March 9, 2014 | POSTED BY | Clinical Optometry, Clinical Pearls
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Taking distance visual acuity through a pinhole is an easy way to determine whether a patient’s decreased vision is due to refractive error or pathology. This handy equipment can also aid us in determining what a patient’s visual acuity may be post-cataract or post-YAG laser surgery. The standard equipment for this auxiliary test is the potential acuity meter (PAM). However, this device is not always readily available, and thus this “super pinhole” technique is a valuable
tool to determine whether cataract surgery or YAG laser is warranted.


  1. Patient holds pinhole occluder with +5.00 diopter trial lens attached.
  2. Patient also holds near visual acuity chart where they can see best (closer than 40 cm is okay).
  3. Moderate room illumination.
  4. Shine transilluminator to acuity line & have patient read it.
  5. Repeat until smallest line is read (indicates the potential acuity if no cataract is present or post-YAG laser).

Disclaimer: This technique may slightly over estimate the potential visual acuity compared to the traditional PAM.