standards. This discrepancy needs mol 2001; 16: 2-7.
to be resolved promptly to share accurate and 11. Blanchard DL. Jaeger, about glaucoma. Doc
reproducible information in a globalized world, Ophthalmol 1995; 89: 185-191.
which is increasingly relying on trustworthy data 12. González Martín-Moro J, Hernández Verdejo
for artificial intelligence systems. For this reason, JL, Azurza Rivas G. History and pre-history of op-
the CAO, with the development of the Byromat totypes: from Alcor and Mizar to the ETDRS op-
chart, has aimed to provide an accessible tool for totype. Arch Soc Esp Oftalmol 2016; 91: e91-e92.
all Spanish-speaking colleagues. This chart is the 13. de Jong PTVM. A history of visual acuity tes-
only one developed entirely in Spanish from the ting and optotypes. Eye (Lond) August 3, 2022.
outset, without translation or adaptation. We doi:10.1038/s41433-022-02180-6
understand that transitioning away from Jaeger 14. Colenbrander A. Consilium ophthalmologi-
will be a slow process, but it is necessary. Modern cum universale visual functions committee, vi-
medicine is based on evidence, and the data on sual acuity measurement standard. Ital J Ophthal-
near vision is crucial, as is its accurate acquisition. mol 1988; 11: 5-19.
15. Radner W. Reading charts in ophthalmolo-
gy. Graefes Arch Clin Exp Ophthalmol 2017; 255:
Referencias 1465-1482.
16. Ntonti P, Mitsi C, Chatzimichael E et al. A sys-
1. Heird WC. Infant feeding and vision. Am J tematic review of reading tests. Int J Ophthalmol
Clin Nutr 2008; 87: 1120. 2023; 16: 121-127.
2. Clark-Gambelunghe MB, Clark DA. Sen- 17. Nguyen TX, Ran AR, Hu X et al. Federated
sory development. Pediatr Clin North Am 2015; learning in ocular imaging: current progress and
62: 367-384. future direction. Diagnostics (Basel) 2022; 12:
3. Futagi Y. Eye-hand-mouth coordination in 2835.
the human newborn. Pediatr Neurol 2017; 75: 18. Li J, Yan P, Li Y et al. Harnessing the power of
43-47. Raman spectroscopic imaging for ophthalmolo-
4. Danna J, Velay JL. Basic and supplementary gy. Front Chem 2023; 11: 1211121.
sensory feedback in handwriting. Front Psychol 19. Luo C, Wang H, Chen X et al. Recent ad-
2015; 6: 169. vances of intraocular lens materials and surface
5. Ptito M, Bleau M, Bouskila J. The retina: a modification in cataract surgery. Front Bioeng
window into the brain. Cells 2021; 10: 3269. Biotechnol 2022; 10: 913383.

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20. Yang F, Dong Y, Bai C et al. Bibliometric and ble change of visual acuity measurements using
visualized analysis of myopic corneal refractive ETDRS charts (Early Treatment Diabetic Reti-
surgery research: from 1979 to 2022. Front Med nopathy Study). Int J Environ Res Public Health
(Lausanne) 2023; 10: 1141438. 2021; 18: 7876.
21. Benozzi J, Benozzi G, Orman B. Presbyo- 31. Künzel SH, Lindner M, Sassen J et al. Asso-
pia: a new potential pharmacological treatment. ciation of reading performance in geographic
Med Hypothesis Discov Innov Ophthalmol 2012; atrophy secondary to age-related macular de-
1: 3-5. generation with visual function and structural
22. Orman B, Benozzi G. Pharmacological biomarkers. JAMA Ophthalmol 2021; 139: 1191-
treatments for presbyopia. Drugs Aging 2023; 1199.
40: 105-116. 32. Chung STL. Reading in the presence of ma-
23. Colenbrander A. Consilium ophthalmolo- cular disease: a mini-review. Ophthalmic Physiol
gicum universale visual functions committee, Opt 2020; 40: 171-186.
visual acuity measurement standard. Ital J Oph- 33. Stifter E, Weghaupt H, Benesch T et al. Dis-
thalmol 1988; 11: 5-19. criminative power of reading tests to differen-
24. Labiris G, Ntonti P, Panagiotopoulou EK et tiate visual impairment caused by cataract and
al. Impact of light conditions on reading ability age-related macular degeneration. J Cataract
following multifocal pseudophakic corrections. Refract Surg 2005; 31: 2111-2119.
Clin Ophthalmol 2018; 12: 2639-2646. 34. Elliott DB, Patel B, Whitaker D. Develop-
25. Jainta S, Nikolova M, Liversedge SP. Does ment of a reading speed test for potential-vision
text contrast mediate binocular advantages in measurements. Invest Ophthalmol Vis Sci 2001;
reading? J Exp Psychol Hum Percept Perform 42: 1945-1949.
2017; 43: 55-68. 35. Soldan A, Pettigrew C, Cai Q et al. Cogniti-
26. Suptaweeponboon J, Bhornmata A, Tanpra- ve reserve and long-term change in cognition in
sertkul C, Makornwattana M. Comparison of aging and preclinical Alzheimer’s disease. Neu-
near vision in glaucoma patients using standard robiol Aging 2017; 60: 164-172.
and reversed-contrast charts. Clin Exp Optom 36. van der Lijn I, de Haan GA, van der Feen FE
2023; 106: 516-522. et al. Reading difficulties in Parkinson’s disease:
27. Radner W, Obermayer W, Richter-Mueksch a stepped care model for neurovisual rehabilita-
S et al. The validity and reliability of short Ger- tion. J Parkinsons Dis 2023; 13: 1225-1237.
man sentences for measuring reading speed. 37. Labiris G, Panagiotopoulou EK, Chatzimi-
Graefes Arch Clin Exp Ophthalmol 2002; 240: chael E et al. Introduction of a digital near-vi-
461-467. sion reading test for normal and low vision
28. Stifter E, König F, Lang T et al. Reliability of adults: development and validation. Eye Vis
a standardized reading chart system: variance (Lond) 2020; 7: 51.
component analysis, test-retest and inter-chart 38. Labiris G, Delibasis K, Panagiotopoulou EK
reliability. Graefes Arch Clin Exp Ophthalmol et al. Development and validation of the first
2004; 242: 31-39. smart tv-based visual acuity test: a prospective
29. Sloan LL. New test charts for the measure- study. Healthcare (Basel) 2022; 10: 2117.
ment of visual acuity at far and near distances. 39. Karampatakis V, Almaliotis D, Talimtzi P,
Am J Ophthalmol 1959; 48: 807-813. Almpanidou S. Design and validation of a novel
30. Sánchez-González MC, García-Oliver R, smartphone-based visual acuity test: the K-VA
Sánchez-González JM et al. Minimum detecta- test. Ophthalmol Ther 2023; 12: 1657-1670.

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