Physical Exam

Visual Acuity

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Video coming September 2026

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

Refractive Error

Visual acuity that improves when looking through a pinhole

Rule in

Very helpfulNo CI

Rule out

HelpfulNo CI

Evidence:LimitedResearch in progress

References

Research in progress on one or more findings above; ratings may change.

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.
Marmamula S, et al. Population-based assessment of sensitivity and specificity of a pinhole for detection of significant refractive errors in the community. Clin Exp Optom. 2014. PMID: 24909916.
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.