Visual acuity testing. From the laboratory to the clinic

•The process leading to the Bailey-Lovie chart and the logMAR designation of visual acuity.•Development of the ETDRS and other logMAR charts and reading charts.•Studying and following severely impaired vision requires new research and clinical tests of VA.

The need for precision in visual acuity assessment for low vision research led to the design of the Bailey-Lovie letter chart. This paper describes the decisions behind the design principles used and how the logarithmic progression of sizes led to the development of the logMAR designation of visual acuity and the improved sensitivity gained from letter-by-letter scoring. While the principles have since been adopted by most major clinical research studies and for use in most low vision clinics, use of charts of this design and application of letter-by-letter scoring are also important for the accurate assessment of visual acuity in any clinical setting. We discuss the test protocols that should be applied to visual acuity testing and the use of other tests for assessing profound low vision when the limits of visual acuity measurement by letter charts are reached.