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Which option is NOT an objective measurement for starting point for refraction?

Keratometry

Pinhole acuity

Starting point for refraction relies on measurements that do not depend on how the patient reports their vision. Objective tests provide a numerical sense of refractive error without needing patient feedback. Keratometry measures the cornea’s curvature and converts it into a corneal power estimate, which helps predict refractive error and astigmatism. Retinoscopy observes the reflex from the retina as a light source is swept; when the reflex is neutralized, you get an estimate of refractive error independent of the patient’s responses. Pinhole acuity, on the other hand, is a functional test that depends on the patient’s subjective perception of clarity through a pinhole. It indicates whether reducing blur might help, but it does not yield a numeric starting lens power. Large lens changes are part of the refinement process during refraction and not a direct objective measurement either. Therefore, pinhole acuity is not an objective starting-point measurement.

Retinoscopy

Large lens changes

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