Eye Exams

Why Do You Need an Annual Comprehensive Eye Exam?

One of the most common misconceptions is that if you are not experiencing noticeable vision issues, an eye exam by an eyecare professional is unnecessary, or even a waste of time and money. Scheduling an eye exam is the most important thing you can do for your vision. Comprehensive eye exams actually go beyond determining your prescription for eyeglasses or contacts. Eye doctors are often the first healthcare professionals to detect systemic conditions, such as high cholesterol, high blood pressure (hypertension), diabetes, lupus, risk of stroke and even some cancers.

In fact, the eyes are the only organ that can be viewed from the outside of the body. 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 reading an eye chart) to complex tests (such as using a high-powered lens) to examine the health of the tissues inside of your eyes.

During a comprehensive eye exam, your eye doctor determines your prescription for eyeglasses or contact lenses, checks your eyes for common eye diseases, assesses how your eyes work together as a team, and evaluates your eyes as an indicator of your overall health. Remember that only an eye doctor can provide prescription eyewear and medications.

Who Should Get an Eye Exam?

The short answer is...everyone. Regardless of your age or physical health, an annual comprehensive eye exam helps detect any eye problems at their early stages when they are most treatable. In fact, the American Optometric Association recommends a first comprehensive eye exam at age 6-12 months.

Annual eye exams for children can be particularly important. Many times, children do not complain of vision problems simply because they do not know what "normal" vision looks like. This can lead to vision ailments going undetected for longer than necessary. While school vision screenings are valuable, they can still miss hyperopia (far-sightedness) and binocular vision (eyes not teaming together), both of which make it difficult to read up close or at mid-range.

Undetected, vision issues can undermine school performance, self-esteem, and lead to low motivation or misdiagnosis of a learning disability. If your child performs poorly at school or exhibits a reading or learning problem, be sure to schedule an eye examination to rule out an underlying visual cause.

Even after childhood, annual comprehensive eye exams should be a part of everyone's routine. Adolescents through seniors require regular monitoring of their vision. Not only does an exam help identify issues early, but it helps you protect your vision and your overall health for the future.

What are the different eye tests and what do they look for?

Retinoscopy: The retinoscopy test helps your eye 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 are then 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. Concurrently, your doctor flips different lenses on the phoropter in front of your eyes.

Based on the way the light reflects from your eye during this procedure, your doctor can get an idea of what is appropriate for your eyeglasses prescription. 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.

Refraction: The refraction test determines your exact eyeglasses prescription. During a refraction test, the doctor puts the phoropter in front of your eyes and shows you a series of lens choices. He or she then asks you which of the two lenses in each choice (“1 or 2,” “A or B,” for example) make the letters on the wall chart look clearer.

Based on your answers, your doctor determines your range of nearsightedness, farsightedness, and/or astigmatism, and concludes the type of eyeglass lenses required to correct the vision problem (which are called refractive errors).

Autorefractors and Aberrometers: Your eye doctor may use an autorefractor or aberrometer to help determine your glasses prescription. With both devices, a chin rest stabilizes your head while you look at a pinpoint of light or other image.

An autorefractor evaluates the way an image is focused on the retina, where vision processing takes place. This makes autorefractors especially useful when examining young children or people who may have difficulty with a regular (“subjective”) refraction, which requires the patient’s interaction. Automated refractions and subjective refractions are often used together during a comprehensive exam to determine the correct eyeglasses prescription.

An aberrometer uses advanced wavefront technology to detect even obscure vision errors based on the way light travels through your eye.

Cover test: 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 has you focus on a small object at distance and then covers each of your eyes alternately while you stare at the target. The eye doctor observes 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.”

Slit-lamp examination: The slit lamp (biomicroscope) is an instrument that the eye doctor uses to examine the health of your eyes. In order to thoroughly evaluate your eyes for signs of infection or disease, the slit lamp gives your doctor a highly magnified view of the structures of the eye, including the lens behind the pupil. The slit lamp is basically an illuminated binocular microscope that is mounted on a table and includes a chin rest and head band to position the patient’s head properly. With the help of hand-held lenses, your doctor can also use the slit lamp to examine the 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 the eye. Elevated internal eye pressure can cause glaucoma, or vision loss, due to damage to the sensitive optic nerve in the back of the eye. 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.

The most 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 is 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 and creates a slightly heavy feeling when the drops start working. This is not a dilating drop — it is simply a numbing agent combined with a yellow dye. Then, as you stare straight ahead in the slit lamp, the doctor 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.

Pupil dilation: Your comprehensive exam may include the use of dilating drops, which enlarge your pupils 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 become sensitive to light, because more light is being received by your eyes. 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.

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.

What is the Eye Doctor Checking For?

In addition to evaluating whether you have nearsightedness, farsightedness, or astigmatism, your eye doctor checks your eyes for eye diseases and other problems that could lead to vision loss. Here are some examples of the conditions that your eye doctor looks for:

  • Amblyopia: This occurs when the eyes are misaligned or when one eye has a much different prescription than the other. The brain "shuts off" the image from the turned or blurry eye. If left untreated, amblyopia can stunt the visual development of the affected eye, resulting in permanent vision impairment. Amblyopia is often treated by patching the stronger eye for periods of time.
    Strabismus: Strabismus is defined as crossed or turned eyes. Strabismus causes problems with depth perception and can lead to amblyopia.
    Eye Diseases: Many eye diseases, such as glaucoma and diabetic eye disease, have no obvious symptoms during the early stages. In most cases, early detection and treatment of eye diseases can help reduce your risk for permanent vision loss.

Your eye doctor can detect early signs of other systemic conditions and diseases by looking at your eye's blood vessels, retina, etc. They may be able to tell you if you are developing high blood pressure, high cholesterol or other problems.

For example, diabetes can cause small blood vessel leaks or bleeding in the eye, as well as swelling of the macula (the most sensitive part of the retina), which can lead to vision loss. It is estimated that one-third of Americans who have diabetes do not know it. Your eye doctor may detect the disease before your primary care physician does, especially if you are overdue for a physical.

What are Vision Screenings?

Vision screenings can be an important first step to vision health, but they cannot take the place of a comprehensive eye exam with an optometrist or ophthalmologist. Vision screenings are usually performed by a pediatrician, nurse, physician’s aide, or a school nurse. They can help identify people with specific types of vision problems but are not as thorough as the comprehensive eye exams.

An example of a vision screening is when, during a child’s routine physical, their doctor has him or her cover on eye and read an eye chart in the distance, usually 20 feet away. Another example of a vision screening is the eye test you take when you get your driver’s license renewed.

In some cases, screenings can include tests for muscle coordination, blur and/or common eye diseases, but screenings can miss important vision issues that require treatment. It is important to understand that only an optometrist or ophthalmologist is trained and licensed to perform a comprehensive eye exam.