Physical examination maneuver

Physical Exam

Visual Acuity

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How to Perform

With the patient at the chart's specified distance (commonly 20 feet / 6 meters for a wall chart) and wearing their usual distance glasses, test each eye separately, covering the other, and ask the patient to read the smallest line they can. Record the result for each eye as the line on which they can correctly identify more than half of the letters.

How to Interpret

Showing 2 of 3 findings

Refractive Error

Visual acuity that improves when looking through a pinhole
Rule in
Very helpfulDerived CI
Rule out
HelpfulDerived CI
Evidence:Moderate

Visual Impairment

Reduced acuity that does NOT improve with pinhole
Rule in
Very helpfulDerived CI
Rule out
HelpfulDerived CI
Evidence:Moderate

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Related Systems / Regions

Head, Eyes, Ears, Nose, ThroatNeurological

Related Diagnoses

Diabetic RetinopathyRefractive ErrorVisual Impairment

Related Chief Complaints

Blurred VisionDark Spots in VisionDecreased VisionDifficulty ReadingDifficulty Seeing Far AwayEye StrainFloatersFluctuating VisionHeadacheSquintingVision ChangesVision Loss

References

  • Marmamula S, Keeffe JE, Narsaiah S, Khanna RC, Rao GN. Population-based assessment of sensitivity and specificity of a pinhole for detection of significant refractive errors in the community. Clin Exp Optom. 2014 Nov;97(6):523-527. doi:10.1111/cxo.12172. PMID: 24909916.
  • Scanlon PH, Foy C, Chen FK. Visual acuity measurement and ocular co-morbidity in diabetic retinopathy screening. Br J Ophthalmol. 2008;92(6):775-778. doi:10.1136/bjo.2007.128561. PMID: 18356262.
  • Kumar RS, Rackenchath MV, Sathidevi AV, Nagaraj S, Moe CA, Stamper RL, Keenan JD. Accuracy of pinhole visual acuity at an urban Indian hospital. Eye (Lond). 2019;33(2):335-337. doi:10.1038/s41433-018-0237-6. PMID: 30341426. PMC6367369.
  • Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
  • Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 9, 2026.