20/20
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20/20 is a passive item.
Effect
- Isaac fires two tears at once, one from each eye.
0.8× damage multiplier.
Notes
- Unlike other multiple shot items like
Mutant Spider or 
The Inner Eye, 20/20 does not reduce the rate of fire. - The maximum amount of tears per volley that can be reached by combining and/or duplicating 20/20, The Inner Eye, Mutant Spider, and
The Wiz is 16, or 20 with the 
Keeper.
Synergies
Blood Clot / 
Chemical Peel: Every second row of tears has increased damage.
Brimstone: Two Brimstone shots are fired, without an increase in charge time.
Diplopia:
Every additional 20/20 adds 2 more tears in a tight pattern.- Adds one more tear without further lowering damage.
Doctor's Remote / 
Epic Fetus: Replaces the single missile strike with a barrage of two consecutive missiles.- The Inner Eye / Mutant Spider:
- Adds two/three tears to each shot, with no extra fire rate decrease.
- Removes the fire rate penalty while reducing damage to 80%. Additional copies will add one additional tear with no further change to damage/fire rate.
- Keeper:
- Fires 5 tears with no fire rate decrease.
- Decreases tears' spread. Reduces damage dealt to 80%, but makes his base tear stat equal 2.73. This is a damage per second increase if tear rate before picking up was less than 3.75; otherwise this is a damage per second decrease. This is the same for
Tainted Keeper.
The Ludovico Technique: The Ludovico tear gains one smaller tear orbiting the main one, each dealing the same amount of damage.
Monstro's Lung: Adds two tears to the tear barrage, for a total of 16.
Polyphemus: Grants additional +5 flat damage and removes the fire rate penalty, firing 2 tears per shot.
Sprinkler: Fires two tears at once that almost completely overlap each other.
Technology: Fires two technology shots simultaneously.
Tractor Beam: Both tears are fired along the beam. Only one tear can be seen, as they overlap each other.- The Wiz: Two tears are fired in each direction.
Interactions
Brimstone: Overrides 20/20.- The Inner Eye: Overrides 20/20.
Kidney Stone: Increase number of tears in tear barrage; however, only fires one stone.
Loki's Horns: Only occasionally fires one tear in the other three directions.
Mom's Eye: Only occasionally fires one tear out of the back of Isaac's head.
Mom's Knife: Overrides 20/20.- Monstro's Lung: Overrides 20/20.
- Mutant Spider: Overrides 20/20.
Sad Bombs: Does not affect the number of tears when bombs explode.- Technology: Overrides 20/20.
Varicose Veins: No effect on number of tears when taking damage.
In-game Footage
Trivia
- 20/20 is an idiom that refers to someone with near-perfect vision.
- Despite only having one eye,
Cain shoots two tears at once with this item. - This item is used in Seeing Double (challenge #40).
 The Binding of Isaac: Rebirth
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