Physical examination maneuver

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 (for example, the Snellen fraction). A near card held at the specified reading distance is used for near acuity.

How to Interpret

Showing all 1 finding

Refractive Error

Visual acuity that improves when looking through a pinhole
Rule in
Very helpful
Rule out
Helpful
Evidence:Limited

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.
  • 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.

Related Diagnoses

Refractive Error

Related Bedside Tests

🎬Video coming Sept 2026
Ophthalmoscopy
aka Fundoscopy
Rule in:VHGlaucoma, SHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more
Rule out:SHGlaucoma, MHDiabetic Retinopathy, MHIncreased Intracranial Pressure +13 more
🎬Video coming Sept 2026
Pupillary Light Reaction
Rule in:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more
Rule out:IEAnticholinergic Toxicity, IECholinergic Toxicity, IECranial Nerve III Palsy +7 more
POCUS
🎬Video coming Sept 2026
Ocular Ultrasound
Rule in:VHRetinal Detachment
Rule out:VHRetinal Detachment
🎬Video coming Sept 2026
Swinging Flashlight Test
aka Alternating light test
Rule in:IERhegmatogenous Retinal Detachment (Extensive / Macula-off), IEUnilateral or Asymmetric Optic Neuropathy (E.g., Optic Neuritis, Ischemic Optic Neuropathy)
Rule out:IERhegmatogenous Retinal Detachment (Extensive / Macula-off), IEUnilateral or Asymmetric Optic Neuropathy (E.g., Optic Neuritis, Ischemic Optic Neuropathy)
🎬Video coming Sept 2026
Visual Field Testing
Rule in:HVisual Field Defect
Rule out:SHVisual Field Defect
🎬Video coming Sept 2026
Alternate Cover Test (Test of Skew)
aka Cross-cover test
Rule in:IEPeripheral Vestibular Dysfunction, IEPosterior Circulation Stroke
Rule out:IEPeripheral Vestibular Dysfunction, IEPosterior Circulation Stroke