The Eye Exam: A New Look by Dr. Grossman – 2020 Vision

eye exam of a senior citizenGetting a thorough eye exam has always been about more than reading letters off an eye chart. That is even truer today. One reason: We are harder on our eyes than ever before. Many of us spend hours each day staring and squinting at screens, developing digital eyestrain, and exposing our eyes to potentially damaging blue light.

But the typical tests offered during a standard eye exam may not go far enough to find problems as early as possible. Even a basic dilated eye exam may not be enough.

Your eye exam will still include the basics, such as testing your vision and doing a refraction test to find the right strength to correct any near- or far-sightedness. The doctor will also ask you to follow his or her finger with your eyes. This tests your eye muscles and evaluates how well your eyes move together and track objects.

Eye Exam Tests: Old and New

Here is a list of innovations in standard tests and newer, high-tech testing options with important benefits. Not every eye doctor offers them, but it could be worth your time to find an eye doctor who does.

Medical History

Taking Your History: Your eye doctor should ask about your health, family history, and medications. He or she should also ask about any eye problems, such as blurry vision, floaters, and trouble seeing at night.

Beyond the Basics: The most important questions may be about how you use your eyes and, in particular, how many hours you spend each day looking at electronic devices. If you work at a computer for more than 8 hours a day, ask your doctor if you need to use a blue light filter to reduce eyestrain. If your screen does not have built-in blue light filtering, you can download an app or simply wear blue-light filtering eyeglasses when you work.

Eye Pressure Test

Eye Pressure Testing: This test screens for glaucoma, the build-up of fluid in the eye. Glaucoma can damage the optic nerve and cause blindness. This basic test involves a puff of air from a machine called a tonometer. The eye doctor might instead use an applanation tonometer, which presses gently on the front of the eye.

Beyond the Basics: There is now a tonometer called the “ocular response analyzer.” The cornea is the eye’s clear protective outer layer. An ocular response analyzer measures corneal hysteresis, the rigidity of the cornea. An additional simple test can be used to measure the thickness of the cornea. These measurements help put eye pressure readings in perspective, since thicker or more elastic corneas may withstand more pressure. The results allow for a more accurate diagnosis. You could avoid medications you would otherwise be prescribed or alert your doctor to a problem that might otherwise be missed.

Retina Exam

Retina Exam: Every eye exam should include a check of your retinas, the light-sensing layer of tissue at the back of your eyes. A retina exam checks for several conditions, including macular degeneration. Macular degeneration is common with age. It causes retinal damage that can ultimately lead to vision loss and blindness. Changes in the retina and underlying blood vessels also can suggest health problems such as diabetes and high blood pressure. Traditional testing involves dilating your pupils and then using a strong light to look inside your eyes.

Beyond the Basics: Optomap is a digital retinal scanner that does not involve dilation. It takes pictures of the retinas. The images can be shared easily with other health care providers if needed.

A newer additional retina-testing option is optical coherence tomography, which uses light waves to take cross-sectional pictures of your retina and the vascular layers beneath it. Such images can help to diagnose and track conditions, including macular degeneration, glaucoma, and diabetic eye disease. If you are over age 50, consider baseline testing with this technology. It might help spot early signs of trouble and lead to taking preventative steps, such as supplements for eye health.

Slit Lamp Test

Slit Lamp Testing: Using a microscope attached to a bright light, the doctor can examine the front parts of your eye, including the lids and your tear ducts. He or she may introduce a dye to see how quickly your tears evaporate to check for signs of dry eye.

Beyond the Basics: Special lenses used with the slit lamp are available to enable the doctor to better see deeper parts of the eye, such as the optic nerve.

Testing the Visual Field

Visual Field Testing: A variety of tests assess your visual field — the center and sides of your vision. Glaucoma, retina problems, flashes, and floaters can impair the visual field. The most basic screening test involves the doctor moving his or her fingers to the side while you look straight ahead and count the fingers.

Beyond the Basics: More formal testing involves looking through a machine called a “visual field tester” and responding to light cues or patterns.

Next Steps

Dr Marc Grossman's 2020 VisionWhen planning your next eye exam, call eye care offices near you and ask which of these tests they offer and the charges. The new optional tests will likely add between $35 to more than $100 each to the basic exam fee, depending in part on where you live. They are less likely to be covered by insurance than the basic exam. However, the investment in your future vision could be more than worth it.

nutrients Up Next: See our page on Eye Diseases and learn more about Macular Degeneration.

This article is part of a series called “Marc Grossman’s 2020 Vision.”