DPDoctor's PassportEducation
Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
RapidMLAMSRAGP

Visual acuity, pinhole and near vision

Essential points for quick revision.

!
A new loss of sight needs explanation

An abrupt fall in acuity can reflect retinal, optic-nerve, corneal or cerebral disease even when the eye is comfortable or pinhole produces some improvement.

Action: Record onset and monocular acuity promptly, look for associated red flags and contact the appropriate urgent eye or stroke service without delaying emergency care for a perfect chart measurement.

Synopsis

Measure central visual function reproducibly, recognise the contribution and limits of optical correction, and use abnormal findings to guide investigation and referral.

  • Measure each eye independently at the chart's specified distance, using habitual distance correction and documenting exactly what was worn.
  • Keep the fellow eye fully covered without pressing on it; binocular testing alone can conceal marked unilateral impairment.
  • Record the chart, viewing distance, right and left results, correction and any pinhole response rather than writing simply that vision is normal.

Key red flags

Sudden unexplained reduction in either eye, a new field defect, severe pain or neurological symptoms requires urgent specialist assessment; good vision in the other eye does not reduce the urgency.

Investigation priorities

01
Monocular distance acuity with habitual correctionFirst step

Establish the presenting central visual function of each eye separately.

Management branches

PreparationMake the measurement reproducible

A patient presents with an eye complaint or needs a baseline visual assessment.

  1. Identify the patient, explain monocular testing and check which distance correction they normally use, including whether contact lenses should be removed for the clinical problem.
  2. Position the patient at the chart's marked distance with suitable lighting and test each eye using an occluder that prevents peeking without applying pressure.
Open full textbook Answer 2 questions
Sources and review status3 sources · checked 7 Sept 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom