Comprehensive Eye Exam
A comprehensive eye exam involves a history and physical examination of the eyes which allows the doctor to properly evaluate your vision and ocular health. The exam may include diagnostic testing when necessary to provide additional, important information regarding your eyes.
This portion of the visit involves learning about your general health. We will discuss your current and past medical history, your family’s medical history and what medications you take. We will also discuss whether you have any current eye problems (such as dry eyes, blurry vision or trouble reading).
Testing Before Exam
You will look at an eye chart and be asked to read varying sizes of letters or numbers. If you wear prescription glasses or contacts we will typically ask you to read the chart with them on. Each eye is tested individually. You may be asked to read through a pinhole which can improve your vision if you have an uncorrected refractive error (meaning you may need to update your glasses prescription) or have an eye disorder that is disrupting the passage of light through the eye (such as a cataract).
After testing your vision, the doctor or technician may determine that you could benefit from a refraction (the process of acquiring a glasses prescription). An initial test called an autorefraction is usually performed to determine a fairly close estimate of your prescription. A device called a phoropter (pronounced for-op-tur) is then used to refine your prescription.
A light will be used to observe how your pupils react. This can provide information to help diagnose certain diseases such as glaucoma.
Motility / Alignment
You will be asked to follow a target in different directions to see if your eyes are moving properly. We then will cover one eye and then the other to see if the eyes are properly aligned. If any abnormality is noted, then further testing using a tool called a prism can be used to get a more precise measurement. This is helpful when evaluating patients with double vision after a stroke or trauma.
Peripheral Vision Testing
While some diseases affect our central vision, others can interfere with our peripheral vision. This test allows us to do a preliminary evaluation of your side vision to evaluate for blind spots. If there is a concern for decreased peripheral vision we may decide to perform a more formal test using a device called a Humphrey Visual Field. This test looks like a fish bowl and is useful to evaluate patients with diseases such as glaucoma or stroke.
Intraocular Pressure (IOP)
Just like you have a blood pressure, you also have an eye pressure. And just like high blood pressure can lead to diseases such as strokes or heart attacks, high eye pressure could be a sign of ocular diseases such as glaucoma. At Metro Eye Center we use two different tools to check the intraocular pressure. A numbing drop is used prior to measuring with either device.
This is a quick test that is used as a screening tool to check for elevated eye pressure. If there is any concern about your pressure with the Tono-Pen we typically use Goldmann Applanation.
This test requires the additional use of orange dye known as fluorescein. This dye may make your eyes (and your vision) a little yellow, but the effect is temporary. A blue light will be used for this test to help visualize the measuring device.
During this part of the exam we look at the general appearance and position of the eyes and eyelids. This is helpful when evaluating eye lid abnormalities such as drooping eyelids or eye lid growths.
Slit Lamp Examination
The slit lamp is a microscope that uses a thin beam or “slit” of light to provide a magnified view of the various structures in the eye. In this portion of the exam we evaluate the following:
The white part of the eye. The muscles that move the eye are attached here.
The thin, transparent layer that covers the sclera.
The clear dome on the front of the eye. Looking through the cornea we can see the internal structures of the eye.
This is the space between the cornea and the iris. It is filled with a liquid known as aqueous humor.
The colored structure of the eye has a central opening known as the pupil. The iris controls the amount of light that enters the eye by changing the size of the pupil.
The normally clear structure behind the iris that helps focus light on the retina. The lens can change shape to help us focus on either distant or near objects.
This is the gel like substance that fills the space between the lens and the very back portion of the eye.
In order to properly evaluate the retina and complete your comprehensive eye exam, you will need to have your eyes dilated. A dilated eye exam helps evaluate for diseases that affect that back portion of the eye such as diabetic eye disease, macular degeneration, retinal detachment and glaucoma. Certain eye conditions can be properly managed if treated early on, but in the beginning stages some of these diseases can affect you without causing a noticeable change in vision. This is why it is important to undergo a dilated eye exam even if you think your vision has not changed.
The fundus is the back portion of the eye. For this part of the exam we use special lenses along with the slit lamp and sometimes an indirect microscope (looks like a miner’s helmet) to adequately visualize the following structures:
This part of the eye contains cells that convert light into a signal that our brain can turn into an image. The macula is the center portion of the retina that allows us to see high resolution details of objects.
This is the portion of the optic nerve that connects to the retina. The optic nerve carries the signal created by the retina to the brain for processing.
These include the arteries that bring blood to the eye and veins that carry blood away from the eye.
If the doctor notes any abnormalities during the exam, further testing may be necessary with specialized equipment.
The clinic utilizes the following devices:
– Optical Coherence Tomography (OCT)
– Visual Field Analyzer
– Fundus Camera
– Corneal Topographer
– A-scan / B-scan
Glasses / Contacts
Why do I need glasses or contacts?
In order to see clearly the light that enters your eye needs to be properly focused on your retina (this is the part of the eye that turns light into a signal that our brain converts into an image). If the light does not focus properly on your retina, you may not see images clearly. This improper focus is what we call a refractive error. There are different types of refractive error depending on where the light ends up focusing in the eye.
Here are some examples of refractive error:
Myopia (near sightedness) occurs when light is focused in front of the retina. This can occur in patients with longer eyes (increased axial length). With myopia, objects may appear clearer up close than they do further away.
Hyperopia (far sightedness) occurs when light is focused behind the retina. This can occur in patients with shorter eyes (decreased axial length). In some cases, patients with hyperopia may see objects at a distance more clearly than up close. For others with hyperopia objects may look blurry at all distances.
Astigmatism occurs when light is not evenly focused on the retina. This can occur from a change in shape of the cornea or lens in your eye. Patients may experience blurred or distorted vision.
Some patients have minimal refractive errors and may do well without glasses. For those with more significant refractive errors, glasses or contacts may be prescribed to help patients see their best.
How do you check my glasses prescription?
A phoropter is a device that contains a number of spherical and cylindrical lenses to correct for myopia, hyperopia and astigmatism. Each eye is tested individually. The doctor will then trial various combinations of corrective lenses while asking the patient to read the letters or numbers on the acuity chart. This is the part of the exam where you are asked the familiar question “Which is better, one or two?” The final combination of lenses that provides the sharpest vision is then written down as your glasses prescription.
Why do I have to pay for my glasses or contacts prescription?
Glasses and contacts prescriptions are generally not covered by medical insurance. Alternatively, if you have vision insurance (such as VSP or EyeBenefits) your glasses and contacts prescriptions may be covered. Metro Eye Center does not accept vision insurance at this time, and therefore we charge a competitive fee for providing you with a glasses or contacts prescription.
If I am using insurance for my visit, what will I pay for a prescription for glasses or contact lenses?
A prescription for glasses is $50. The prescription can be used at our optical shop, or we can provide you a copy that you can take to any optical shop of your choosing.
A prescription for single vision, soft contact lenses is $150. This includes the cost for a spectacle prescription, a trial pack of contact lenses, and a follow up exam to check the fit of the contacts. Once we are sure that the contacts are working well for you, we will provide you a copy of the prescription so you may buy your contacts wherever you like.
Commonly Managed Eye Diseases
- Subconjunctival Hemorrhage
- Infectious Conjunctivitis (pink eye)
- Allergic Conjunctivitis
- Dry Eye Disease
- Corneal Abrasion
- Infectious Keratitis
- Primary Open Angle Glaucoma (POAG)
- Angle Closure Glaucoma
- Posterior Capsular Opacification
- Posterior Vitreous Detachment
- Diabetic Retinopathy
- Macular Degeneration