A visual acuity result is most useful when another clinician can understand exactly how it was measured. Recording “20/40” alone leaves out the eye tested, the correction worn, the test distance and, in some situations, the chart or optotypes used. A clear entry makes follow-up measurements easier to compare and helps distinguish a screening result from a comprehensive examination finding.
How to document visual acuity results
Record the right eye (OD) and left eye (OS) separately unless the protocol specifically calls for binocular testing. State whether acuity was measured without correction (sc), with correction (cc) or through a pinhole (PH), and include the testing distance when it is not obvious from the chart protocol. When recording a screening outcome, also note the test used and the pass or refer result under the applicable screening criteria.
Example of a complete chart entry
Distance VA at 20 ft: OD sc 20/60, PH 20/30; OS sc 20/40, PH 20/25. Chart: Snellen. This example identifies the eye, uncorrected acuity, pinhole response, chart and distance. It is an illustrative notation example, not a diagnosis; actual findings should always reflect the examination performed.
For a patient wearing habitual glasses, an entry such as OD cc 20/25; OS cc 20/20 at 20 ft records presenting acuity with that correction. Reserve “best-corrected visual acuity” (BCVA) for a result obtained with the best correction determined by the examination or protocol, rather than assuming habitual-glasses acuity is the patient's best possible result.
Snellen, decimal and logMAR notation
The Snellen fraction expresses the testing distance over the distance at which the tested optotype is intended to be resolved by an observer with standard acuity. Thus, 20/40 means that the person identifies at 20 feet a line conventionally identified at 40 feet by an observer with standard acuity. In metric notation, the approximately corresponding value is 6/12.
Decimal notation represents the ratio numerically, while logMAR expresses the logarithm of the minimum angle of resolution. A value of 0.0 logMAR corresponds to 20/20, approximately 0.30 corresponds to 20/40, and 1.0 corresponds to 20/200. The conversion assumes equivalent testing conditions; it does not make different chart designs automatically interchangeable.
- 20/20: 6/6, decimal 1.0, logMAR 0.0
- 20/40: 6/12, decimal 0.5, logMAR approximately 0.30
- 20/200: 6/60, decimal 0.1, logMAR 1.0
Snellen remains familiar in routine care, but chart designs vary in optotype spacing, letter counts and line progression. Standardized logMAR charts help make comparisons more consistent, particularly when the same protocol must be followed across visits or study sites. Clinicians selecting equipment can review Good-Lite's eye charts for different clinical testing needs.
ETDRS letter-by-letter scoring
ETDRS-style charts use five letters per line and a regular logarithmic progression in optotype size. In the standard logMAR scoring convention, each correctly read letter corresponds to 0.02 logMAR and each five-letter line to 0.10 logMAR. Document the chart, testing distance, starting conditions and scoring procedure specified by the protocol rather than reporting a logMAR number without context.
Essential charting abbreviations
- OD: right eye (oculus dexter)
- OS: left eye (oculus sinister)
- OU: both eyes (oculi uterque)
- sc: without correction (sine correctione)
- cc: with correction (cum correctione)
- PH: pinhole
- UCVA: uncorrected visual acuity
- BCVA: best-corrected visual acuity
These abbreviations are compact, but they do not replace a description of unusual testing circumstances. If a patient cannot complete a standard chart or must be tested at a modified distance, record that change explicitly. Presenting acuity, uncorrected acuity and BCVA answer different clinical questions, so label them accordingly.
How to document pinhole testing
Pinhole testing can help assess whether reduced acuity has an optical or refractive component. Improvement through a pinhole supports that possibility, but it does not identify a specific refractive error or rule out coexisting ocular disease. Likewise, no improvement does not independently establish a pathological cause, because technique, aperture size, patient factors and other conditions can affect the response.
Record the measured acuity rather than writing only “pinhole positive” or “no improvement.” For example, OD sc 20/80, PH 20/30 reports an improvement, while OS sc 20/80, PH NI identifies no improvement under the conditions used. Good-Lite's occluder collection includes clinical occlusion and pinhole-testing options relevant to this step.
Recording near visual acuity
Near acuity should include the notation system, actual viewing distance and correction used. Jaeger labels can vary among charts and are not a universally standardized acuity scale, so a Jaeger result is easier to interpret when the chart is identified. N notation and M notation can also be useful, provided the examination records the relevant distance and chart conventions.
An example is Near VA OD cc N6 at 40 cm; OS cc N6 at 40 cm. For low-vision and reading assessments, M notation paired with measured viewing distance can support more reproducible interpretation than an unqualified Jaeger label. Record distance and near findings separately whenever both are tested.
Documenting very low visual acuity
When the patient cannot identify the largest line on the chart at the standard distance, first follow the chart or examination protocol for reduced-distance testing if appropriate. Not all charts share the same lower measurement limit, so 20/200 should not be treated as a universal cutoff for chart-based acuity. If optotype measurement is not feasible, carefully document the available functional response.
- CF: counting fingers, with the testing distance, such as “CF at 3 ft”
- HM: hand motion, with the viewing distance when feasible
- LP: light perception, with projection if assessed
- NLP: no light perception
Counting fingers, hand motion and light perception are descriptive examination findings, not standardized logMAR measurements. Approximate numerical conversions sometimes used in research should not be substituted for the original recorded finding without explaining the method. Use the clinical and regulatory definitions applicable to the specific jurisdiction when documenting visual impairment or legal blindness.
Pediatric visual acuity and screening records
For children who do not yet recognize conventional letters, LEA SYMBOLS® and HOTV optotypes are established options for age-appropriate screening. Record the optotype set, whether a matching card was used, the actual test distance, monocular occlusion and the child's level of cooperation. If a child cannot complete testing reliably, record the result as untestable rather than assigning an unsupported acuity value.
For example, 10-ft screening, LEA SYMBOLS®, OD 20/40, OS 20/40, without correction; pass or refer according to the screening protocol keeps the measurement separate from the screening decision. Good-Lite offers LEA SYMBOLS® vision tests that can support pediatric testing programs. Screening identifies children who may need further evaluation; it is not itself a diagnosis.
Age-specific screening thresholds
Current AAPOS vision-screening recommendations use age-specific thresholds: at 36–47 months, children should identify the majority of optotypes on the 20/50 line; at 48–59 months, on the 20/40 line; and at age 5 years or older, on the 20/32 line with each eye. These thresholds differ from one another and should not be combined into a single rule for all children aged three through five. Follow the full AAPOS recommendations and any applicable local screening policy, including instructions on rescreening or referral.
A meaningful difference between the two eyes also deserves attention, even if both measurements appear reasonably good. Record the separate monocular values, any observed testing difficulty and the outcome communicated to the family or referring clinician. Consistent documentation helps the next provider understand what the screening did and did not establish.
EHR and SOAP-note documentation
In an electronic health record or SOAP note, place acuity findings with the examination data and make the testing conditions explicit. A useful format is VA distance at 20 ft: OD cc 20/25, OS cc 20/40, OS PH 20/30. Include the chart type when it differs from the practice default or when a research, pediatric or low-vision protocol requires it.
Structured fields can improve consistency, but templates still need careful review. Avoid automatically describing any result as BCVA without supporting refraction information, and do not use the visual acuity record by itself to infer a diagnosis. Keep screening outcomes, referral decisions and clinical interpretations distinct.
Explore related vision testing products
Accurate visual acuity records depend on matching the testing method to the patient and documenting the conditions consistently. The following Good-Lite charts and occluder are relevant to the standardized, pediatric and pinhole testing approaches described above.
Chart(Distance): ESV3000™ and ESC2000™ - ETDRS Original Series - Chart 1 (13ft/4m)
Designed for standardized visual acuity assessment, including Best Corrected Visual Acuity (BCVA), this Original Series ETDRS Chart 1 uses proportionall...
$59.75
Chart(Distance): ESV1200™ and ESV1500™ - LEA SYMBOLS® 13-Line - 10ft/3m
A LEA SYMBOLS® distance chart with proportionally spaced optotypes (logMAR); line sizes range from 10/63 to 10/4 (3/19 to 3/1.2) equivalent. The other e...
From $27.00
Occluder: Double Ended
Double-ended handheld occluder with opaque and pinhole sides for comprehensive vision screening. Choose from single pinhole, 17-pinhole, or 49-pinhole c...
From $18.25
Visual acuity charting checklist
- Identify the eye tested: OD, OS or OU.
- Record the actual acuity result and notation system.
- State the correction condition: sc, cc or PH.
- Record testing distance, chart or optotype type when relevant.
- Document pinhole acuity or no improvement when performed.
- For pediatric screening, record optotypes, cooperation, pass/refer criteria and follow-up.
- For low vision, document reduced-distance testing or CF/HM/LP/NLP findings precisely.
Good documentation makes every visual acuity measurement more useful at the next visit, whether the patient is attending a routine exam, pediatric screening or longitudinal research assessment. The goal is not a longer chart entry, but a result that another clinician can interpret without guessing how it was obtained.
