Problems with design and format of the traditional Snellen chart have led to the development of alternative charts for the measurement of visual acuity in adults. However, advances in chart design for the measurement of visual acuity in pre-school children have not paralleled those used in adult test charts. Visual acuity can be measured in infants and very young children using behavioural and electrophysiological techniques but clinical measurement of letter acuity tends to commence when the child is old enough to interact and co-operate with the examiner. Charts which are commercially available in the UK for measuring letter acuity in pre-school children (3-5 years old) either use single optotypes or are derivatives of the Snellen format. There is a need for a test of letter acuity for use with this young age group which is accurate, reliable and based upon sound and established design principles. Glasgow Acuity Cards have been designed to include features that should allow change in letter acuity to be detected in pre-school children, especially those undergoing vision therapy training. The test is performed at 3 m and incorporates several design features which have been used previously in adult charts but are new to childrens' test charts. These include: linear progression of letter sizes using a log scale; letters of approximately equal legibility; equal number of letters per line; control of contour interaction; screening cards to determine initial level of acuity. The test is quick and easy to perform and should provide a means of detecting change in letter acuity, with increased confidence.