The cards of test-letters in common use are admirably adapted to the subjective determination of errors of refraction; but as a test for visual acuity they probably afford the poorest and most inexact standard on which any scientific observations are now based. As a standard for visual acuity, test-letters belong to the stage of mental and scientific development when the standard for length was "three full grains of barley corn taken from the middle of the ear," or "the distance a man can walk between sunrise and sunset."
As a help in the subjective measuring of refraction they are superior to any substitute that has been proposed and are not likely to be given up. But as a scientific standard they possess two essential defects:
The different letters when made as uniform as possible are visible from very different distances. This makes them unsuitable for a scientific standard.
JACKSON E. INTERNATIONAL STANDARD FOR TESTING VISION AND STANDARDIZING OTHER VISUAL TESTS. JAMA. 1914;LXIII(9):718-721. doi:10.1001/jama.1914.02570090004002