Comprehensive Eye Exams

Light waves are bent as they pass through your cornea and lens. If light rays do not focus perfectly on the back of your eye, you have a refractive error. Having a refractive error may mean you need some form of correction, such as prescription glasses, contact lenses or refractive surgery, to see as clearly as possible.

During a refraction assessment, your doctor asks you to look through a masklike device (phoropter) that contains wheels with different lenses having different visual strengths.

Assessment of your refractive error helps your doctor determine a lens prescription that will give you the sharpest, most comfortable vision.

Your doctor may use a computerized refractor to estimate your prescription for glasses or contact lenses. Or he or she may use a technique called retinoscopy. In this procedure, the doctor shines a light into your eye and measures the refractive error by evaluating the movement of the light reflected by your retina back through your pupil.

Your eye doctor usually fine-tunes this refraction assessment by having you look through a masklike device that contains wheels of different lenses (phoropter). He or she asks you to judge which combination of lenses gives you the sharpest vision.

Other forms of testing are useful for the following:

• Auto-Refraction (refractive error estimate)
• Auto-Keratometry (cornea curvature)
• Non-Contact Tonometry (glaucoma)
• Pachymetry (cornea thickness)
• Digital Retina Scan
• Tear Osmolarity Testing with TearLab for at risk patients

These tests are done by advanced imaging and scanning technologies and techniques. More about these tests can be found below under Advanced Eye Examinations. 

Your doctor will ask questions about your personal and family medical/visual history. This may reveal specific eye tests the patient should undergo.

They will also review 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).

Visual acuity (VA) measures the ability of the eye to distinguish shapes and the details of objects at a given distance (20 feet) using a chart similar to the one you see on your right hand side. It is important to assess VA annually in order to detect any changes in vision. One eye is tested at a time. Your near vision may also be tested using a card with letters similar to the distant eye chart. The card is held at reading distance.

The visual field test is a subjective measure of central and peripheral vision, or “side vision,” and is used by your doctor to diagnose, determine the severity of, and monitor your eye conditions such as glaucoma. The most common visual field test uses a light spot that is repeatedly presented in different areas of your peripheral vision.

Different types of Visual Field Tests include:

• Confrontation exam.Your eye doctor sits directly in front of you and asks you to cover one eye. You look straight ahead and tell the doctor each time you see his or her hand move into view.
• Manual testing, including tangent screen and Goldmann exams.You sit a short distance from a screen and focus on a target at its center. You tell the doctor when you can see an object move into your peripheral vision and when it disappears.
• Automated perimetry. As you look at a screen with blinking lights on it, you press a button each time you see a blink.

Using your responses to one or more of these tests, your eye doctor determines the fullness of your field of vision. If you aren’t able to see in certain areas, identifying the pattern of your visual field loss may help your eye doctor diagnose your eye condition.

Binocular vision assessment (ability to see using both eyes together), as it relates to eye coordination, depth perception, and eye movements, or in some cases, eye-hand coordination.

• Cover test
• Near point of convergence
• Broad H test
• Stereoacuity

Usually performed on pediatric patients or any patient when medically necessary.

Sometimes, problems with color vision are due to a disease affecting your optic nerve, such as glaucoma. Poor color vision can also be the result of an inherited problem with the cones (color-sensitive photoreceptors) in your retina. The retina is the light-sensitive layer at the back of your eye.

Certain diseases can cause color vision impairment, including:

• Diabetes
• Alcoholism
• Macular degeneration
• Leukemia
• Alzheimer’s disease
• Parkinson’s disease
• Sickle cell anemia

Your color vision may improve if you receive treatment for the underlying condition.

A slit lamp is a microscope that magnifies and illuminates the front of your eye with an intense line of light. Your doctor uses this device to examine the eyelids, lashes, cornea, iris, lens and fluid chamber between your cornea and iris. It allows the doctor to microscopically examine your eyes for any abnormalities or problems.

What does this exam help diagnose?

A slit lamp exam can help diagnose the following conditions:

• Macular degeneration, a chronic condition affecting the part of the eye that is responsible for central vision
• Detached retina, a condition when the retina, which is an important layer of tissue at the back of the eye, becomes detached from its base
• Cataracts, a clouding of the lens that negatively affects the ability to see images clearly
• Injury to the cornea, an injury to one of the tissues that covers the surface of the eye
• Blockages of the retinal vessel, obstructions in the eye’s blood vessels that can cause a sudden or gradual loss of vision

What do abnormal results mean?

If the results of your slit lamp exam are abnormal, a variety of conditions may be present, including:

• infection
• inflammation
• increased pressure in the eye
• degeneration of the arteries or veins in the eye

For example, if macular degeneration is taking place, the doctor may find drusen, which are yellow deposits that can form in the macula early on in age-related macular degeneration. If your doctor suspects a particular cause of vision problems, they may recommend further testing to get a more definitive diagnosis.

A retinal examinations – sometimes called ophthalmoscopy or funduscopy –  is a test that allows your doctor to look at the back of your eye. This part of your eye is called the fundus, and consists of:

• Retina
• Optic disc
• Underlying layer of blood vessels

This test is often included in a routine eye exam to screen for eye diseases. Your eye doctor may also order it if you have a condition that affects your blood vessels, such as high blood pressure or diabetes.

When is a retinal examination used?

Your eye doctor can use ophthalmoscopy to screen for eye diseases and conditions that can affect blood vessels. These conditions include:

• damage to your optic nerve
• retinal tear or detachment
• glaucoma, which is excessive pressure in your eye
• macular degeneration, a loss of vision in the center of your visual field
• cytomegalovirus (CMV) retinitis, an infection of your retina
• melanoma, a type of skin cancer that can spread to your eye
• hypertension, which is also known as high blood pressure
• diabetes

What other techniques are used?

Usually before your doctor can see these structures, your pupils must be dilated with eye drops that keep the pupil from getting smaller when your doctor shines light into the eye.

After administering eye drops and giving them time to work, your eye doctor may use one or more of these techniques to view the back of your eye:

• Direct exam.Your eye doctor uses an ophthalmoscope to shine a beam of light through your pupil to see the back of the eye. Sometimes eye drops aren’t necessary to dilate your eyes before this exam.
• Indirect exam.During this exam, you might lie down, recline in a chair or sit up. Your eye doctor examines the inside of the eye with the aid of a condensing lens and a bright light mounted on his or her forehead. This exam lets your doctor see the retina and other structures inside your eye in great detail and in three dimensions.
• Slit-lamp examination. This procedure gives your eye doctor the same view of your eye as an indirect examination, but with greater magnification.

You’ll sit with an instrument in front of you, known as a slit-lamp. It will have a place for you to rest your chin and forehead. This will help keep your head steady during your exam.

Once you’re positioned, your eye doctor will turn on a bright light in front of your eye. Then they will use a microscope to look at the back of your eye. They may ask you to look in different directions and use their finger to open your eye to get a better view. They may also apply some pressure to your eye using a small, blunt probe.

• internal examination of ocular structures, i.e. retina, optic nerve, vitreous, etc.
• patient pupils are fully dilated (using drops) to allow greater viewing area.
• performed when medically necessary for at-risk patients

• discuss examination results with and provide a strategic plan of action with a medical recommendation
• Q & A

• eyeglasses and contact lens purchase

Corneal topography is a computer assisted diagnostic tool that creates a three-dimensional map of the surface curvature of the cornea. The cornea (the front window of the eye) is responsible for about 70 percent of the eye’s focusing power.

An eye with normal vision has an evenly rounded cornea, but if the cornea is too flat, too steep, or unevenly curved, less than perfect vision results. The greatest advantage of corneal topography is its ability to detect irregular conditions invisible to most conventional testing.

This test can show problems with your eye’s surface, like swelling or scarring, or conditions such as astigmatism. You may have this test done before refractive surgery such as LASIK, a cornea transplant, or a contact lens fitting.

More about Corneal Mapping:

Corneal topography produces a detailed, visual description of the shape and power of the cornea. This type of analysis provides your doctor with very fine details regarding the condition of the corneal surface. These details are used to diagnose, monitor, and treat various eye conditions. They are also used in fitting contact lenses and for planning surgery, including laser vision correction. For laser vision correction the corneal topography map is used in conjunction with other tests to determine exactly how much corneal tissue will be removed to correct vision and with what ablation pattern.

Computerized corneal topography can be beneficial in the evaluation of certain diseases and injuries of the cornea including:

• Corneal diseases
• Corneal abrasions
• Corneal deformities
• Irregular astigmatism following corneal transplants
• Postoperative cataract extraction with acquired astigmatism

The corneal topography equipment consists of a computer linked to a lighted bowl that contains a pattern of rings. During a diagnostic test, the patient sits in front of the bowl with his or her head pressed against a bar while a series of data points are generated. Computer software digitizes these data points to produce a printout of the corneal shape, using different colors to identify different elevations, much like a topographic map of the earth displays changes in the land surface. The non-contact testing is painless and brief.

We use cutting-edge digital imaging technology to assess your eyes. Many eye diseases, if detected at an early stage, can be treated successfully without total loss of vision. Your retinal Images will be stored electronically. This gives the eye doctor a permanent record of the condition and state of your retina.

This is very important in assisting your Optometrist to detect and measure any changes to your retina each time you get your eyes examined, as many eye conditions, such as glaucoma, diabetic retinopathy and macular degeneration are diagnosed by detecting changes over time.

The advantages of digital imaging include:

• Quick, safe, non-invasive and painless
• Provides detailed images of your retina and sub-surface of your eyes
• Provides instant, direct imaging of the form and structure of eye tissue
• Image resolution is extremely high quality
• Uses eye-safe near-infra-red light
• No patient prep required

Digital Retinal Imaging

Digital Retinal Imaging allows your eye doctor to evaluate the health of the back of your eye, the retina. It is critical to confirm the health of the retina, optic nerve and other retinal structures.

The digital camera snaps a high-resolution digital picture of your retina. This picture clearly shows the health of your eyes and is used as a baseline to track any changes in your eyes in future eye examinations.

We use cutting-edge digital imaging technology to assess your eyes. Many eye diseases, if detected at an early stage, can be treated successfully without total loss of vision. Your retinal Images will be stored electronically. This gives the eye doctor a permanent record of the condition and state of your retina.

This is very important in assisting your Optometrist to detect and measure any changes to your retina each time you get your eyes examined, as many eye conditions, such as glaucoma, diabetic retinopathy and macular degeneration are diagnosed by detecting changes over time.

The advantages of digital imaging include:

• Quick, safe, non-invasive and painless
• Provides detailed images of your retina and sub-surface of your eyes
• Provides instant, direct imaging of the form and structure of eye tissue
• Image resolution is extremely high quality
• Uses eye-safe near-infra-red light
• No patient prep required

Optical Coherence Tomography (OCT Scan)

An OCT Scan is the latest advancement in imaging technology. Similar to ultrasound, this diagnostic technique employs light rather than sound waves to achieve higher resolution pictures of the structural layers of the back of the eye.

A scanning laser used to analyze the layers of the retina and optic nerve for any signs of eye disease. It works using light without radiation, and is essential for early diagnosis of glaucoma, macular degeneration and diabetic retinal disease.

With an OCT scan, doctors are provided with color-coded, cross-sectional images of the retina. These detailed images have revolutionized early detection and treatment of eye conditions such as wet and dry age-related macular degeneration, glaucoma, retinal detachment and diabetic retinopathy.

An OCT scan is a non-invasive, painless test. It is performed in about 10 minutes right in our office.

Please contact our office to inquire about an OCT at your next appointment.

To diagnose glaucoma, your doctor will want to perform a comprehensive eye examination. They will check for signs of deterioration, including loss of nerve tissue.

Tonometry measures the fluid pressure inside your eye (intraocular pressure). This is one test that helps your eye doctor detect glaucoma, a disease that damages the optic nerve.

Your Optometrist may also use one or more of the following tests and procedures:

• Applanation Tonometry. This test measures the amount of force needed to temporarily flatten a part of your cornea.
• You will be given eyedrops with fluorescein, the same dye used in a regular slit-lamp examination. You will also receive eyedrops containing an anesthetic.
• Using the slit lamp, your doctor moves the tonometer to touch your cornea and determine the eye pressure. Because your eye is numbed, the test does not hurt.
• Noncontact Tonometry. This method uses a puff of air to estimate the pressure in your eye. No instruments touch your eye, so you will not need an anesthetic.
• Pachymetry Test. If your eye pressure is higher than average, or your optic nerve looks unusual, your doctor may use a pachymetry test.
• This test uses sound waves to measure the thickness of your cornea. The most common way of measuring corneal thickness is to put an anesthetic drop in your eye, then place a small probe in contact with the front surface of the eye. This measurement takes seconds.
• Visual Field Test (Perimetry Test). This test can tell your doctor if glaucoma is affecting your vision by measuring your peripheral vision, side vision and your central vision.
• Monitoring Your Optic Nerve. If your doctor wants to monitor for gradual changes to your optic nerve, they may take photographs of your optic nerve to conduct a side-by-side comparison over time.

You may need more-specialized tests, depending on your age, medical history and risk of developing eye disease.

The optomap® Retinal Exam produces an image that is as unique as your fingerprint, providing us with a health overview of your retina. The retina is the part of your eye that captures the image of what you are looking at, similar to the film in a camera!

Many eye problems can develop without you knowing. You may not even notice any change in your sight. But, diseases such as macular degeneration, glaucoma, retinal tears or detachments, and other health problems such as diabetes and high blood pressure can be seen with a thorough exam of the retina.

An optomap® Retinal Exam provides:

• A scan to show a healthy eye or detect disease.
• A view of the retina, giving your doctor a more detailed view than he/she can get by other means.
• The opportunity for you to view and discuss the optomap® image of your eye with your doctor at the time of your exam.
• A permanent record for your file, which allows us to view your images each year to look for changes.

The optomap® Retinal Exam is fast, easy, and comfortable for all ages. To have the exam, you simply look into the device one eye at a time and you will see a comfortable flash of light to let you know the image of your retina has been taken. The optomap® image is shown immediately on a computer screen so we can review it with you.

For more information on the optomap® Retinal Exam, go to the Optos website.

Normal results from an eye exam may include:

• 20/20 vision
• Good peripheral vision
• Ability to distinguish various colors
• Normal-appearing structures of the external eye
• Absence of cataract, glaucoma or retinal disorders, such as macular degeneration

Your doctor may give you a prescription for corrective lenses. If your eye exam yields other abnormal results, your doctor will discuss with you next steps for further testing or for treating an underlying condition.

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 in 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 in the recent 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.

While there are some basic eye vision tests common to most eye exams, children and young adults have different vision testing needs than 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.

• Autorefractors: are machines that automatically determine the correct lens prescription for your eyes.

• Eye Dilation means your pupil in front of the eye has been opened using special drops.

• Glaucoma Test: involves measuring internal eye pressure and a detailed scan of the retina for signs of disease.

• Ophthalmoscope: a handheld device used to examine your eye’s interior structure, including the retina.

• Optomap®: new technology that allows for detailed retina examination without dilating pupils.

• Peripheral Vision Test: tests the “outside” of your vision.

• Phoropter: an instrument used to test individual lenses on each eye during an exam.

• Puffer Test: a specific form of glaucoma testing measuring eye pressure (intraocular pressure).

• Retinoscope: a procedure using a retinoscope that helps to see if you need a prescription.

• Slit Lamp Exam: magnified analysis of your eye from front to back.

• Snellen Chart: the “Big E” chart—or Snellen eye chart—is the most familiar type of visual acuity test.

• Vision Testing: includes vision testing equipment and procedures that either measure or gauge your visual ability, or look closely at specific structures of the eye.