It can be used directly or indirectly (i.e. using a mirror).The illiterate E also known as the tumbling E for testing visual acuity of people who are illiterate, handicapped or where English is not their first language or for persons who cannot speak.It can be used in conjunction with a card with an E marked on it that the patient holds and rotates to indicate the direction the fingers of the E are pointing.Alternatively, the fingers of the hand can be used to indicate the direction the E fingers are pointing to.Each line is numbered for easy referral. Made from semi-rigid, non-reflective white plastic sheet with non-reflective black letters. Each chart comes with a set-up kit. Letter sizes: 60/6, 36/6, 24/6, 18/6, 12/6, 9/6, 7.5/6, 6/6, 5/6. The letter size is printed under each line. This chart is available for test at 3, 4, and 6 metres distance from the patient Chart size: 3 metres 230 mm x 145 mm 4 metres 340 mm x 150 mm 6 metres 370 mm x 290 mm Product reference: EYTTC3DE (3-metre) – $41.30 EYTTC4DE (4-metre) – $44.30 EYTTC6DE (6-metre) – $47.70