As many patients visit their eye doctor to simply obtain a new eyeglass prescription, your eye doctor is also concerned about the total health of your eye. A comprehensive eye exam, with dilation, is a crucial part of maintaining your whole-body wellness. While patients under 50 may wait several years between eye exams if they have no visual problems or risk factors, we recommend a dilated exam at least biannually for patients over age 50 and annually after age 65.
This section summarizes a few key points about eye exams: (a) how to determine if your exam qualifies as a ‘routine vision exam’ if you have a vision plan, (b) the information that patients need to provide at the exam, (c) the purpose of dilation, and (d) how a comprehensive eye exam can provide your doctor with information about more than just your eyes.
Is your exam routine or medical?
Some of our patients choose to purchase an insurance product (or their employer purchases it for them) that may entitle them to a low-cost routine eye exam each year as well as discounts or allowances on eyeglasses and/or contact lenses. These routine eye exams do not take the place of a medical exam, so we want patients to understand the difference between a routine eye exam and a medical eye exam.
A routine eye exam is intended to rule out eye disease and provide the patient with an eyeglass prescription if they request it. It is a ‘healthy eye exam.’ If any abnormalities are found during a routine exam, your doctor will schedule a return visit to discuss your condition and the recommended treatment plan. Medical tests will not be performed on the same day as a routine exam unless an urgent issue is detected. Routine exam services do not include the completion of forms, insurance paperwork or correspondence with other doctors. A routine eye exam does not include a contact lens exam or fitting services. These services can be provided for an additional cost.
A medical eye exam includes the diagnosis, treatment plan and/or follow up of medical issues, including cataracts, diabetes with complications, moderate to severe dry eyes, eye infections, eye pain or injuries, flashes or floaters, foreign bodies, glaucoma, lid infections and red or irritated eyes. A treatment plan for a medical exam may include discussions regarding additional testing, procedures or surgery. Correspondence with other medical professionals is included in the exam cost. The completion of other paperwork, except for information requested by or provided to attorneys, is also included in the cost of the exam.
Prior to your exam, you may be asked to complete a ‘Routine or Medical’ form so that we clearly understand the reason for your visit and which insurance company you want to be billed. If you have scheduled a routine eye exam and your doctor finds a medical condition, the doctor may give you the option of converting that day’s visit to a medical exam that is billed to your medical insurance plan. If the exam is not converted to a medical eye exam, then the medical problems will be addressed at a future exam. Regardless of whether your vision plan insurance or medical insurance is used for your eye exam, you can still purchase eyeglasses and/or contact lenses using your vision plan benefits.
Eyes are the windows to the health of the body
A thorough dilated eye examination can provide useful information about your whole body (systemic) health. Based on years of research and observation, eye doctors now have an excellent understanding of how systemic disease can first be detected during an eye exam.
Most importantly, the eye is the only organ in the body where a doctor can directly see blood vessels. The health of these vessels may indicate the condition of blood vessels throughout the body, and thus is helpful in identifying heart disease and diabetes. Changes in the retina (where blood vessels are massed) can also signal the presence of high blood pressure, stroke, HIV/AIDS, high cholesterol and sickle cell anemia. Inflammation of the iris may indicate the presence of an autoimmune disease such as rheumatoid arthritis or lupus.
Protruding eyes might point to the presence of Grave’s disease; dry eyes may indicate Sjogren’s Syndrome or thyroid disorders; difficulty with eye movement, optic nerve inflammation or blind spots may suggest multiple sclerosis. We also have a handful of patients each year where a complaint of visual field loss leads us to the discovery of a previously undetected brain tumor. Dozens of other less common systemic conditions can also be detected through eye exams.
The internal systems of the eye, as well as the ocular surface and tissues surrounding the eye, are truly windows to the health of your body, so be sure to see your eye doctor for regular, dilated examinations. If your eye doctor detects any systemic abnormalities, he or she will work with your family physician or internist to determine if further treatment is required.
The purpose of dilation
The dilation process is fairly simple: a doctor or technician instills eye drops that make your pupils expand. The pupil is the ‘window’ that the doctor uses to examine the back (posterior) segment of your eye – the retina and the vitreous fluid. In order to examine the posterior segment, your doctor will generally use an instrument (ophthalmoscope) that incorporates a light and a magnified viewing system. Without dilating drops, the instrument’s light causes the pupil to shrink, virtually closing the viewing ‘window.’
The retina is the most important part of your eye – it processes the light that passes through the eye, and then transmits those images to the brain. A dilated exam will better reveal ocular conditions such as macular degeneration, retinal detachments, retinal tears, swelling, hemorrhages, vitreous infections, tumors, glaucoma and cataracts. A dilated exam can also reveal problems associated with ‘whole-body’ diseases like diabetes, vascular disease and hypertension. Finally, with dilation a doctor can identify conditions still in their early stages and often without symptoms – helping us to minimize long-term vision loss.
Narrow angle glaucoma is the only common contra-indication for dilation, and repeated dilation does not harm the eye; absent this condition, you should opt for a dilated exam when given a choice.
Your role in an eye exam
Because the eye is affected by dozens of systemic diseases – such as diabetes, high blood pressure, multiple sclerosis, HIV/AIDS, thyroid disorders and rheumatoid arthritis – your health history is especially useful to your doctor when she examines your eyes. For example, a history of hypertension may cause the doctor to order additional tests for glaucoma. You will also be asked about your own eye history, since previous surgeries, diseases and injuries may impact your current condition and future treatment options.
The technician or doctor frequently asks for the eye and health history of your parents and grandparents because heredity plays a major role in glaucoma, macular degeneration, cataracts, diabetes and vascular disease.
Your doctor may request a list of the medications you take. The list often alerts the doctor to systemic diseases you may have forgotten to report. Your doctor also will consider your current medications when selecting eye medications, since some medications can counteract or amplify the effects of other medications.
Through training and experience, your eye doctor is well-versed in the complex conditions that impact your eyes. By collecting accurate information regarding your family history, systemic diseases, ocular history and medications, she can thoroughly evaluate the health of your eyes.