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In order to maintain healthy eyes it is essential to have eye examinations. In the process of assessing the condition of your eyes the doctor utilizes a wide variety of tests and procedures. These tests can range from simple evaluations, such as reading a wall eye chart, to complex process like the use of high-powered lens to visualize the structures inside your eyes. The depth and range of the exam varies to the type of exam and the personal need of the individual.
Below are some examples of eye exams and procedures available to evaluate the status and health your family’s eyes.
Visual Acuity Test
This exam measures the sharpness of your vision. Usually are performed using a projected eye chart to measure the distance visual acuity and a small, hand-held acuity chart to measure the patient's near vision.
Color Blindness Test
This type of screening test checks your color vision often is performed early in a comprehensive eye exam to rule out color blindness. In addition to detecting hereditary color vision deficiencies, color blind tests also can alert your eye doctor to possible eye health problems that may affect your color vision.
One of the simplest and most common ways the eye doctor has to check how the eyes work together is the cover test. It is used to check how well the eyes work together to focus on an object, eye alignment. To perform this test the eye doctor will have ask to focus on a small object across the room then proceed to cover each of the eyes alternately while maintaining a focus on the target.
In the process, the eye doctor will evaluate whether the uncovered eye must move to pick up the fixation target, an indicator of strabismus or more subtle binocular vision problem that could cause eye strain or amblyopia ("lazy eye"). The test is then repeated up close.
Diabetes Eye Exam
The doctor will check the patient’s vision using a chart of random letters of different sizes. This is called the Snellen chart.
The patient will then be given eye drops so that the doctor can better see the back of the eye. Patient may feel stinging when the drops are first placed. There also may be a metallic taste in the mouth.
To see the back of the eye, the doctor looks through a special magnifying glass using a bright light. The doctor can then see areas that may be damaged by diabetes:
Blood vessels in the front or middle parts of the eye. The back of the eye. The optic nerve area
Another device called a slit lamp is used to see the clear surface of the eye (cornea).
The exam is to obtain an approximation of your eyeglass prescription. In retinoscopy, the room lights will be dimmed and the patient will be given a large target (usually the big "E" on the chart) to fixate on. As the patient stares at the "E," the eye doctor will shine a light at the eye and flip lenses in a machine in front of your eyes. According to the way the light reflects from the eye, the doctor is able to "ballpark" the prescription — often very accurately!
This test is especially useful for children and patients who are unable to accurately answer the doctor's questions.
This is the test that the eye doctor uses to determine the exact eyeglass prescription. During refraction, the doctor puts the instrument called a phoropter in front of the patient’s eyes and shows him/her a series of lens choices. The doctor will then ask which of the two lenses in each choice looks clearer. Based on the answers, the eye doctor will continue to fine-tune the lens power until reaching a final eyeglass prescription. The refraction determines the level of hyperopia (farsightedness), myopia (nearsightedness), astigmatism and presbyopia.
Autorefractors & Aberrometers
The eye doctor also may use an autorefractor or aberrometer to automatically determine the prescription. With both devices, a chin rest stabilizes the patient’s head while he/she typically look at a pinpoint of light or other image.
An autorefractor, like a manual refraction, determines the lens power required to accurately focus light on the retina. Autorefractors are especially useful in certain cases such as evaluating young children who may not sit still, pay attention or interact with the eye doctor adequately for an accurate manual refraction.
Technological development has significantly improved the accuracy of autoractors. Studies also support and have shown that modern autorefractors are very accurate. They also save time. The autorefraction takes only a few seconds, and the results obtained from the automated test greatly reduce the time required for your eye doctor to perform a manual refraction and determine the eyeglass prescription.
An aberrometer uses advanced wavefront technology to detect even obscure vision errors based on the way light travels through your eye. Aberrometers primarily are used for custom or wavefront LASIK vision correction procedures, but many eye doctors are now incorporating this advanced technology into their routine eye exams as well.
The slit lamp is an instrument that the eye doctor uses to examine the health of the eyes.
The slit lamp lets the eye doctor see the structures of the patient’s eyes up close.
Slit lamp exam of the front of the eye.
The slit lamp, also called a biomicroscope, allows the eye doctor to get a highly magnified view of the structures of the patient’s eye to thoroughly evaluate the eye health and detect any signs of infection or disease.
During this test, the doctor will have the patient place the chin on the chin rest of the slit lamp and will then shine the lamp's light at the eye. The doctor looks through a set of oculars (much like a microscope in a science lab) and examines each part of the eye in turn.
The doctor will first examine the structures of the front of the eye (lids, cornea, conjunctiva, iris, etc.). Then, with the help of a special high-powered lens, the doctor will view the inside of the eye (retina, optic nerve, macula and more).
A wide range of eye conditions and diseases can be detected with slit-lamp examination, including cataracts, macular degeneration, corneal ulcers, diabetic retinopathy, etc.
There are several variations to the Glaucoma; all designed to measure the pressure inside the eyes.
A common glaucoma test is the "puff-of-air" test, technically known as non-contact tonometry, or NCT.
For NCT, the test begins by putting the patient’s chin on the machine's chin rest. While he/she look at a light inside the machine, the doctor or a trained assistant will puff a small burst of air at the open eye. It is completely painless, and the tonometer does not touch the eye. Based on the eye's resistance to the puff of air, the machine calculates the intraocular pressure (IOP). Patient’s that have high eye pressure may be at risk for or have glaucoma.
Another type of glaucoma test is performed with an instrument called an applanation tonometer. The most common of several versions of this instrument is mounted on the slit lamp.
For this test, the eye doctor will put yellow eye drops in the patient’s eye to numb it. The eyes will feel slightly heavy when the drops start working. This is not a dilating drop — it is a numbing agent combined with a yellow dye that glows under a blue light. Then the doctor will have you stare straight ahead into the slit lamp while he/she gently touches the surface of the patient’s eye with the tonometer to measure your IOP.
Like NCT, applanation tonometry is painless. At most, the patient may feel the tonometer probe tickle the eyelashes. The whole test takes just a few seconds.
Typically Glaucoma has no warning signs until there is already significant vision loss. For this reason, routine eye exams that include tonometry are essential to rule out early signs of glaucoma and protect eyesight.
To obtain a better view of the eye's internal structures, the eye doctor instills dilating drops to enlarge the pupils. Dilating drops usually take about 20 to 30 minutes to start working. When the pupils are dilated, they will be sensitive to light (because more light is getting into your eye) and it may cause difficulty focusing on objects up close. These effects can last for up to several hours, depending on the strength of the drop used.
Once the drops have taken effect, the eye doctor will use various instruments to look inside the eyes. It is recommended that the patient bring sunglasses to the eye exam, to minimize glare and light sensitivity post testing.
Pupil dilation is very important for people with risk factors for eye disease, because it allows for the most thorough evaluation of the health of the inside of the eyes.
Visual Field Tests
In some cases, the eye doctor may want to check for the possible presence of blind spots (scotomas) in the peripheral or "side" vision by performing a visual field test. These types of blind spots can originate from eye diseases such as glaucoma.
Analysis of blind spots also may help identify specific areas of brain damage caused by a stroke or tumor.
Other Eye Tests
In some cases, besides these common tests performed during a standard comprehensive eye exam, your eye doctor may recommend other, more specialized eye tests. Often, such tests are performed by other eye doctors, such as retinal specialists, on a referral basis.
About Contact Lens Fittings
It's important to understand that a comprehensive eye exam typically does not include a contact lens fitting, and therefore the patient will not be given a contact lens prescription at the end of a routine eye exam.
There is a possible exception: If the patient wear contacts currently and the lenses were fitted by the same eye doctor who is performing the comprehensive eye exam, he or she may issue an updated contact lens prescription at the end of the eye exam.
A contact lens exam that includes fitting services typically is done during a subsequent office visit, when the pupils are not dilated. The contact lens exam may be performed by the same eye doctor who performed the comprehensive eye exam, or it may be done by a different eye care practitioner (ECP).
Generally, it's better to have the eye exam and the contact lens exam performed at the same practice. Sometimes, if you have these exams performed at different locations, the ECP conducting the contact lens fitting will want to repeat certain tests already performed in a comprehensive eye exam. In part, this is done for liability reasons — to verify the accuracy of the eyeglasses prescription and make sure the eyes are healthy enough to wear contacts. This duplication of effort often will result in additional costs that you would not experience if your eye exam and contact lens exam are performed at the same location.