Eye Exam Guide
Common Questions and Considerations for Eye Exams
WHY ARE EYE EXAMS IMPORTANT?
For both adults and children alike, eye exams are an important part of one’s general health maintenance and assessment. Your eyes should be checked regularly to ensure that you are able to see as best as possible. Regular eye health exams will also check for signs of eye disease or conditions that can affect not only your vision but your overall health. Vision and eye health are such a critical part of learning and development, therefore, we highly recommend eye exams for infants and children.
Vision Screening vs. an Eye Exam
When we recommend regular eye exams, this should not be confused with a vision screening. A vision screening is a basic test that indicates if you have difficulty seeing and require further assessment and corrective measures. It can be performed by anyone, whether it is a school nurse, a pediatrician, or even a volunteer at a vision clinic. A vision screening usually only checks vision, it does not check eye health. Also, most vision screenings for kids only check for nearsightedness (when you can not see far), but what happens when the majority of children are farsighted? Most of the time many of these kids get overlooked. A comprehensive eye exam, on the other hand, can only be performed by an eye doctor as it requires special knowledge and equipment to look around and into your eye to check your eye and vision health. Such an exam can assess whether there are underlying causes for vision problems and whether there are any signs of disease which can threaten your site and the health of your eye. A comprehensive eye examination can also diagnose symptoms of diabetes, high blood pressure, high cholesterol, tumors, cancer, autoimmune disorders, and thyroid disorders. A comprehensive eye examination will also provide an accurate prescription for eyeglasses or contact lenses.
Eye Exams for Eye Health
Eye exams are critical because many vision-threatening eye diseases such as glaucoma, macular degeneration, cataracts, or diabetic retinopathy have no or minimal symptoms until the disease has progressed. In these cases, early detection and treatment are essential to halting or slowing down the progression of the disease and saving eyesight. During a comprehensive eye examination, your eye doctor will be looking for initial signs of these diseases. If a problem with your eyes arises such as red eyes, eye allergies, dry eyes, eye swelling, eye pain, always seek an eye doctor as your first doctor to call since they are specifically trained to treat eye diseases.
Eye Exams and Children
If your child is having developmental delays or trouble in school there could be an underlying vision problem. Proper learning, motor development, reading, and many other skills are dependent upon not only good vision, but your eyes functioning together. Children that have problems with focusing or hand-eye coordination will often experience frustration and may exhibit behavioral problems as well. Often they don’t know that the vision they are experiencing is abnormal so they aren’t able to express that they need help. Many conditions are much easier to treat when they are caught early while the eyes are still developing, so it is important to diagnose any eye health and vision issues as early as possible.
Eye Exams Over 40
Just like the rest of our bodies, our eyes begin to weaken as we age. There are a number of common age-related eye conditions such as presbyopia, cataracts, and age-related macular degeneration that can begin to affect your vision and your daily life. While some of these conditions are more of an inconvenience, others could lead to vision loss and dependency. In addition to regular yearly eye exams, it is important to be aware of any changes in your eye health and vision. Also, know your potential risk factors as well as your family ocular and medical history. Over half of the vision loss worldwide is preventable with proper treatment and care.
PREPARING FOR AN EYE EXAM
For both adults and children, an eye exam is a critical part of maintaining your overall health and well-being, and therefore, regular eye exams should be incorporated into your health routine. Comprehensive eye exams assess your vision and the health of your eye, looking for early signs of disease that may not have obvious symptoms. You should not wait until you experience a vision problem or symptoms of an eye condition to schedule a routine exam. Depending on your age, family history, general health, and eye health, it is recommended to have an eye exam every one to two years. Of course, if you experience any serious symptoms that affect your eyes or your vision, you should contact your eye doctor immediately.
The Difference Between an Optometrist (OD) and an Ophthalmologist (MD or DO)
Confusion about the difference between optometrists and ophthalmologists is common, and many people are not aware of how the two eye care professionals differ. Optometrists or Doctors of Optometry attend optometry school which is usually at least four years of graduate-level training. They are able to perform eye exams, provide prescriptions for eyeglasses and contact lenses, and diagnose and treat eye diseases as glaucoma, dry eyes, or eye infections that may require medication or drops. They can consult with and co-manage patients in pre-or post-op surgical care, however, they do not perform surgery. Ophthalmologists are medical doctors that attend medical school and later specialize in ophthalmology. They are able to do all of the services mentioned above but also perform eye surgeries such as cataract surgery, refractive surgery such as LASIK, and deal with more urgent eye conditions such as retinal detachment.
Infant and Child Eye Exams
According to the American Optometric Association (AOA) children should have their eyes examined by an eye doctor at 6 months, 3 years, at the start of school, and then at least every 2 years following. If there are any signs that there may be a vision problem or if the child has certain risk factors (such as developmental delays, premature birth, crossed eyes, family history, or previous injuries) more frequent exams are recommended. A child that wears eyeglasses or contact lenses should have his or her eyes examined yearly.
Adult Eye Exams
Healthy adults under 40 with good vision and who do not wear eyeglasses or contact lenses are recommended to have an eye exam at least every two years. Those that do use vision correction or have a health issue such as diabetes, high blood pressure or another health condition that can have an impact on your eye health should schedule a yearly exam, unless the eye doctor recommends more frequent visits. Once you reach 40, you become susceptible to a number of age-related eye conditions such as presbyopia, cataracts or macular degeneration, therefore annual or bi-annual exams are strongly recommended. As you continue to age, particularly after age 55, the risks of eye disease increase, and early detection can be critical to preventing significant vision loss or blindness. Scheduling a yearly eye exam can make all the difference in maintaining your independence and quality of life.
How to Prepare for Your Exam
Prior to your exam you should decide whether you will be seeking special services such as a contact lens exam or LASIK consultation. These services may cost extra. Check with the doctor’s office or your insurance provider to see if they cover any of the exam expenses. You need to know if you have medical insurance, vision plan coverage or both. Medical insurance usually does not cover “wellness/refractive” exams for glasses or contact lenses. Vision plans will cover exams for glasses or contacts, but usually cannot be used for red eyes, floaters, or other medical eye health problems. Please bring your insurance cards with you. In addition to bringing your current pair of glasses or contacts if applicable, it is important to be aware of your personal and family history and to have a list of medications or supplements you are currently taking. Your pupils will probably be dilated as apart of your exam, so plan accordingly.
WHAT TO EXPECT DURING AN EYE EXAM
You might be going to a regularly-scheduled eye exam. You may be following a recommendation to see an eye doctor after a vision screening at a local clinic or wellness center. Or your next eye doctor visit could be a response to vision problems or eye discomfort. The more you know going in, the easier the entire vision care process will be. For regularly scheduled eye exams, expect to talk about any changes in your medical history since the last time you saw your eye doctor. And if this is your first time in a new practice, you’ll be asked to provide a more complete medical history, including a list of medications you’re currently taking, and any vision problems your parents may have experienced. In addition, you’ll undergo a series of vision and eye tests that help determine the overall health and quality of your vision. These tests also help to check that your current prescription glasses or contacts (if you have one) is still meeting your vision needs. Your eye doctor will also check your eyes for signs of any potential vision problems or eye diseases. In many instances, your pupil may be dilated (opened) using special drops so that your eye doctor can better see the structures of the eye. You’ll then have an honest discussion about the current state of your eye health and vision, and your eye doctor may “prescribe” vision correction for you in the form of eyeglasses or contact lenses. Any health concerns or possibly serious vision complications will also be discussed, including the next steps you must take to preserve and protect your sight. In general, a routine eye exam will last less than an hour depending upon the number of tests you have, and may be partially or completely covered by many vision insurance plans. Visiting eye doctors as a result of a vision screening is also common, but remember: vision screenings offered by health clinics, pediatricians, public schools or local charitable organizations are not a substitute for comprehensive eye exams. Be sure to bring the findings from your screening to your eye doctor—it’s a great way to begin the discussion of your current eye health. For eye doctor visits that result from eye pain, eye discomfort or vision problems you actually can see, expect to take many of the steps involved in a routine eye exam, but specific to the symptoms you’re having. There may be a number of additional tests required as well, so it’s important—especially when suffering pain or discomfort—to allow for as much time as possible for a complete, comprehensive eye exam. And if you feel you are in an emergency situation with your eyes or your vision—don’t wait. Seek immediate emergency medical treatment.
What to Remember
Many vision problems and eye diseases often present minimal, if any, symptoms. That’s why it’s so important to make regular appointments to see your eye doctor. And since vision can change gradually over time, it’s important to know that you’re seeing your best, year after year. Remember the following for your next eye doctor visit:
- Know your medical history and list of current medications
- Know your current symptoms and be able to describe them—write them down if necessary
- Know your family history—some eye diseases like glaucoma and cataracts are hereditary
- Ask in advance about your particular vision insurance plan, and if a co-pay will be due
- Bring your insurance card, identification, and method of payment, if necessary
- Bring your most recent prescription for glasses or contact lenses
- Bring your corrective eyewear to the exam
- If undergoing a test using dilation eye drops, bring proper eye protection, like sunglasses, for after your appointment
Most importantly, remember that eye doctors—and everyone within the eyecare practice—are there to help you see your best and feel your best.
VISITING YOUR EYE CARE PROFESSIONAL
Whether you or a loved one are having a first eye exam, a repeat eye exam, or are seeing a new eye doctor for the first time, there are a number of routine questions you can expect. But your answers to these questions during eye exams are anything but routine for your eye doctor. That’s because there are any number of factors in your medical history that can contribute to current or potential vision problems. Understanding your lifestyle and describing any visual problems you’re having helps to point your eye exam in the right direction. And there are medical conditions, medications, and circumstances that can put you or a family member at a higher risk for certain eye diseases. Though the processes and procedures involved in an eye doctor visit and exam are similar for everyone—your exam is unique to you and you alone. That’s because the process of examining your visual acuity (sharpness), visual ability, and then using different machines and procedures to examine your eyes, is as individual as a fingerprint. Over time, your vision and overall health change. That, more than anything, is why there’s a general procedure to follow during an eye exam, and why it’s important to visit your eye doctor. Without eye doctor visits, these critical changes in vision and eye health may go unnoticed.
An Eye Doctor Visit is a Process
Beyond what you need to know going into an exam, know that visiting your eye doctor is a process you should repeat regularly to maintain eye health and ideal vision.
- You can expect an eye doctor visit to last about an hour or so, depending upon whether or not you’ll need to have your pupils dilated (opened up) with special drops to allow your eyecare professional to fully analyze the internal structure of the eye.
- Your eye doctor visit starts with a review of your eye exam history, and any visible changes in your sight, your lifestyle, and any changes in your medical condition that may affect your vision. (This includes knowing all medications you’re taking.)
- Then you’ll undergo simple visual acuity tests designed to check your overall vision, near vision, and side vision. These tests may reveal vision errors that need correction; errors that usually direct your exam toward special equipment used to accurately determine your prescription.
But expect even more out of your visit to the eye doctor—because correcting vision and maintaining good eye health do require additional, regularly-performed tests.
Visiting your eye doctor regularly is the only reliable way to maintain healthy sight and possibly prevent mild to serious eye diseases. For children, teens, and adults of all ages, an eye doctor visit needs to happen regularly; at the minimum once every two years, and more frequently if you currently have an eye disease, are at risk or have diabetes, or are approaching stages in life that put you at risk for age-related eye disease.
Things to Know Before Eye Exams
Beyond having your vision insurance information, necessary payment, and identification ready, here’s a checklist of things to know before you approach the front desk at your next eye exam.
- What eye problems are you having now? Is your vision blurry or hazy at certain distances? Do you have problems with your side vision? Are you experiencing pain or discomfort in certain lighting situations?
- Do you have a history of any eye problems or eye injury? Do you have a current prescription for glasses or contact lenses? Are you wearing them regularly, and if so, are you still happy with them?
- Were you or your loved one born prematurely? Have you had any health problems recently such as high blood pressure or heart disease? Are you diabetic? Are you considered overweight?
- Are you taking any medications? Do you have allergies to medications, food, or other materials? Seasonal allergies?
- Has anyone in your family (including parents) suffered from eye problems or diseases such as cataracts, glaucoma, or macular degeneration?
- Has anyone in your family (including parents) suffered from high blood pressure, heart disease, or diabetes? What about other health problems that can affect the whole body like blood disorders or cancer?
Eye exams include a detailed history because many things you might consider unrelated to vision may actually affect your current vision, or reveal potential risks for developing certain eye diseases. Be ready to provide a complete history at your next eye exam, and help the front desk, and your eye doctor, best prepare for the examination that follows.
WHAT TO ASK DURING AN EYE EXAM
It’s essential, too, that you make the most out of your exams. We’ve included a range of questions for you to ask during your next eye exam, or if necessary, before your exam to avoid any miscommunication. We hope you find these helpful and that the information contained in our EyeGlass Guide 2.0 will help to facilitate a comprehensive and informed dialogue between you and your eye care professional.
Questions to ask before your eye exam:
- Do you accept my insurance plan’s vision coverage?
- Is payment required at the time of service?
- What will my eye exam entail?
- How long should I expect to be there?
- Will my pupils be dilated?
- What should I bring with me?
Questions to ask at your eye exam:
- Given my age, eye condition, and other risk factors, how often should I have my eyes examined?
- At what age should I start to schedule my children for regular eye exams?
- What lens designs and options are a good fit for me?
- Can my glasses block UV rays?
- Do all sunglasses protect my eyes from UV rays?
- What are photochromic lenses and are they a good option for me?
Things to remember:
It’s always a good idea to bring any of the following (if available) to your eye exam appointment:
- Your insurance card/insurance information
- A list of all medications, vitamins, and other supplements you are taking
- All pairs of prescription glasses you currently own
- If you have it, a copy of your latest eyeglass prescription
- Information on frames you like, or lenses you’ve researched
Don’t forget, if participating in a flexible spending account program, you may be able to use the account to pay for portions of your eye care not covered directly by your insurance plan. To create a printable personal eyeglass suggestion based on your own preferences and lifestyle, use our interactive tool.
EYE EXAMS FOR CONTACT LENSES
Contact lenses are a great alternative to wearing eyeglasses. An often unknown fact is that not all patients wear contact lenses as their primary source of vision correction. Each patient is different, with some patients wearing contact lenses only on weekends, special occasions, or just for sports. That is the beauty of contact lens wear, the flexibility it gives each individual patient, and their lifestyle. If you decide to opt for contact lens wear, it is very important that the lenses fit properly and comfortably and that you understand contact lens safety and hygiene. A contact lens exam will include both a comprehensive eye exam to check your overall eye health, your general vision prescription, and then a contact lens consultation and measurement to determine the proper lens fit.
The Importance of a Comprehensive Eye Exam
Whether or not you have vision problems, it is important to have your eyes checked regularly to ensure they are healthy and that there are no signs of a developing eye condition. A comprehensive eye exam will check the general health of your eyes as well as the quality of your vision. During this exam the eye doctor will determine your prescription for eyeglasses, however, this prescription alone is not sufficient for contact lenses. The doctor may also check for any eye health issues that could interfere with the comfort and success of contact lens wear.
The Contact Lens Consultation
The contact lens industry is always developing new innovations to make contacts more comfortable, convenient, and accessible. Therefore, one of the initial steps in a contact lens consultation is to discuss with your eye doctor some lifestyle and health considerations that could impact the type of contacts that suit you best. Some of the options to consider are whether you would prefer daily disposables or monthly disposable lenses, as well as soft versus rigid gas permeable (GP) lenses. If you have any particular eye conditions, such as astigmatism or dry eye syndrome, your eye doctor might have specific recommendations for the right type or brand for your optimal comfort and vision needs. Now is the time to tell your eye doctor if you would like to consider colored contact lenses as well. If you are over 40 and experience problems seeing small print, for which you need bifocals to see close objects, your eye doctor may recommend multifocal lenses or a combination of multifocal and monovision lenses to correct your unique vision needs.
Contact Lens Fitting
One size does not fit all when it comes to contact lenses. Your eye doctor will need to take some measurements to properly fit your contact lenses. Contact lenses that do not fit properly could cause discomfort, blurry vision or even damage the eye. Here are some of the measurements your eye doctor will take for a contact lens fitting:
- Corneal Curvature: In order to assure that the fitting curve of the lens properly fits the curve of your eye, your doctor will measure the curvature of the cornea or front surface of the eye. The curvature is measured with an instrument called a keratometer to determine the appropriate curve for your contact lenses. If you have astigmatism, the curvature of your cornea is not perfectly round and therefore a “toric” lens, which is designed specifically for an eye with astigmatism, would be fit to provide the best vision and lens fit. In certain cases, your eye doctor may decide to measure your cornea in greater detail with a mapping of the corneal surface called corneal topography.
- Pupil or Iris Size: Your eye doctor may measure the size of your pupil or your iris (the colored area of your eye) with an instrument called a biomicroscope or slit lamp or manually with a ruler or card. This measurement is especially important if you are considering specialized lenses such as Gas Permeable (GP) contacts.
- Tear Film Evaluation: One of the most common problems affecting contact lens wear is dry eyes. If the lenses are not kept adequately hydrated and moist, they will become uncomfortable and your eyes will feel dry, irritated, and itchy. Particularly if you have dry eye syndrome, your doctor will want to make sure that you have a sufficient tear film to keep the lenses moist and comfortable, otherwise, contact lenses may not be a suitable vision option. A tear film evaluation is performed by the doctor by putting a drop of liquid dye on your eye and then viewing your tears with a slit lamp or by placing a special strip of paper under the lid to absorb the tears to see how much moisture is produced. If your tear film is weak, your eye doctor may recommend certain types of contact lenses that are more successful in maintaining moisture.
- Contact Lens Trial and Prescription: After deciding which pair of lenses could work best with your eyes, the eye doctor may have you try on a pair of lenses to confirm the fit and comfort before finalizing and ordering your lenses. The doctor or assistant would insert the lenses and keep them in for 15-20 minutes before the doctor exams the fit, movement and tearing in your eye. If after the fitting, the lenses appear to be a good fit, your eye doctor will order the lenses for you. Your eye doctor will also provide care and hygiene instructions including how to insert and remove your lenses, how long to wear them and how to store them if relevant.
- Follow-up: Your eye doctor may request that you schedule a follow-up appointment to check that your contact lenses are fitting properly and that your eyes are adjusting properly. If you are experiencing discomfort or dryness in your eyes you should visit your eye doctor as soon as possible. Your eye doctor may decide to try a different lens, a different contact lens disinfecting solution or to try an adjustment in your wearing schedule.
EYE EXAMS FOR CHILDREN
According to experts, 80% of learning is visual, which means that if your child is having difficulty seeing clearly, his or her learning can be affected. This also goes for infants who develop and learn about the world around them through their sense of sight. To ensure that your children have the visual resources they need to grow and develop normally, their eyes and vision should be checked by an eye doctor at certain stages of their development.
According to the American Optometric Association (AOA) children should have their eyes examined by an eye doctor at 6 months, 3 years, at the start of school, and then at least every 2 years following. If there are any signs that there may be a vision problem or if the child has certain risk factors (such as developmental delays, premature birth, crossed or lazy eyes, family history, or previous injuries) more frequent exams are recommended. A child that wears eyeglasses or contact lenses should have his or her eyes examined yearly. Children’s eyes can change rapidly as they grow.
Eye Exams in Infants: Birth – 24 Months
A baby’s visual system develops gradually over the first few months of life. They have to learn to focus and move their eyes and use them together as a team. The brain also needs to learn how to process the visual information from the eyes to understand and interact with the world. With the development of eyesight, comes also the foundation for motor development such as crawling, walking, and hand-eye coordination.
You can ensure that your baby is reaching milestones by keeping an eye on what is happening with your infant’s development and by ensuring that you schedule a comprehensive infant eye exam at 6 months. At this exam, the eye doctor will check that the child is seeing properly and developing on track and look for conditions that could impair eye health or vision (such as strabismus (misalignment or crossing of the eyes), farsightedness, nearsightedness, or astigmatism).
Since there is a higher risk of eye and vision problems if your infant was born premature or is showing signs of developmental delay, your eye doctor may require more frequent visits to keep watch on his or her progress.
Eye Exams in Preschool Children: 2-5
The toddler and preschool age is a period where children experience drastic growth in intellectual and motor skills. During this time they will develop fine motor skills, hand-eye coordination, and perceptual abilities that will prepare them to read and write, play sports and participate in creative activities such as drawing, sculpting, or building. This is all dependent upon good vision and visual processes.
This is the age when parents should be on the lookout for signs of lazy eye (amblyopia) – when one eye doesn’t see clearly, or crossed eyes (strabismus) – when one or both eyes turns inward or outward. The earlier these conditions are treated, the higher the success rate.
Parents should also be aware of any developmental delays having to do with object, number or letter recognition, color recognition, or coordination, as the root of such problems can often be visual. If you notice your child squinting, rubbing his eyes frequently, sitting very close to the tv or reading material, or generally avoiding activities such as puzzles or coloring, it is worth a trip to the eye doctor.
Eye Exams in School-Aged Children: Ages 6-18
Undetected or uncorrected vision problems can cause children and teens to suffer academically, socially, athletically, and personally. If your child is having trouble in school or afterschool activities there could be an underlying vision problem. Proper learning, motor development, reading, and many other skills are dependent upon not only good vision but also the ability of your eyes to work together. Children that have problems with focusing, reading, teaming their eyes, or hand-eye coordination will often experience frustration and may exhibit behavioral problems as well. Often they don’t know that the vision they are experiencing is abnormal, so they aren’t able to express that they need help.
In addition to the symptoms written above, signs of vision problems in older children include:
- Short attention span
- Frequent blinking
- Avoiding reading
- Tilting the head to one side
- Losing their place often while reading
- Double vision
- Poor reading comprehension
The Eye Exam
In addition to basic visual acuity (distance and near vision) an eye exam may assess the following visual skills that are required for learning and mobility:
- Binocular vision: how the eyes work together as a team
- Peripheral Vision
- Color Vision
- Hand-eye Coordination
The doctor will also examine the area around the eye and inside the eye to check for any eye diseases or health conditions. You should tell the doctor any relevant personal history of your child such as a premature birth, developmental delays, family history of eye problems, eye injuries or medications the child is taking. This would also be the time to address any concerns or issues your child has that might indicate a vision problem.
If the eye doctor does determine that your child has a vision problem, they may discuss a number of therapeutic options such as eyeglasses or contact lenses, an eye patch, vision therapy or Ortho-k, depending on the condition and the doctor’s specialty. Since some conditions are much easier to treat when they are caught early while the eyes are still developing, it is important to diagnose any eye and vision issues as early as possible.
Following the guidelines for children’s eye exams and staying alert to any signs of vision problems can help your child to reach his or her potential.
How Can Medications Affect Eyesight?
In addition to being “windows to the soul”, your eyes are also a clear indicator—or window—to your overall general health. That’s why it’s so important to understand the relationship between your eyes and any medications you may currently be using. Since eye doctors can use your eye health as a predictor or measure of your general health, all medications that could affect your eyes need to be discussed with your eye care professional.
Can Non-Eye-related Medications Affect My Eyesight?
Yes, they can. Because of its rich blood supply and relatively small mass, the eye is susceptible to certain drugs and toxic agents. Many medications, both prescription and nonprescription (over the counter) can alter the quantity or the quality of your vision, or pose a threat to your future eye health. Your current medications and healthy sight actually go hand in hand and need to be discussed with your eye doctor. Potential adverse effects of medications on your eyes can be classified into three basic categories:
- Medications that can cause blurred vision or alter your eyes’ ability to adjust to the environment can affect your quantity of vision.
- Medications that can induce glare, increase light sensitivity, or impair light-dark adaptation affect your quality of vision.
- Medications that can contribute to the development of ocular disorders. Certain medications can become a factor in developing disorders such as cataracts, keratopathies, retinopathies, maculopathies, optic neuropathies, and glaucoma. These potential effects of certain medications are typically long-term, potentially more serious, and pose a greater threat to vision. However, their progression can usually be prevented (or limited) if recognized early and the offending agent is discontinued or the dosage reduced.
Are There Other Factors to Consider Connecting Medications and Eyesight?
There is a growing body of experimental and epidemiological evidence connecting chronic UVR exposure with vision-threatening ocular disorders such as cataracts. Medications that either dilate the pupil (increasing the amount of UV entering the eye) or increase the effects of UV on the eye (photosensitizers) may increase the risk of developing UV-related eye disease. If you are concerned about the effects your medications may have on your eyes, or experience any eye-related side effects, you should consult your primary care doctor or eye care professional.
Common Tests Used During Eye Exams
While there are some basic eye vision tests common to most eye exams, children and young adults have different vision testing needs than say, a healthy middle-aged adult, or an adult with a history of eye problems. Vision testing equipment ranges from simple tools like the “Big E” eye chart (Snellen Chart) and a hand-held penlight and eye cover, to more complex devices that swap lenses in front of your eyes or use special lamps to view the eye’s structure. A comprehensive eye exam includes vision testing, and vision testing equipment that is common to almost all eye exams, but is often tailored to your age, your specific need, or your individual symptoms. The following are some common tests you may be given during a routine eye exam.
What is an Autorefractor?
Autorefractors are machines that automatically determine the correct lens prescription for your eyes.
How Do Autorefractors Work?
If you’ve discovered you might need vision correction during your eye examination, it’s vital to determine just how “much” your eyes need to be corrected with lenses or contact lenses. This is called measuring your “refraction. Autorefractors automatically measure this value during an eye examination. While seated with your chin in a stabilizing chinrest, you’ll be asked to focus on an image or point of light. The autorefractor automatically determines the correction needed to place your “focus point” on top of the retina, the light-sensitive area at the back of the eye responsible for correctly processing images. The measurement taken by an autorefractor can be translated into a prescription for eyeglasses. In eye exams for small children, or for people with special needs who may have trouble sitting calmly during an extended exam, or verbally describing their vision problems—autorefractors give highly accurate measurements used to determine vision correction needs, automatically. Autorefractors only take a few moments to determine each measurement for each eye. What’s more, autorefractors are quite reliable and are sometimes used in conjunction with a machine called a phoropter to manually switch lenses in front of your eyes to provide ideal vision correction.
DILATED EYE EXAM
What is Eye Dilation?
Eye dilation means your pupil in front of the eye has been opened using special drops.
How Does a Dilated Eye Exam Work?
A truly comprehensive eye exam almost always includes eye dilation—the addition of special eye drops that “open up” the pupil at the front of the eyeball. This allows for a maximum amount of light to enter the eyeball, giving your eye doctor the best possible visibility during a variety of specific eye tests. Eye dilation is common during an eye exam after preliminary testing of visual acuity, pressure testing, and any vision-correction measurements have been taken. Your eyes are dilated using special drops, by far the most effective way to examine the structures inside the eye, and the light-sensitive retina at the back of the eye. Most eye care professionals agree: eye dilation is a critical component of a comprehensive eye exam, and vital to the detection of symptoms of eye disease like macular degeneration, diabetic eye disease, glaucoma, cataracts, and more.
Anything Else I Should Know?
Having your eyes dilated doesn’t hurt—it just feels a little strange. Your pupil at the front of your eye automatically adjusts to light intensity, closing when light is more intense, and opening in lower lighting conditions—much like an automatic camera adjusts to take photos indoors or outdoors. The drops used to dilate your eyes don’t wear off immediately, that’s why it’s recommended you bring sunwear with you to a comprehensive eye exam. And if you’re driving, you may want to consider having a friend with you to help you drive home, or assist you if you feel slightly disoriented. (Remember, your eyes won’t automatically adjust to changing light conditions until the drops wear off.)
Can I Have an Eye Exam Without Having My Eyes Dilated?
In short, yes. Most vision screenings done at a pediatrician’s office, health clinic or community health organizations don’t include eye dilation. But these basic vision tests cannot help you diagnose eye disease, and are certainly no substitute for a regular and thorough eye exam from a qualified eyecare professional. Most eye doctors will tell you with very few exceptions, dilated eyes mean the best possible eye exam environment.
What is Glaucoma Testing Involve?
Glaucoma testing involves measuring internal eye pressure and a detailed scan of the retina for signs of disease.
How Does Glaucoma Testing Work?
Glaucoma is the generalized name for a group of eye diseases that damage the optic nerve of the eye, preventing the eye from sending accurate visual information to the brain.
Glaucoma tests are designed to test your eyes for one of the key symptoms of the disease—increased eye pressure—however only a comprehensive eye exam can reveal whether or not you have glaucoma.
Increased pressure inside the eye is often a key indicator of glaucoma, though not exclusively so. Eye doctors can use a number of tests for eye pressure, but will, by default, check for signs of glaucoma as part of a detailed examination of the retina—the light-sensitive area at the back of the eye responsible for processing images.
A glaucoma test is usually part of a routine eye exam.
Both types of glaucoma tests measure the internal pressure of the eye.
One glaucoma test involves measuring what happens when a puff of air is blown across the surface of the eye. (A puff test) Another test uses a special device (in conjunction with eye-numbing drops) to “touch” the surface of the eye to measure eye pressure.
While increased eye pressure is a key indicator of the disease, it does not necessarily mean you have a glaucoma diagnosis. In fact, the only way to detect glaucoma is to have a detailed, comprehensive eye exam that often includes dilation of the pupils.
So “true” glaucoma testing actually involves examining the retina and optic nerve at the back of the eye for signs of the disease.
Glaucoma can cause slight to severe vision loss, and is often discovered only after the disease is present—that’s why glaucoma testing is so important.
What is an Ophthalmoscope?
An ophthalmoscope is a handheld device used to examine your eye’s interior structure, including the retina.
How Does an Ophthalmoscope Work?
While an ophthalmoscope may seem similar to the retina scope, it has a different purpose. This is a handheld device that combines a light source with built-in mirrors and lenses so that your eye doctor can examine the interior structures of the eye. An ophthalmoscope is particularly useful for examining the structures of the retina—the light-sensitive area at the back of the eye responsible for processing images. Traditionally part of almost every eye exam, ophthalmoscopes can identify healthy structures within the eyeball, and easily help your eye doctor see symptoms or indicators of diseases of the eye. In some instances, your eye doctor will use an indirect ophthalmoscope to gain a broader view of your eye’s internal structure, especially the retina. With indirect ophthalmoscopes, your eye doctor wears a head visor (like a jeweler) that projects a bright light. By holding different handheld lenses in front of your eye, your doctor can better see, and magnify, the inside of your eye. Your eye doctor will dim the lights of the room and ask you to focus on a fixed point on a far wall. Using direct or indirect ophthalmoscopes, your eye doctor will examine the structures of your eye. Sometimes, special drops are used to “open up” (dilate) your pupils to aid your eye doctor in the exam. Your eye doctor is looking for signs of a healthy retina, and also for indicators of any number of potential eye problems like cataracts or macular degeneration.
What is an Optomap?
Optomap® is new technology that allows for detailed retina examination without dilating pupils.
How Does an Optomap Work?
For many eyecare patients, having pupils dilated (opened up) using eye drops can be a bother. But as an integral part of a truly comprehensive eye exam, those drops are highly recommended. Dilation gives your eye doctor the widest view of the internal structures at the back of the eye—the optic nerve, retina, even blood vessels. That’s where Optomap technology comes in. Using low-power laser technology, your eyecare professional can take a wide, instantly-viewable and detailed digital scan of your retina (the area responsible for processing images). All in real time. And in no time. Without the use of pupil-dilating eye drops. It’s very similar to sitting down in a type of photo booth and leaning forward to have your picture taken. Except in this instance, the picture being taken is a larger, wide-field image of the inside of your eyeball. Optomap takes around a minute. Since retina scanning is so important in the early detection of cataracts, diabetic eye disease, glaucoma, age-related macular degeneration and more, it’s pretty easy to see why Optomap technology is so promising. Optomap retinal exams are not available everywhere, however. And in some instances, these scans may not be covered by traditional insurance due to cuts in eye doctor reimbursements. Check with your eyecare professional and ask if an Optomap eye exam is right for you.
What is a Phoropter?
A phoropter is an instrument used to test individual lenses on each eye during an exam.
How Does a Phoropter Work?
If during an eye examination, your doctor has discovered a vision problem like nearsightedness, farsightedness, or astigmatism, it’s likely that one of the next steps you’ll take will involve a phoropter. A phoropter is a special machine used to switch multiple lenses in front of your eyes to correct your vision. Phoropters look imposing—like space-age visors—but are really an ingenious way to quickly determine the exact vision correction needed by your individual eyes. By having you look through the phoropter at a visual reference, image, or the “Big E” chart (the Snellen chart), your eye doctor will help guide you toward lenses that correct your vision impairment by switching lenses within the machine on the fly. The process of switching lenses in front of your eyes is less involved than it may look, given the imposing nature of the device. A phoropter is used to manually determine “refraction”—exactly how a lens must be shaped and curved to correct your vision to a normal state, nothing more. Phoropters are subjective, however, based on your visual perception and response to your eye doctor’s questions. Is your vision better, or worse? With this lens, or this lens? How about now? There are other procedures and technologies available that automatically measure the refraction needed within your eye and produce a “prescription” measurement without your input. These are called autorefractors and aberrometers.
What is a Puffer Test?
A puffer test is a specific form of glaucoma testing measuring eye pressure (intraocular pressure).
How Does a Puffer Test Work?
Most people who’ve had a comprehensive eye exam are familiar with the puffer test. A puffer test is what it sounds like: With your head resting in the chinrest of a diagnostic machine called a slit lamp, your eye doctor uses a puff of air across the surface of the eye to measure the intraocular pressure, “inside” pressure, of the eye. High pressure is a key indicator of glaucoma, a series of eye diseases that attacks the optic nerve.
Puff tests are quick and largely without discomfort. You’ll look at a light inside the machine while your eye doctor blows a gentle puff of air across the surface of your open eye. A device called a tonometer measures the eye’s resistance to the air, and calculates your internal eye pressure. This usually takes only a few moments, and while your eye might water slightly, the procedure is generally over before you know it! A puffer test is a part of glaucoma testing, and is a routine part of a comprehensive eye exam. Glaucoma is a serious disease of the optic nerve, and often doesn’t present itself until vision becomes impaired—that’s why it’s so important to have a puffer test to measure your intraocular pressure.
What is Retinoscopy?
Retinoscopy is a procedure using a retinoscope that helps to see if you need a prescription.
What is the Purpose of Retinoscope During an Eye Exam?
A retinoscope is a handheld device used by eyecare professionals to determine whether your eyes are “20/20,” or have difficulties in seeing things up close or far away. By shining a light back and forth across your eye, eye doctors are able to determine (usually with great accuracy) if your vision needs corrective lenses by “dialing” the retinoscope so that the light focuses properly at the back of the eye on the retina. This simple procedure is called a retinoscopy. During a retinoscopy, if light focuses in front of or behind your retina, you have what is called a “refractive error” of the eye. This means you may have difficulty seeing things up close (farsightedness) or difficulty seeing things in the distance (nearsightedness). And means you likely need prescription lenses or contact lenses. Many times, your eye doctor can determine your exact prescription by using only a retinoscope, though other equipment during an eye exam will be used to completely study your eye health, and verify any refractive errors that require you to get glasses or contact lenses.
How Does a Retinoscope Work During Retinoscopy?
Retinoscopy is a relatively quick and pain-free procedure, though your eyes may water or tear up slightly when exposed to the light within the retinoscope. Other high-tech equipment like autorefractors are becoming more common as well, as they take retinoscopy measurements automatically in just a few seconds. The retinoscope is a handy examination tool that can automatically detect a possible vision problem. A retinoscopy can be especially good for young children or people with special needs who might have problems accurately describing “what’s wrong” with their vision.
SLIT LAMP EXAM
What is the Purpose of the Slit Lamp Exam?
If you’ve ever had a comprehensive eye examination, chances are you’ve had a slit lamp exam. Slit lamp tests are designed to help your eye doctor magnify and examine the eye from front to back.
With your head resting in a machine called a slit lamp, your eye doctor can use a combination of bright light and different magnifying lenses to view your eye’s structure. A slit lamp examination helps your eye doctor see the entire physical structure of your eye from the inside.
A slit lamp test is designed to have your eyes tell a story that might indicate the presence of many types of eye diseases and potential vision problems.
How Does a Slit Lamp Exam Work?
A slit lamp examination is relatively quick and largely without discomfort, though your eye may tear or water and you’ll have to resist the urge to blink frequently.
With your head resting in the chin rest of the slit lamp, you’ll look at a light inside the machine while your eye doctor performs a meticulous scan of your eyes using different lenses, much like on a microscope.
Slit lamp tests are ways to magnify what’s happening on the surface of your eye, at the front of the eye, inside the eye, and at the all-important retina at the back of the eye.
A slit lamp test is one of the most common procedures in a comprehensive eye exam because it tells your eye doctor so much about the state of your eye health, and can be used to spot indicators of a wide variety of diseases and conditions including cataracts, glaucoma, diabetic eye disease, age-related macular degeneration, even blood disorders, and certain cancers.
What is the Snellen Chart?
The “Big E” chart—or Snellen eye chart—is the most familiar type of visual acuity test.
Facts About Snellen Chart
Hopefully, by now, we’ve all seen one. The projected or wall-mounted Snellen eye chart, usually topped by the big letter “E”, is a common visual acuity test used to measure your sharpness of vision at multiple distances. Arranged as a pyramid of sorts, the letters in the Snellen chart are specifically chosen and arranged to test your sharpness and clarity of vision at a baseline distance of 20 feet. During a visual acuity test, the Snellen eye chart is viewed as a projection or mounted on a wall. Handheld versions of Snellen charts are used for testing near vision as well. By viewing or reading each line from top to bottom (with one eye covered at a time), your eye doctor can gain a general approximation of the quality of your visual acuity or sharpness. Where a line of characters begins to become difficult to see is the approximate measurement of your vision. The Snellen chart serves as a beginning—not an end—to a comprehensive eye examination.
What Does “20/20” Vision Mean?
Snellen charts help to determine a baseline for your vision in each eye—a baseline typically measured against “20/20” vision. This means when you are 20 feet away from an object, you can comfortably see details that most people with normal vision can also see at 20 feet distance. If you have 20/30 vision, that means what you see comfortably at 20 feet, can be seen by a person with “normal” vision at 30 feet. Your vision is weaker, in other words. Conversely? In the rare instances where vision may test better than normal on a Snellen chart, a value of 20/10 vision means that you can see clearly from a distance of 20 feet, what a person with normal vision sees well at a distance of 10 feet. Make sense? In fact, if you look closely at a Snellen eye chart, you’ll see the vision values associated with measuring your vision on the right or left side of each line of characters.
VISION SCREENING VS. VISION TESTING
What is the Difference Between a Vision Test and a Vision Screening?
If you consider the vision test as the “goal” of having a comprehensive eye exam at regular intervals throughout your life, then a vision screening is one way to reach that goal. Vision screening sometimes determines an immediate need for vision testing.
It’s important to not confuse the two. A vision screening is not a substitute for a vision test or comprehensive eye exam performed by an eye care professional. But it can play an important role in helping numerous groups get the vision testing they need.
What is a Vision Screening?
A set of simple eye tests to help identify people who may have certain eye problems. Often performed by pediatricians, school nurses, assisted living caregivers, and other healthcare professionals and volunteers, vision screening usually includes a vision test for your ability to see clearly at distances using the “Big E” chart (Snellen chart).
A vision screening may also include testing of your eye’s reaction to light, muscle coordination, or by viewing simple images and graphs that could reveal colorblindness or other hidden problems. The vision test you take to get your driver’s license is an example of a vision screening.
Community health organizations, public schools, wellness clinics, and assisted living facilities often offer vision screening as part of their services. Given at important intervals in life, such as early childhood, pre-teen years, and as you age, vision screening can help monitor the quality of your vision, and possibly identify common vision problems.
But they’re not a substitute for a complete vision test given by an eye care professional.
What is Vision Testing?
A comprehensive set of eye tests performed by an eye care professional in a controlled office setting with equipment that goes far beyond what’s available at a vision screening.
Often performed with eye drops that help the pupil “open up” (dilation), vision tests commonly include testing of vision at multiple distances, peripheral vision testing, and a series of procedures designed to check the structures of the eye for evidence of eye disease or eye problems like age-related macular degeneration, glaucoma, cataracts or diabetes.
A vision test from a qualified eye care professional is important because many of the things hidden or unknowable at a vision screening, reveal themselves under closer professional observation.
And just as importantly, only an eyecare professional can direct you to the treatment necessary to improve your vision or protect your eyes—a prescription for corrective lenses, medications to treat common eye problems, or a wide variety of surgical options now available to people with eye problems.
Vision test: How often?
As a general rule of thumb, it’s a good idea to have a comprehensive eye exam and vision test at least every two years. This especially includes children below the age of 5, who may not fully understand that they’re even having a vision problem until they undergo a professional vision test.
Vision can change rapidly throughout childhood. Regular vision testing is a quick and smart way to keep up with those changes.
In many instances, more frequent vision testing is recommended. If you have diabetes, for example, you are at higher risk for developing glaucoma, cataracts, and diabetic retinopathy–damage to the blood vessels in the retina. After age 35, the risks increase for a host of age-related eye problems or diseases such as presbyopia, macular degeneration, and cataracts.
A comprehensive eye exam every year is not unheard of. Vision tests are convenient and protect your eyes in the short term, and long term.
Types of Vision Testing
Vision testing at the eye doctor is as individual as you are. When it comes to vision testing, no two eye exams are alike, because no two people are alike. In fact, it’s those differences that often determine what types of vision testing—and vision testing equipment—are used during any given examination.
Vision testing is both thorough and painless, though there may be some discomfort from direct beams of light momentarily. In addition, the drops used to dilate pupils may take a little time to wear off, so you will be sensitive to bright light and may need assistance driving after vision testing that includes pupil dilation.
VISION ACUITY TESTING
The Snellen Chart (the chart with the big E at the top) is used to test each eye for visual acuity or “sharpness” at a distance. A smaller, hand-held chart is used to test near vision.
VISUAL FIELD TESTING
Manual and automatic testing designed to measure the quality of your side vision (peripheral vision). This type of test usually involves covering one eye and focusing the other on a fixed point in front of you, while describing what you can see on the “periphery” of your vision.
By having you focus on a distant object within a room, and then alternately covering each eye, your eyecare professional can see if your eyes work together, or must refocus slightly.
Using a series of multi-colored dots arranged within a circle, color-blind vision testing “hides” numbers within the overall pattern of dots. These numbers will appear as easy-to-see colored numbers to everyone except those few people who suffer from various degrees of color-blindness—the inability to perceive certain colors or color combinations.
Refraction errors like nearsightedness and farsightedness are the most common eye problems. Vision testing is used to determine how strong your prescription glasses must be to see clearly, based on how your eyes react while using the vision testing equipment.
Phoropters are machines that allow your eye doctor to “switch” lenses during your exam to see if your focus is better, or worse.
Autorefractors are machines that automatically check the lens power needed to clearly focus images on your retina for the best possible vision.
SLIT LAMP TESTING
This piece of vision testing equipment combines a simple chin rest with a light source that produces a “slit” of light that’s used scan your eye. Your eye doctor (with the help of special viewing lenses) can look into the internal structure of your eye to potentially diagnose a host of eye problems and diseases.
TONOMETRY (GLAUCOMA) TESTING
There are two types of glaucoma vision testing, each with the goal of measuring the internal pressure of the eye. Increased eye pressure is a warning sign for glaucoma, a series of eye diseases that damages the optic nerve of the eye, limiting and sometimes eliminating vision.
THE “PUFFER” TEST
A light is beamed into your eye while a gentle puff of air is blown across the eye’s surface. A special machine measures the resistance of the eye to the puff of air, and then calculates internal eye pressure.
THE TOUCH TEST
Using a machine called an applanation tonometer, a special probe makes gentle contact with the eye’s surface to measure internal eye pressure. Your eye doctor may numb your eye in advance.
Sometimes, your eye doctor will use special drops to “open up” your pupil (dilate it) so that as much light as possible can enter the eye. Using special magnifying lenses and other vision testing equipment, your eye doctor can diagnose a host of eye problems and see internal structures that indicate the presence of eye diseases.
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