Original Article|Articles in Press

Development and validation of the first Canadian Aboriginal syllabics visual acuity chart

Published:February 13, 2023DOI:



      To design and validate the first visual acuity (VA) chart in the Canadian Aboriginal syllabics (CAS) alphabet.


      Prospective, nonrandomized, within-subjects cross-sectional study.


      Twenty Latin- and CAS-reading subjects were recruited from Ullivik, a residence in Montreal for Inuit patients.


      VA charts were made in Latin and in CAS using letters conserved across Inuktitut, Cree, and Ojibwe languages. Fonts were similar in style and size between charts. Each chart was made for a viewing distance of 3 m, with 11 lines of VAs from 20/200 to 20/10. Charts were created using LaTeX to ensure proper formatting and optotype sizing and displayed to scale on an iPad Pro. Each participant had his or her best-corrected VA for each eye measured using the Latin and CAS charts sequentially for a total of 40 eyes.


      Median best-corrected VAs were 0.04 logMAR (range, –0.06–0.54) and 0.07 logMAR (range, 0–0.54) for the Latin and CAS charts, respectively. Median difference between CAS and Latin charts was 0 logMAR (range, –0.08–0.1). Mean ± SD difference between charts was 0.01 ± 0.03 logMAR. Pearson's r correlation between groups was 0.97. The two-tailed paired t test between groups was p = 0.26.


      We demonstrate here the first VA chart in Canadian Aboriginal syllabics for Inuktitut-, Ojibwe-, and Cree-reading patients. The CAS VA chart has highly similar measurements to the standard Snellen chart. Testing VA for Indigenous patients in their native alphabet may provide patient-centred care and accurate VA measurements for Indigenous Canadians.
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      1. Heritage C. Statistics on official languages in Canada 2019 [Internet]. Available at: (accessed October 30, 2022).

      2. Government of the Northwest Territories. Official Languages Act [Internet]. N.d. Available (accessed November 26, 2019).

      3. Government of Nunavut. Official Language Act [Internet]. (accessed October 30, 2022).

      4. MacFarlane K. Bill 148: Mi'kmaw Language Act [Internet]. Nova Scotia Legislature, 2022. Available at: (accessed October 30, 2022).

      5. Statistics Canada. Indigenous population continues to grow and is much younger than the non-Indigenous population, although the pace of growth has slowed. The Daily [Internet]. 2022 Sep. 21. Available at: (accessed October 30, 2022).

      6. Statistics Canada. While English and French are still the main languages spoken in Canada, the country's linguistic diversity continues to grow. The Daily [Internet]. 2022. Available (accessed October 30, 2022).

      7. Statistics Canada. Indigenous mother tongue, Indigenous language spoken most often at home and other Indigenous language(s) spoken regularly at home: Canada, provinces and territories {Internet]. 2022. Available at: (accessed October 30, 2022).

        • Moseley C.
        Atlas of the world's languages in danger.
        UNESCO, New York2010
        • Tulloch S.
        Opinion: 5 things to know about bilingual Indigenous education.
        CBC News, 2018 (Available at) (Published on August 18, 2018 (accessed November 20, 2022))
        • Nunatsiaq News
        A full education in Inuktut is possible.
        Nunavut Tunngavik Inc, 2022 (says [Internet]. Available at) (Published on October 4, 2022 (accessed November 20, 2022))
        • Snellen H.
        Probebuchstaben zur Bestimmung der Sehschärfe.
        Van de Weijer, Utrecht1862
        • Azzam D
        • Ronquillo Y
        Snellen chart.
        StatPearls Publishing, Treasure Island, Fla2022
        • Koskin SA
        • Boĭko ÉV
        • Shelepin YE.
        Modern methods of measuring the resolving power of the visual system.
        J Opt Technol. 2008; 75: 17-20
        • Alabdulkader B
        • Leat S.
        A standardized Arabic reading acuity chart: the Balsam Alabdulkader–Leat chart.
        Optom Vis Sci. 2017; 94: 807-816
        • Chen WR
        • Ye HH
        • Qian YY
        • Yang WH
        • Lin ZH.
        Comparison of higher-order aberrations and contrast sensitivity between Tecnis Z9001 and CeeOn 911A intraocular lenses: a prospective randomized study.
        Chin Med J (Engl). 2006; 119: 1779-1784
        • Khamar BM
        • Vyas UH
        • Desai TM.
        New standardized visual acuity charts in Hindi and Gujarati.
        Indian J Ophthalmol. 1996; 44: 161-164
        • Murdoch J.
        Syllabics—a successful educational innovation.
        (Master's thesis. University of Manitoba)1981
      8. Statistics Canada. Census in brief: The Aboriginal languages of First Nations people, Métis and Inuit [Internet]. 2017. Available Published on October 25, 2017 (accessed December 19, 2022).

      9. Inuktut Tusaalanga. Differences between the dialects [Internet]. N.d. Available at: (accessed October 31, 2022).

      10. Inuktut Tusaalanga. Syllabics (qaniujaaqpait) [Internet]. N.d. Available at: (accessed October 31, 2022).

      11. Omniglot. Cree syllabics [Internet]. N.d. Available at: (accessed October 31, 2022).

      12. Omniglot. Ojibwe syllabary, pronunciation and language [Internet]. N.d. Available at: (accessed October 31, 2022).

      13. Language Geek. Languagegeek font download [Internet]. N.d. Available (accessed October 30, 2022).

      14. Bhambra N. CAS VA chart code. GitHub [Internet]. N.d. Available at: (accessed October 30, 2022).

        • Tiew S
        • Lim C
        • Sivagnanasithiyar T.
        Using an Excel spreadsheet to convert Snellen visual acuity to LogMAR visual acuity.
        Eye (Lond). 2020; 34: 2148-2149
        • Carrasquillo O
        • Orav EJ
        • Brennan TA
        • Burstin HR.
        Impact of language barriers on patient satisfaction in an emergency department.
        J Gen Intern Med. 1999; 14: 82-87
        • Al Shamsi H
        • Almutairi AG
        • Al Mashrafi S
        • Al Kalbani T
        Implications of language barriers for healthcare: a systematic review.
        Oman Med J. 2020; 35: e122
      15. CBC News. Too few Nunavummiut can read this article. CBC News, 2005. (accessed November 14, 2005).

        • Shearwood P.
        Inuit identity and literacy in a Nunavut community.
        Etudes Inuit Studies. 2001; 25: 295-307
      16. Statistics Canada. Education—Aboriginal statistics at a glance (2nd ed) [Internet]. 2015. Available at: Published on December 24, 2015 (accessed October 31, 2022).

      17. Official Consolidation of Inuit Language Protection Act Published on June 9, 2022 (accessed October 30, 2022).

        • Bhambra N
        • Gold MS
        • Naumova D
        • Abdelhamid K
        • Lessard D
        • Lebouché B
        Assessing needs for linguistic interpretation in hospital settings: a retrospective analysis of ad hoc interpreter requests.
        J Med Access. 2022; 627550834221105216
      18. Whalen DH, Moss M, Baldwin D. Healing through language: positive physical health effects of indigenous language use. F1000 Research [Internet]. 2016. Available at: Accessed October 30, 2022.