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Comprehensive Eye Exam in Cape Coral, FL
What is an Eye Exam or Comprehensive Eye Exam?
A comprehensive eye exam is also known as a dilated eye exam or complete eye exam. A normal comprehensive eye exam is a thorough examination of the eye including dilation of the pupil. Ophthalmologists and optometrists examine the eye using a variety of equipment, tests, and other methods of examining the eye. This type of eye exam will take around 1 hour or more.
Questionnaire and Paperwork
You will be asked to fill out a health questionnaire, insurance information, and be asked to sign a variety of documents required by the government. The health questionnaire give the staff a good starting point to begin the eye exam.
Chief Complaint or Current Eye Problem
The staff will begin with asking you to describe the eye problem you are having or the reason for your visit. A thorough history of the eye complaint is very important in helping determine the direction of the eye exam and any additional tests that might be needed.
Past Eye History
The past history of any eye diseases, surgeries, or injuries is obtained.
Past Medical History
Documentation of any medical conditions, diseases, surgeries, and hospitalizations will be placed into the record. Many medical conditions or diseases have a connection or relationship to the eye or eye diseases
Current Medications
It is important for the eye doctor to know all the current medications that you are taking. Many medications have ocular side-effects and the doctors needs to know what medications you are taking. If you are on many medications, bring a list of your medications with you.
Review of Systems
The staff will ask you if you are presently having any problems or symptoms of the different organ systems or other anatomical portions of the body.
Social History
A social history is taken as well asking about things such as smoking and alcohol consumption.
Family History
A family history of any medical conditions is taken as many diseases have a genetic component. Especially things such as glaucoma, macular degeneration, and diabetes.
Examination Portion of the Eye Exam
Visual Acuity
The vision is tested usually with a chart that is shown on the wall. The chart is usually 20 feet away. It is sometimes shown with a mirror to accomplish the 20 feet. A near card may be used to test the near vision. There are now computers or smart TV that used for testing the vision. Another way of testing vision is to look through an object with tiny holes in it which is called pin hole. Glare testing is used for people that are developing cataracts to see how much their vision is effected by glare at night. Contrast sensitivity is used in some cases to further test the quality of a person’s vision. Color vision may be tested as well in some circumstances when there is a question about the health of the eye or concern about colored blindness.
Pupils
The pupils are tested to see their reaction to light as this can give an indication of the health of the eye and vision system. The pupils also constrict in accommodation or when you look at near.
Ocular Motility or Eye Movements
The alignment of the eyes is evaluated to see if there is any deviation such as crossed eyes. The eye movements are evaluated by following a light or object. A notation is made if there is any limitation in the movement of the eyes. The quality of the eye movements is also evaluated. Stereopsis or depth perception may be tested if there is any concerned about depth perception.
Field of Vision
The extent of the side vision is evaluated by a method called confrontation fields. The examiner is seated in front of the patient with the patient covering one eye. The examiner holds out fingers in the four quadrants of the visual field and asks the patient to tell them how many fingers do they see? This is good way of finding out if someone has limited side vision. If something is found or suspected, a formal visual field examination is performed with a computerized machine that is able to find very small changes in the side vision.
Refraction
A refraction determines the extent of any hyperopia (farsightedness), myopia (nearsightedness), and/or astigmatism (the eye is shaped more like a football than a basketball). Prior to beginning the refraction, the staff may test your eyes with a computerized autorefractor instrument or a wavefront analyzer (aberrometer). These instruments can help with determining the best possible glass prescription.
You are situated behind a machine called a phoropter which contains all the possible combinations of eye glass prescriptions. You are given a choice between two different lenses and asked which lens do you see better with? The glass prescription is fined tuned based on your answers to which lens is best. This prescription provides more information than just an eyeglass prescription but also gives the eye doctor information about the quality of your vision and the health of your eyes. All clinical decisions about the health of your eye is based on your best correctable vision. If your best correctable vision is not 20/20 or it has changed from the previous visit, the eye doctors needs to find the reason for the level of your vision. They may need to do a variety of others tests to determine the cause of the vision loss.
Most insurances do not cover the cost of the refraction and it is a separate fee. It should be covered as part of an eye exam as it provides important medical information about the health of the eye. But, Medicare and most insurances have chosen not to cover the cost.
Slit Lamp Exam and External Eye Exam
The ocular adnexa or structures around the eyes are examined for any abnormalities.
A slit lamp binocular microscope is used to examine the structures of the eye under high magnification. You place your chin on a chin rest and your forehead up against a band attached to the microscope. The microscope is used to examine the eyelids, conjunctiva, cornea, iris, lens, and once the eye is dilated can be used to examine the retina and optic nerve.
Eye Pressure, Intraocular Pressure, or Glaucoma Test
The eye pressure can be measured with a variety of different instruments.
Non-Contact Tonometer
A non-contact tonometer or air-puff test can measure the eye pressure by using a small burst of air against the cornea. The instrument measures the resistance of the cornea to air applied against the eye. It is painless and does not touch the eye.
Applanation Tonometer
The Goldmann Applanation Tonometer is considered the gold standard for accurately measuring the eye pressure. It is attached to the slit lamp. A numbing drop is placed in the eye which contains a fluorescein dye to allow the eye doctor to measure the eye pressure. The tonometer gently presses against the cornea to measure the eye pressure. It is painless as the eye is numb.
Other instruments are the Icare tonometer, Diaton Transpalpebral tonometer, Perkins tonometer, and Pascal tonometer. Measuring the eye pressure is one of the most important parts of an eye exam. Glaucoma does not give any symptoms until a significant loss of side vision has occurred.
Dilated Fundus Exam of the Retina and Optic Nerve
For the eye doctor to see the entire retina, the pupil needs to be dilated. The pupil is dilated with eye drops that are instilled onto the eye. It takes about 20 minutes or more for the drops to dilate the eyes. It depends on the types of eye drops that are used and darker brown eyes take longer than blue eyes. Once you are dilated, the eye doctor will use a variety of different lenses to look inside the eye to examine the retina and optic nerve for any sign of disease.
How Often Should I have My Eyes Examined?
There are no absolute guidelines on how often to have your eyes examined. You should consider having your child’s eyes examined by age 4 before they start school. If you have a family history of any eye diseases such as glaucoma, job that exposes you to possible hazards to your eyes, take prescription medications that have ocular side-effects, you have diabetes, ocular complaints, or other eye disease, you need to follow the recommendations of an eye doctor. For routine eye exams, you should consider the following.
Age 20 to 60
You should have a routine eye exam every 3 to 5 years.
Age 60 and above
You should have a routine eye exam every 1 to 2 years.
Above age 60, the incidence of many eye diseases such as glaucoma, cataracts, and macular degeneration increases. Many of the diseases do not give symptoms until tremendous damage has occurred.
Overview
The eye doctor will go over any findings that they discover during the exam and give recommendations about any diseases or abnormalities found. They will prescribe medications, order any necessary tests, and a return office visit as appropriate.
You will receive a prescription for glasses. If you are going to get a progressive or no-line bifocal it is extremely important that you get the right brand and fit. There are significant differences between brands of progressive glasses. How well or clear the blending from distance to near progresses and the width of the reading area in the lenses can be dramatically different between brands. In my office 95% of the people that return because they are having trouble with their glasses is from people who have purchased them from some other optical shop than my optical shop in the office. The prescription is correct but they are unhappy with the quality of their vision. If you are going to spend money on glasses that you will be wearing for several years in many cases, you should get a quality pair of glasses.
JAMES E. CROLEY III, M.D.
Dr. James E. Croley III is a board-certified ophthalmologist and the founder of the Cataract & Refractive Institute of Florida. He graduated magna cum laude from Cumberland College before attending medical school at the University of Miami and completing his residency at the University of Alabama Eye Foundation Hospital. Additionally, he studied at Stanford University where he gained further education in advanced ophthalmology techniques. Dr. Croley is a member of the American Academy of Ophthalmology and the Florida Society of Ophthalmology.