Comprehensive Medical Eye Examination
Periodic eye and vision examinations are an important part of eye health care. Many eye and vision problems have no obvious signs or symptoms. As a result, individuals are often unaware that problems exist. Early diagnosis and treatment of eye and vision problems are important for maintaining good vision and eye health, and when possible, preventing vision loss.
For example, in the early stages of cataracts, only a small portion of the lens may be cloudy. This may not noticeably affect your vision, and you may be unaware that you have the beginning stages of cataracts. Without regular eye exams, your cataracts will continue to get bigger and gradually compromise your visual acuity. You may assume you simply need to change glasses, without realizing something more serious is going on.
How Often Do I Need an Eye Exam?
How frequently you need an eye exam depends primarily on your age.
- Adults under the age of 40 should have eye exams every two to three years.
- Adults between the ages of 40 and 60 should have exams every two years.
- Adults over the age of 60 should have eye exams once a year.
If you have been diagnosed with an ongoing eye problem, such as diabetic retinopathy or macular degeneration, you may need more frequent exams.
If you are African-American, you are at a slightly higher risk of diseases like glaucoma, and should have more frequent exams.
If you have a higher risk of developing eye problems, either because of diabetes, a previous eye injury or a family history of eye disease, you should ask your doctor how often to have exams.
Cataract Eye Exams
Patient History
At the beginning of a cataract eye exam, a detailed patient history is taken. You are asked about any symptoms you are experiencing and when the symptoms began. You are also asked about the presence of any general health problems, medications taken and occupational or environmental conditions that may be affecting vision.
Visual Acuity
Visual acuity measurements evaluate how clearly each eye is seeing. As part of the testing, you are asked to read letters on distance and near reading charts. The results of visual acuity testing are written as a fraction such as 20/40.
When testing distance vision, the top number in the fraction is the standard distance at which testing is done: twenty feet. The bottom number is the smallest letter size you were able to read. A person with 20/40 visual acuity would have to get within 20 feet of a letter that should be seen at 40 feet in order to see it clearly. Normal distance visual acuity is 20/20.
Slit Lamp Exam
A slit lamp is a special microscope used to look at the structures of the eye. An intense line of light, called a slit, highlights the lens as well as the cornea, iris and space between the iris and cornea. With the slit, the doctor can review these structures in small sections, looking carefully for any clouding or other abnormalities.
Contrast Sensitivity
Contrast sensitivity refers to the eye’s ability to differentiate between an object and its background. It is important in situations where there is fog, glare or low light, such as driving at night.
Cataracts can cause impaired contrast sensitivity. Contrast sensitivity is measured using a Pelli-Robson chart, which consists of horizontal lines of capital letters. The contrast between the color of the letters and the chart’s background decreases by line.
Pupil Dilation
When testing for cataracts, it is often helpful to dilate the pupils. Special drops are used to widen the pupil, which allows more light in and offers a better view of the entire lens.
Are Cataract Eye Exams Painful?
Cataract eye exams are not painful, although your vision may be blurry and your eyes may be sensitive to light after the pupils are dilated. The effects of the dilating drops tend to last for several hours.
Cataract Treatment
If an exam confirms the presence of cataracts, and the cataracts are bad enough to interfere with reading, driving and other daily tasks, the only way to treat them is with surgery. During surgery, the eye’s lens is surgically removed and replaced with an artificial lens. Modern cataract surgery is very safe and the prognosis is usually excellent. The procedure takes less than an hour and you will be able to see as well as or better than you did before cataracts.
Other Tests Performed During an Eye Exam
A comprehensive adult eye and vision examination may include, but is not limited to, the tests listed below. Individual patient signs and symptoms, along with the professional judgment of the doctor, may significantly influence the testing performed.
Preliminary Tests
Preliminary testing may include evaluation of specific aspects of visual function and eye health such as depth perception, color vision, eye muscle movements, peripheral or side vision, and the way your pupils respond to light.
Keratometry
This test measures the curvature of the cornea (the clear outer surface of the eye) by focusing a circle of light on the cornea and measuring its reflection. This measurement is particularly critical in determining the proper fit for contact lenses.
Refraction
Refraction is conducted to determine the lens power needed to compensate for any refractive error (nearsightedness, farsightedness, or astigmatism). Using an instrument called a phoropter, your doctor places a series of lenses in front of your eyes and measures how they focus light using a handheld lighted instrument called a retinoscope. The doctor may choose to use an automated instrument that automatically evaluates the focusing power of the eye. The power is then refined by your responses to determine the lenses that allow the clearest vision.
Eye Focusing, Eye Teaming and Eye Movement Testing
Assessment of accommodation, ocular motility and binocular vision determines how well the eyes focus, move and work together. In order to obtain a clear, single image of what is being viewed, the eyes must effectively change focus, move and work in unison. This testing will look for problems that keep your eyes from focusing effectively or make using both eyes together difficult.
Eye Health Evaluation
Tonometry measures eye pressure. Elevated pressure in the eye signals an increased risk for glaucoma.
External examination of the eye includes evaluation of the cornea, eyelids, conjunctiva and surrounding eye tissue using bright light and magnification.
Evaluation of the lens, retina and posterior section of the eye may be done through a dilated pupil to provide a better view of the internal structures of the eye.
Measurement of pressure within the eye (tonometry) is performed. Normal eye pressures range from 10 to 21 millimeters of mercury (mm Hg), averaging about 14 to 16 mm Hg. Anyone with eye pressure greater than 22 mm Hg is at an increased risk of developing glaucoma, although many people with normal pressure also develop glaucoma.
Supplemental Testing
Additional testing may be needed based on the results of the previous tests to confirm or rule out possible problems, to clarify uncertain findings, or to provide a more in-depth assessment.
At the completion of the examination, your doctor will assess and evaluate the results of the testing to determine a diagnosis and develop a treatment plan. He or she will discuss with you the nature of any visual or eye health problems found and explain available treatment options. In some cases, referral for consultation with, or treatment by, another optometrist or other health care provider may be indicated.
What to Bring to an Eye Exam
- Medical insurance information
- Glasses or contacts (if applicable)
- A list of all current medications
Frequently Asked Questions About Eye Exams
Do I need an eye exam if my eyes seem fine?
Yes. Certain eye disease, including some that lead to permanent vision loss, can progress without causing noticeable symptoms. The only way to detect these diseases is by undergoing a medical eye exam with an experienced doctor. Regular eye exams can lead to an early diagnosis, which often allows us to manage diseases with minimally invasive means.
Furthermore, your eyes are a window into your overall health. By taking a close look at the inside of your eyes, your doctor can check for clues that suggest serious health conditions that may otherwise go undetected. For instance, examining the tiny blood vessels in your eyes can uncover signs of diabetes and blood pressure problems. Your eyes are the only area of your body where we can look at your veins without performing surgery.
Is an eye exam uncomfortable?
No, medical eye exams are painless. Dilating your pupils does not hurt, although you can expect to have slightly blurry vision and sensitivity to light for a few hours after the exam.
How long does an eye exam take?
A regular eye exam and tests take approximately 30 to 45 minutes. Between the time it takes to fill out paperwork, undergo preliminary tests, interpret the results of the tests and answer all of your questions, expect to spend about an hour at our practice.
Why do I need my pupils dilated during an eye exam?
Dilating or widening your pupils allows our doctors to get a complete look at the inside of your eye. We can more thoroughly evaluate the parts of your eye like the retina, macula and optic nerve, which directly influence your ocular health. Dilation is not painful or uncomfortable and the effects of dilation wear off within a few hours with no lasting effects.
Should I have an eye exam if I am experiencing digital eye strain?
Yes, if you are experiencing symptoms such as dry or tired eyes or headaches after prolonged use of digital devices, we encourage you to undergo an eye exam. We can determine whether any underlying eye problems are contributing to digital eye strain, and recommend solutions to relieve your symptoms.
What does an eye chart measure?
The Snellen eye chart, which consists of rows of letters that gradually get smaller in size, is used to measure visual acuity. Visual acuity is the sharpness of your vision. Using the Snellen chart can help our doctors determine whether you need to wear glasses or contacts — or, if you already wear glasses or contacts, the chart can help us determine whether your prescription needs to be adjusted.
Why should I trust Wiles Eye Center for my eye exam?
The team at Wiles Eye Center has provided exceptional eye care for more than 40 years. Our doctors are committed to catching and managing eye diseases so you can enjoy healthy eyes for life. We always take your concerns seriously and go above and beyond to make you feel valued.
Contact Wiles Eye Center Today
If you have questions regarding any eye or vision conditions diagnosed, or treatment recommended, don’t hesitate to ask Dr. Stephen B. Wiles, M.D., F.A.C.S., or one of our staff members at Wiles Eye Center.