The acuity card procedure was used to assess the visual acuity of 510 neurologically normal and abnormal infants and children. Acuity estimates were obtained for 93 per cent of 842 binocular and 279 monocular tests. The observed development of binocular acuity of normal fullterm and preterm infants agreed well with previous reports using the traditional forced-choice preferential looking technique. Monocular tests seemed to support earlier suggestions that grating acuity may be relatively insensitive to strabismic amblyopia. Infants at risk of later neurological deficits but developing normally had only a slight delay in development of acuity, but there was a high incidence of acuity deficits (54 per cent) among those with severe neurological defects. The great majority of a group of multiply handicapped children had low acuity for age. Repeat tests showed a high degree of test-retest consistency. The acuity card procedure was a successful and useful method for assessing the acuity of infants and children who cannot be tested with standard ophthalmological methods.