A comprehensive eye exam includes a number of tests and procedures to examine and evaluate the health of your eyes and the quality of your vision. These tests range from simple ones, like having you read an eye chart, to complex tests, such as using a high-powered lens to examine the health of the tissues inside of your eyes.
Here are some tests you are likely to encounter during a routine comprehensive eye exam:
This test helps your doctor get a good approximation of your eyeglasses prescription. For retinoscopy, the room lights are dimmed and an instrument containing wheels of lenses (called a phoropter) is positioned in front of your eyes. You will be asked to look at an object across the room (usually the big "E" on the wall chart or screen) while your doctor shines a light from a hand-held instrument into your eyes from arm's length and flips different lenses in front of your eyes.
Based on the way the light reflects from your eye during this procedure, your doctor can get a very good idea of what your eyeglasses prescription should be. This test is especially useful for children and non-verbal patients who are unable to accurately answer the doctor's questions.
With the widespread use of automated instruments to help determine eyeglass prescriptions today, many doctors forgo performing retinoscopy during comprehensive eye exams. However, this test can provide valuable information about the clarity of the internal lens and other media inside the eye. So doctors who no longer perform this test routinely may still use it when examining someone who may be at risk of cataracts or other internal eye problems.
This is the test your doctor uses to determine your exact eyeglasses prescription. During refraction, the doctor puts the phoropter in front of your eyes and shows you a series of lens choices. He or she will then ask you which one of the two lenses in each choice ("1 or 2," "A or B," for example) makes the letters on the wall chart look clearer.
Based on your answers, your doctor will determine the amount of nearsightedness, farsightedness and/or astigmatism you have, and the eyeglass lenses required to correct these vision problems (which are called refractive errors).
Autorefractors and Aberrometers
Your eye doctor also may use an autorefractor or aberrometer to help determine your glasses prescription. With these devices, you rest your chin and head on the instrument and look ahead at a pinpoint of light or other image.
An autorefractor evaluates the way images focus on your retina, where vision processing takes place, without the need for you to say anything. This makes autorefractors especially useful when examining young children or people who may have difficulty with a regular ("subjective") refraction. Automated refractions and subjective refractions are often used together during a comprehensive exam to determine your eyeglasses prescription.
An aberrometer uses advanced wavefront technology to detect even obscure vision errors based on the way light travels through your eye.
While there are many ways for your eye doctor to check how your eyes work together, the cover test is the simplest and most common.
During a cover test, the eye doctor will have you focus on a small object at distance and will then cover each of your eyes alternately while you stare at the target. As they do this, eye doctors observe how much each eye has to move when uncovered to pick up the fixation target. The test is then repeated as you focus on a near object.
Cover tests can detect even very subtle misalignments that can interfere with your eyes working together properly (binocular vision) and cause amblyopia or "lazy eye."
The slit lamp is an instrument that the eye doctor uses to examine the health of your eyes. Also called a biomicroscope, the slit lamp gives your doctor a highly magnified view of the structures of the eye, including the lens behind the pupil, in order to thoroughly evaluate them for signs of infection or disease.
The slit lamp is basically an illuminated microscope that's mounted on a table and includes a chin and head rest so you can rest comfortably while the doctor looks at your eyes. After the doctor looks at the front of your eye, additional hand-held lenses may be used to also examine your retina (the light-sensitive inner lining of the back of the eye.)
Tonometry (Glaucoma Testing)
Tonometry is the name for a variety of tests that can be performed to determine the pressure inside your eye. Elevated internal eye pressure can cause glaucoma, which is vision loss due to damage to the sensitive optic nerve in the back of the eye.
One common method used for tonometry is the "air puff" test - where an automated instrument discharges a small burst of air to the surface of your eye. Based on your eye's resistance to the puff of air, the machine calculates the pressure inside your eye - called your intraocular pressure (IOP).
Though the test itself can be startling, nothing but air touches your eye during this measurement, and there's no risk of eye injury from the air puff test.
Another popular way to measure eye pressure is with an instrument called an applanation tonometer, which is usually attached to a slit lamp. For this test, a yellow eye drop is placed on your eyes. Your eyes will feel slightly heavy when the drops start working. This is not a dilating drop — it is simply a numbing agent combined with a yellow dye. Then the doctor will have you stare straight ahead in the slit lamp while he or she gently rests the bright-blue glowing probe of the tonometer on the front of each eye and manually measures the intraocular pressure.
Like the air puff test, applanation tonometry is painless and takes just a few seconds.
Since glaucoma is often the result of an increase of pressure inside the eye, these are important tests for ensuring the long-term health of your eyes.
Your comprehensive exam may include the use of dilating drops. These medicated eye drops enlarge your pupil so your doctor can get a better view of the internal structures in the back of the eye. Dilating drops usually take about 20 minutes to start working. When your pupils are dilated, you will be sensitive to light, because more light is getting into your eye. You may also notice difficulty reading or focusing on close objects. These effects can last for up to several hours, depending on the strength of the drops used.
If you don't have sunglasses to wear after the exam, disposable sunglasses will be provided to help you drive home. Dilation is very important for people with risk factors for eye disease, because it allows for a more thorough evaluation of the health of the inside of your eyes.
These are the most common tests performed during a standard comprehensive eye exam. Depending on your particular needs, your doctor may perform additional tests or schedule them to be performed at a later date.
Your eyes reveal a lot about your overall health. This makes going to the eye doctor once a year important for everyone, regardless if you have prescription eye glasses or contact lenses. Our comprehensive eye exam checks for the following:
1. Complete evaluation of eye symptoms, diagnosis, and treatment
2. Refraction for glasses prescription
3. Contact Lens Evaluation, performed as needed
4. Ocular motility testing/depth perceptual (3D) testing
5. Automated visual field testing
6. Eye balance testing
7. Color vision - Ishihara or Farnsworth D-15 testing
8. Glaucoma testing
9. Cataract Testing
10. Diabetes testing - use of retinal photos or dilation
11. Complete eye health assessment
12. Blood Pressure
13. Retinal examination
Most eye diseases do not display symptoms in the beginning stages, therefore you could have an issue with your eyes and not even know it. Annual eye exams are essential to early diagnosis and treatment of conditions. In more extreme cases, doing so can save you from losing your vision entirely.
Some of the most common symptoms you could experience if you have an eye disease are as follows:
1. Complete loss of peripheral vision
2. Sudden loss of vision
3. Slowly or suddenly blurred vision
4. Eye floaters
5. Sudden increased reaction to bright lights or sunlight glare
6. Eye discomfort
If you do notice yourself suffering from an eye symptom, schedule an exam as soon as possible. Ignoring a symptom can become increasingly more uncomfortable and could also make the problem much worse than it has to be. We are here to help and will be sure to evaluate all your symptoms so that we can get to the root of your issue and provide you with the best treatment possible.
Many eye conditions are common problems experienced by millions of people around the globe. When you visit the eye doctor, whether it’s for a specific reason or just for your checkup, you don’t have to feel alone if you have some of these common problems: dry eyes, cataracts, and retinal disorders.
Whether it’s from allergies or it’s simply a year-round issue, dry eyes affect more than 3 million people in the U.S. each year. They are treatable but oftentimes self-diagnosed because it’s truly only noticeable by the sole person. Dry eyes are simply just as it claims — an inadequate amount of moisture in the eyes and therefore can lead to inflammation. Dry eyes are also referred to as keratoconjunctivitis sicca.
With dry eyes, minor discomfort may occur and light sensitivity is common. To help with the discomfort, prescription and lubricating eye drops are available.
There are more than 200,000 cases of cataracts in the U.S. each year. This is a chronic condition that can last for years or even an entire lifetime, but can also be treatable by a specialist. This condition requires a medical diagnosis by an optometrist, as cataracts tend to develop slowly over time.
Everyone is susceptible to developing cataracts, especially those that spend a fair amount of time outside. Many times, the progression of cataracts can be slowed by wearing sunglasses when outdoors. Those who spend more time outdoors and do not wear sunglasses will require surgery much sooner than those who wear sunglasses or do not spend as much time outside.
Typically, the main symptoms are blurry vision and having trouble seeing in certain lighting — dim lighting, or seeing halos around lights. Surgery is available for cataract correction. When cataracts disturb someone’s day-to-day tasks, it is highly recommended that they undergo the replacement of the cloudy lens with a clear, artificial lens.
Retinal is the chemical basis for vision. There are many different retinal disorders that people may be faced to cope with, all affecting visual clarity, including:
· Macular degeneration: this is a disease that destroys the sharp, clear, main focus of vision.
· Diabetic eye disease: this disease is found in those who suffer from diabetes. Due to the fluctuation in blood sugar, there is damage done to the blood vessels in the back of the eye where the retina is.
· Retinal detachment: this is considered a medical emergency, and it’s when the retina is pulled away from the back of the eye.
· Retinoblastoma: this is cancer of the retina.
These are just a few of the common, and sometimes severe, cases of retinal disorders. All are diagnosed by a specialist and can be cared for on a case-by-case basis. Visit your optometrist to learn more about your eyes and have your vision assessed today.
The cost of routine eye exams and prescription eyewear can be of real concern, especially for large families. In many cases, vision insurance can lower these annual expenses.
A vision insurance policy is not the same as health insurance. Regular health insurance plans protect you against financial losses due to unexpected eye injuries or disease. Vision insurance, on the other hand, is a wellness benefit designed to provide routine eye care, prescription eyewear and other vision-related services at a reduced cost.
Where Can I Get Vision Insurance?
Group vision insurance can be obtained through your company, association, school district, etc., or through a government program such as Medicare or Medicaid.
Also, as an individual, you have the option of purchasing your own vision benefit plan.
Vision insurance is often a value-added benefit included in indemnity health insurance plans, health maintenance organization (HMO) plans and plans offered by preferred provider organizations (PPOs):
What Kinds of Vision Insurance Plans Are Available?
Vision insurance typically comes in the form of either a vision benefits package or a discount vision plan.
Typically, a vision benefits package provides enrollees eye care services in exchange for an annual premium or membership fee, a yearly deductible (a dollar amount) for each enrolled member and a co-pay (a smaller dollar amount) each time a member accesses a service.
A discount vision plan provides eye care at fixed discounted rates after an annual premium or membership fee and a deductible are paid.
Both kinds of vision insurance can be custom-designed to meet the different requirements of a wide range of customers, including school districts, unions, and big and small companies.
What Does Vision Insurance Cover?
Vision insurance generally covers the following services and products:
Generally, services acquired from network providers are cheaper than services from out-of-network providers.
What Are My Payment Options?
Typically, if group vision insurance is available from your employer, you pay for it through payroll deductions or flexible spending accounts (FSAs).
An FSA, sometimes called a cafeteria plan, allows an employee to use pre-tax dollars to purchase selected health benefits such as vision insurance. You save money because you receive the full benefit of income that has been set aside for health costs, making it not subject to or reduced by taxation.
If you purchase an individual vision insurance plan because your employer doesn't offer a group plan (or because you are self-employed), you can expect to be billed monthly or annually.
Many normal, age-related problems affecting vision can be addressed with practical solutions, such as extra lighting for reading recipes or tinkering with garage projects.
In fact, after about age 60, you may find you need additional illumination for most tasks performed indoors or in darker conditions outdoors. This is because your eye's pupil no longer opens as widely as it once did to allow light to enter. Because less light is reaching your retina, where vision processing occurs, images are no longer as sharp as they once were.
To help offset this problem, you might consider extra steps such as:
Also, make sure you have regular eye exams that include critical tests for older eyes to rule out potentially serious age-related eye diseases that may affect vision quality. Your eye doctor also can advise you about the best vision correction options to reduce the effects of normal age-related declines in near vision, color vision and contrast sensitivity.
Cataracts, which are very common in the over-60 age group, also can cause cloudy or hazy vision. Cataracts usually are easily remedied with surgery that removes the eye's cloudy lens and replaces it with an artificial one.
What Can You Do About Permanent Vision Loss?
Unfortunately, some age-related eye diseases — including glaucoma, advanced macular degeneration and diabetic retinopathy — can cause serious vision loss and blind spots.
Many low vision devices are available to assist people with permanent vision loss so they can perform daily living tasks more easily. These devices include:
Vision Loss and the Elderly
One disturbing trend noted in recent years has been an increased tendency in our society to overlook or neglect the vision correction needs of elderly citizens, including those living in nursing homes.
As an example, researchers say almost one third of older Americans diagnosed with glaucoma receive no treatment for this potentially blinding eye disease.
Consequences of delaying vision correction or needed treatment, especially in elderly people, can be severe. Uncorrected vision problems can contribute to falls that seriously injure elderly people and greatly reduce their confidence in their ability to live independently.
If you have older relatives or friends living alone or in a nursing home, consider serving as their advocate to make sure they receive appropriate vision care and treatment of age-related eye diseases, to maximize their quality of life.
Just as our physical strength decreases with age, our eyes also exhibit an age-related decline in performance - particularly as we reach our 60s and beyond.
Some age-related eye changes, such as presbyopia, are perfectly normal and don't signify any sort of disease process. Similarly, cataracts can be considered an age-related disease that is extremely common among seniors and can be readily corrected with cataract surgery.
Some of us, however, will experience more serious age-related eye diseases that have greater potential for affecting our quality of life as we grow older. These conditions include glaucoma, macular degeneration and diabetic retinopathy.
When Do Age-Related Vision Changes Occur?
Presbyopia. After you pass the milestone age of 40, you'll notice it's more difficult to focus on objects up close. This normal loss of focusing ability is called presbyopia and is due to hardening of the lens inside your eye.
For a time, you can compensate for this decline in focusing ability by just holding reading material farther away from your eyes. But eventually you'll need reading glasses, multifocal contact lenses or multifocal eyeglasses. Some corrective surgery options for presbyopia also are available, such as monovision LASIK and conductive keratoplasty (CK).
Cataracts. Even though cataracts are considered an age-related eye disease, they are so common among seniors that they can also be classified as a normal aging change. According to the Mayo Clinic, about half of all 65-year-old Americans have some degree of cataract formation in their eyes. As you enter your 70s, the percentage is even higher. It's estimated that by 2020 more than 30 million Americans will have cataracts.
Thankfully, modern cataract surgery is extremely safe and so effective that 100% of vision lost to cataract formation usually is restored. If you are noticing vision changes due to cataracts, don't hesitate to discuss symptoms with your eye doctor. It's often better to have cataracts removed before they advance too far. Also, multifocal lens implants are now available. These advanced intraocular lenses (IOLs) potentially can restore all ranges of vision, thus reducing your need for reading glasses as well as distance glasses after cataract surgery.
Major Age-Related Eye Diseases
Macular degeneration. Macular degeneration (also called age-related macular degeneration or AMD) is the leading cause of blindness among American seniors. According to the National Eye Institute (NEI), macular degeneration affects more than 1.75 million people in the United States. The U.S. population is aging rapidly, and this number is expected to increase to almost 3 million by 2020. Currently there is no cure for AMD, but medical treatment may slow its progression or stabilize it.
Glaucoma. Your risk of developing glaucoma increases with each decade after age 40 - from around 1% in your 40s to up to 12% in your 80s. The number of Americans with glaucoma is expected to increase by 50% (to 3.6 million) by 2020. If detected early enough, glaucoma can often be controlled with medical treatment or surgery, and vision loss can be prevented.
Diabetic retinopathy. According to the NEI, approximately 10.2 million Americans over age 40 are known to have diabetes. Many experts believe that up to 30% of people who have diabetes have not yet been diagnosed. Among known diabetics over age 40, NEI estimates that 40% have some degree of diabetic retinopathy, and one of every 12 people with diabetes in this age group has advanced, vision-threatening retinopathy. Controlling the underlying diabetic condition in its early stages is the key to preventing vision loss.
How Aging Affects Other Eye Structures
While normally we think of aging as it relates to conditions such as presbyopia and cataracts, more subtle changes in our vision and eye structures also take place as we grow older. These changes include:
Because the loss of visual field increases the risk for automobile accidents, make sure you are more cautious when driving. To increase your range of vision, turn your head and look both ways when approaching intersections.Â
What You Can Do About Age-Related Vision Changes
A healthy diet and wise lifestyle choices - including exercising regularly, maintaining a healthy weight, reducing stress and not smoking - are your best natural defenses against vision loss as you age. Also, have regular eye exams with a caring and knowledgeable optometrist or ophthalmologist.
Be sure to talk to your eye doctor about any concerns you have about your eyes and vision. Tell them about any history of eye problems in your family and any health problems you may have. Also, let your eye doctor know about any medications you take, including non-prescription vitamins, herbs and supplements.
Sight-threatening eye problems affect one in six adults aged 45 and older. And the risk for vision loss increases with age. In fact, a recent American Academy of Ophthalmology (AAO) report estimates that more than 43 million Americans will develop age-related eye diseases by 2020.
Tips for Protecting Your Eyes
To protect your eyesight and keep your eyes healthy as you age, consider these simple guidelines:
Following these steps is no guarantee of perfect vision throughout your lifetime. But maintaining a healthy lifestyle and having regular eye exams will certainly decrease your risk of sight-stealing eye problems and help you enjoy your precious gift of eyesight to the fullest.
An occupational lens is a type of multifocal that is specifically suited for performing a particular job or hobby. Glasses with these lenses are special-purpose eyewear and are not designed for everyday wear. By strategically placing t he near, intermediate and far vision zones on certain areas of the lens, specific visual tasks are made easier.
The Double-D Bifocal: For Reading and Overhead Near Work
The Double-D is an occupational bifocal that consists of a D-shaped flat-top bifocal at the bottom of the lens and an upside-down flat-top near segment located at the top of the lens. The rest of the lens area consists of distance correction.
People in occupations such as auto maintenance and repair can benefit from a Double-D occupational bifocal. This design allows workers to be able to see well up-close, both when looking down and when looking up to work on the undercarriage of a car on a lift. Mail clerks and others who read documents and may need to file them overhead might also find this lens useful at work.
The E-D Trifocal: For When You Need to See Everywhere, but Especially at Arm's Length
The E-D trifocal has the distance correction in the top half of the lens and an intermediate correction for vision at arm's length in the bottom half of the lens. The line separating these two zones extends across the entire width of the lens, like an Executive bifocal. But in the E-D trifocal, a small D-shaped segment for near vision is embedded within the intermediate zone.
The E-D trifocal is an excellent choice for someone who needs a wide field of view at arm's length, but also needs to see clearly close up and in the distance. A television production person, who must keep an eye on several TV monitors while being able to read notes from a clipboard and recognize someone across the room, would be a good candidate for this lens.
Need to Read All Day at Work?
Sometimes, a common multifocal can become an occupational lens simply by changing the position of the intermediate or near segment or the characteristics of the progressive design.
For example, if your job requires you to read most of the day, you may want to consider a separate pair of glasses for work that have the bifocal or trifocal segments placed higher than normal in the lens. This would enable you to read or use your computer for extended periods without having to tip your head back in an uncomfortable posture.
Or you may want to try an "office" progressive lens, which has a larger, wider intermediate zone for computer use and a smaller zone for distance vision. These occupational lenses give you more usable vision for your computer and desk work, yet still provide adequate distance vision for spotting people across the room. However, because the distance zone of occupational progressive lenses is limited, they're not suitable for driving or for other tasks that require a wide field of view in the distance.
What About on the Golf Course?
If you're a golfer and wear multifocal lenses, you know these lenses can be a problem on the course. The near vision zones of bifocal, trifocal and progressive lenses can interfere with your view of the ball, requiring you to tilt your head down in an uncomfortable posture. Everyday multifocals can also make lining up a putt much more difficult.
The solution? Consider trying an occupational multifocal commonly called a "golfer's bifocal." The small (usually round) near segment is placed very low and in the outside corner of just one lens, so it's completely out of the way when you address your ball or line up a putt. But it still gives you enough near vision to read your scorecard or browse a menu for lunch in the clubhouse.
Customized Eyewear Solutions
Nearly all adults - especially anyone over age 40 who needs multifocal lenses - can benefit from having more than one pair of eyeglasses, with the second pair having an occupational design.
Progressive addition lenses (also called progressives or PALs) are the most popular multifocal lenses sold in the United States. Sometimes called "no-line bifocals," these line-free multifocals provide a more complete vision solution than bifocals. Instead of having just two lens powers like a bifocal - one for distance vision and one for up close - progressives have a gradual change in power from the top to the bottom of the lens, providing a range of powers for clear vision far away, up close and everywhere in between.
Progressive lenses provide the closest thing to natural vision after the onset of presbyopia - the normal age-related loss of near vision that occurs after age 40. The gradual change of power in progressives allows you to look up to see in the distance, look straight ahead to clearly see your computer or other objects at arm's length, and drop your gaze downward to read and do fine work comfortably close up.
While progressive lenses typically are worn by middle-aged and older adults, a recent study suggests that they may also be able to slow progression of myopia in children whose parents also are nearsighted.
Choosing the Right Frame for Progressive Lenses
Because a progressive lens changes in power from top to bottom, these lenses require frames that have a vertical dimension that is tall enough for all powers to be included in the finished eyewear. If the frame is too small, the distance or near zone of the progressive lens may end up too small for comfortable viewing when the lens is cut to fit into the frame.
To solve this problem and to expand options in frame styles, most progressive lens manufacturers now offer "short corridor" lens designs that fit in smaller frames. Today, an experienced optician can usually find a progressive lens that will work well in nearly any frame you choose.
Different Progressives for Different Purposes
Many different progressive lenses are available on the market today, and each has its own unique design characteristics. There are even progressive lenses designed for specific activities. For example, for the computer user, special "occupational" progressive lenses are available with an extra-wide intermediate zone to maximize comfort when working at the computer for prolonged periods of time. Other designs for office work have a larger reading portion.
It may take a few minutes to a few days before you are completely comfortable with your first pair of progressive lenses, or when you change from one progressive lens design to another. You have to learn how to use the lenses so that you are always looking through the best part of the lens for the distance you are viewing. While you get used to the lenses, you may notice a slight sensation of movement when you quickly move your eyes or your head. But for most wearers, progressive lenses are comfortable right from the start.
Once we reach our mid-40s, presbyopia - the normal, age-related loss of flexibility of the lens inside our eye - makes it difficult for us to focus on near objects.
In the past, reading glasses were the only option available to contact lens wearers who wanted to read a menu or do other everyday tasks that require good near vision.
Today, a number of multifocal contact lens options are available for you to consider. Multifocal contact lenses offer the best of both worlds: no glasses, along with good near and distance vision.
Types of Multifocal Contact Lenses
Some multifocal contact lenses have a bifocal design with two distinct lens powers - one for your distance vision and one for near. Others have a multifocal design somewhat like progressive eyeglass lenses, with a gradual change in lens power for a natural visual transition from distance to close-up.
Multifocal contacts are available in both soft and rigid gas permeable (RGP or GP) lens materials and are designed for daily wear or extended (overnight) wear. Soft multifocal lenses can be worn comfortably on a part-time basis, so they're great for weekends and other occasions if you prefer not to wear them on an all-day, every day schedule.
For the ultimate in convenience, one-day disposable soft multifocal lenses allow you to discard the lenses at the end of a single day of wear, so there's no hassle with lens care.
In some cases, GP multifocal contact lenses provide sharper vision than soft multifocals. But because of their rigid nature, GP multifocal contacts require some adaptation and are more comfortable if you condition your eyes by wearing the lenses every day.
Hybrid multifocal contacts are an exciting new alternative. These lenses have a GP center and a soft periphery, making it easier to adapt.
Astigmatism? No Problem
All types of multifocal contact lenses - GP, soft, and hybrid - are available to correct astigmatism at the same time as presbyopia.
Until you have a contact lens fitting, there's no way to know for sure if you'll be able to adapt successfully to wearing multifocal contact lenses. If multifocal lenses aren't comfortable or don't give you adequate vision, a monovision contact lens fitting may be a good alternative.
Monovision uses your dominant eye for distance vision and the non-dominant eye for near vision. Right-handed people tend to be right-eye dominant, and left-handed folks left-eye dominant. But your eyecare professional will perform testing to make that determination.
Usually, single vision contact lenses are used for monovision. One advantage here is that single vision lenses are less costly to replace, lowering your annual contact lens expenses. But in some cases, better results can be achieved using a single vision lens on the dominant eye for distance vision and a multifocal lens on the other eye for intermediate and near vision. Other times, your eyecare professional may choose a distance-biased multifocal on your dominant eye and a near-biased multifocal on the other eye. These techniques are referred to as "modified monovision" fits.