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By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/eye-exam/MY00245
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Definition
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Visual acuity test |
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Automated perimetry |
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Refraction assessment |
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Slit-lamp examination |
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Indirect ophthalmoscopy |
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Applanation tonometry |
A complete eye exam involves a series of tests designed to evaluate your vision and check for eye diseases. Your eye doctor may use a variety of instruments, aim bright lights directly at your eyes and request that you look through a wide array of lenses. Each test during an eye exam evaluates a different aspect of your vision.
Why it's done
An eye exam helps detect eye problems at their earliest stage — when they're most treatable. Regular eye exams give your eye care professional a chance to help you correct or adapt to vision changes and provide you with tips on caring for your eyes.
When to have an eye exam
Several factors may determine how frequently you need an eye exam, including your age, health and risk of developing eye problems. General guidelines include:
- Children 5 years and younger. For children under 3, your pediatrician will likely look for the most common eye problems — lazy eye, crossed eyes or turned-out eyes. Depending on your child's willingness to cooperate, his or her first more comprehensive eye exam should be done between the ages of 3 and 5.
- School-age children and adolescents. Have your child's vision checked before he or she enters first grade. If your child has no symptoms of vision problems and you don't have a family history of vision problems, have your child's vision rechecked every two years. If your child does have vision problems or a family history of vision problems, have your child's vision rechecked as advised by your eye doctor.
- Adults. In general, if you're healthy and have no symptoms of vision problems, you should have your vision checked every five to 10 years in your 20s and 30s. Between ages 40 and 65, have your vision checked every two to four years. After age 65, get your eyes checked every one to two years. If you wear glasses, have a family history of eye disease or have a chronic disease that puts you at greater risk of eye disease, such as diabetes, have your eyes checked more frequently.
How you prepare
Three kinds of eye specialists may perform an eye exam:
- Ophthalmologists. Ophthalmologists are medical doctors who provide full eye care, such as giving you a complete eye exam, prescribing corrective lenses, diagnosing and treating complex eye diseases, and performing eye surgery.
- Optometrists. Optometrists provide many of the same services as ophthalmologists, such as evaluating your vision, prescribing corrective lenses, diagnosing common eye disorders and treating selected eye diseases with drugs. But you'll likely be referred to an ophthalmologist for more complex eye problems and for conditions requiring surgery.
- Opticians. Opticians fill prescriptions for eyeglasses, including assembling, fitting and selling them. Some opticians also sell and fit contact lenses.
Which specialist you choose may be a matter of personal preference, or one specialist may be best for treating your particular eye concern.
What to expect from your doctor
If you're seeing a new eye doctor or if you're having your first eye exam, expect questions about your vision history. Your answers help your eye doctor understand your risk of eye disease and vision problems. Be prepared to give specific information, including:
- Are you having any eye problems now?
- Have you had any eye problems in the past?
- Were you born prematurely?
- Do you wear glasses or contacts now? If so, are you satisfied with them?
- What health problems have you had in recent years?
- Are you taking any medications?
- Do you have any allergies to medications, food or other substances?
- Does anyone in your family have eye problems, such as cataracts or glaucoma?
- Does anyone in your family have diabetes, high blood pressure, heart disease or any other health problems that can affect the whole body?
If you wear contact lenses or glasses, bring them to your appointment. Your eye doctor will want to make sure your prescription is the best one for you. Also be prepared to remove your contacts or glasses for certain exams. Tests that use dye (fluorescein) to temporarily color your eyes may permanently dye your contact lenses, so take them out before those types of tests.
What you can expect
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Visual acuity test |
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Automated perimetry |
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Refraction assessment |
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Slit-lamp examination |
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Indirect ophthalmoscopy |
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Applanation tonometry |
An eye exam usually involves these steps:
- First, your doctor asks about your medical history and any vision problems you might be experiencing.
- Next, your eye doctor checks your eyes using a light to ensure the exterior parts of your eyes are healthy.
- Finally, your doctor measures your visual acuity, assesses your need for corrective lenses and examines your eyes for signs of disease.
Part of the examination, such as taking your medical history and the initial eye test, may be performed by a technician who assists your doctor.
Several different tests may be performed during the eye exam. The tests are designed to check your vision and to examine the appearance and function of all parts of your eyes.
Eye muscle test
This test examines the muscles that control eye movement, looking for weakness or poor control. Your eye doctor looks at your eyes as you move them in specific directions and as you visually track a moving object, such as a pen or a light.
Visual acuity test
This test measures how clearly you can see from a distance. Your doctor will ask you to identify different letters of the alphabet printed on a chart (Snellen chart) or a screen positioned usually 20 feet away. The lines of type get smaller as you move down the chart. You cover one eye and read aloud, and then cover the other eye and read aloud.
Refraction assessment
Refraction refers to how light waves are bent as they pass through your cornea and lens. A refraction assessment helps your doctor determine a corrective lens prescription that will give you the sharpest vision. A refraction assessment may also determine that you don't need corrective lenses.
Your doctor may use a computerized refractor to measure your eyes and estimate the prescription you need to correct a refractive error. 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.
Your eye doctor usually fine-tunes this refraction assessment by having you look through a Phoroptor, a mask-like device that contains wheels of different lenses, and judge which combination gives you the sharpest vision. By repeating this step several times, your doctor finds the lenses that give you the greatest possible acuity.
Visual field test (perimetry)
Your visual field is the broad expanse of vision that you can see without moving your eyes. The visual field test determines whether you have difficulty seeing in any areas of your overall field of vision. There are a few different types of visual field tests:
- Confrontation visual field exam. Your eye doctor sits directly in front of you and asks you to cover one eye. You look directly at your eye doctor while he or she moves his or her hand in and out of your visual field. You tell your doctor when you can see his or her hand or fingers.
- Tangent screen exam. You sit a short distance from a screen and stare at a target at its center. You tell your doctor when you can see an object move into your peripheral vision.
- Automated perimetry. Your eye doctor uses a computer program that flashes small lights as you look into a special instrument. You press a button when you see the lights.
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, noting the pattern of your visual field loss may help your eye doctor diagnose your eye condition.
Color vision testing
You could have poor color vision and not even realize it. If you have difficulty distinguishing certain colors, your eye doctor may screen your vision for a color deficiency. To do this, your doctor shows you several multicolored dot-pattern tests. If you have no color deficiency, you'll be able to pick out numbers and shapes from within the dot patterns. However, if you do have a color deficiency, you'll find it difficult to see certain patterns within the dots.
Slit-lamp examination
A slit lamp is a microscope that enlarges and illuminates the front of your eye with an intense line of light. Your doctor uses this light to examine the cornea, iris, lens and anterior chamber of your eye.
When examining your cornea, your doctor may use eyedrops or strips of paper containing fluorescein (flooh-RES-ene) to color the tear film on the front of your eye. The dye spreads across your eyes to help your eye doctor detect tiny cuts, scrapes, tears, foreign objects or infections on your cornea. Your eyes' tears eventually wash the dye away.
Retinal examination
A retinal examination — sometimes called ophthalmoscopy or funduscopy — examines the back of your eye, including your retina, optic disk and the underlying layer of blood vessels that nourish the retina (choroid). Usually before your doctor can see these structures, your pupils must be dilated with special eyedrops.
After administering eyedrops, your eye doctor may use one or more of these techniques to view the back of your eye:
- Direct examination. Your eye doctor shines a beam of light through your pupil and uses an ophthalmoscope to see the back of your eye. Sometimes eyedrops aren't necessary to dilate your eyes before this exam.
- Indirect examination. For this exam you might lie down or recline in a chair. Your eye doctor will hold each eye open and examine it with a bright light mounted on his or her forehead — a bit like a miner's lamp. This exam lets your eye doctor see the inside of your eye in great detail and in three dimensions.
- Slit-lamp exam. In this exam your doctor uses the slit lamp along with an accessory condensing lens or a contact lens. The slit lamp reveals a more-detailed view of the back of your eye.
The retinal examination takes only five to 10 minutes, but if you're given eyedrops, their effects may not wear off for several hours. Your vision will likely be blurry, and you may have trouble focusing your eyes. If you're particularly sensitive to light, you may need to wear dark glasses (or sunglasses) for a short time. You may not be able to drive, so make sure you have a way back to work or home. Depending on your job, you might not be able to work until the effects of the eyedrops wear off.
Glaucoma test
A glaucoma test (tonometry) measures your intraocular pressure — the pressure inside your eyes. It helps your eye doctor detect glaucoma, a disease that causes pressure to build up inside your eyes and can lead to blindness.
Methods your eye doctor may use to test your eyes for glaucoma include:
- Applanation tonometry. This test measures the amount of force needed to temporarily flatten a part of your cornea. Fluorescein, the same dye used in a regular slit-lamp exam, is usually put in your eye to make your cornea easier to see. You'll also receive eyedrops containing an anesthetic. Using the slit lamp, your doctor moves the tonometer to touch your cornea. It doesn't hurt.
- Noncontact tonometry. This method uses a puff of air to test the pressure in your eye. No instruments will touch your eye, so you won't need an anesthetic. You'll feel a mild pressure on your eye that lasts only a moment, but can be a bit uncomfortable.
- Pachymetry. This test measures the thickness of your cornea — an important factor in evaluating your intraocular pressure measurement. After applying numbing eyedrops, your eye doctor uses an instrument that emits ultrasound waves to measure your corneal thickness.
Besides these basic evaluations, you may need more-specialized tests, depending on your age, medical history and risk of developing eye disease.
Results
At the end of your eye exam, your doctor will provide you with a detailed assessment of your vision, along with any risks you should be aware of and preventive measures you can take to protect your eyesight.
Normal results from an eye exam 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.
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- Comprehensive eye and vision examination. American Optometric Association. http://www.aoa.org/eye-exams.xml. Accessed Sept. 8, 2010.
- Comprehensive Adult Eye and Vision Examination. St. Louis, Mo.: American Optometric Association. http://www.aoa.org/documents/CPG-1.pdf. Accessed Sept. 8, 2010.
- Chang DF. Ophthalmologic examination. In: Riodan-Eva P, et al. Vaughan & Asbury's General Ophthalmology. 17th ed. New York, N.Y.: Lange Medical Books McGraw-Hill Companies, Inc.; 2008. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=19. Accessed Sept. 8, 2010.
- Comprehensive adult medical eye evaluation. San Francisco, Calif.: American Academy of Ophthalmology. http://one.aao.org/asset.axd?id=f49066eb-0297-4b65-820a-ee59e398bbd8. Accessed Sept. 8, 2010.
- What is a doctor of optometry? American Optometric Association. http://www.aoa.org/x4891.xml. Accessed Sept. 10, 2010.
- Pediatric eye and vision examination. St. Louis, Mo.: American Optometric Association. http://www.aoa.org/documents/CPG-2.pdf. Accessed Sept. 8, 2010.
- What is an ophthalmologist? EyeCare America. http://www.eyecareamerica.org/eyecare/tmp/What-is-an-Ophthalmologist.cfm. Accessed Sept. 10, 2010.
- Robertson DM (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 14, 2010.
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