Sunday, June 9, 2013

My Idea of a Comprehensive Eye Examination

This month’s entry will walk you through what exactly to expect during a routine full eye examination at our office.

Simple cross-section of the eye
Your visual system and the anatomy of your eyes are certainly more complicated than most people think. Therefore a comprehensive eye examination by a medical eye doctor should not only evaluate the clarity of your vision, but also determine how healthy all of the parts of your eye are. To this end, your examination will consist of several tests and procedures. We make sure our patients are aware that their exam may require more than an hour, although most of our exams are completed within 30 minutes.

Intake forms are typically filled out in advance and may be found on our website. These forms and previous records (if an established patient) are reviewed prior to seeing the patient.

Your exam begins with a complete history of why you are here. The reason for your visit, visual problems, and potential eye health issues are identified. Your medical and family history are reviewed.  Your current medication list is reviewed. You will be asked about your family history or any eye diseases; specifically histories of macular degeneration, glaucoma, or cataracts. If you are a new patient and presently wear corrective lenses, your most current prescription glasses and/or contact lenses are analyzed, reviewed, and recorded.

Look familiar? Justin Timblerlake
certainly needs to see clearly
Your vision is evaluated with your present corrective lenses if applicable. A refraction will be performed to determine your optimal spectacle and/or contact lens correction (think “what’s clearer, 1 or 2?”). All options and the pros and cons of spectacle lens and contact lens designs and modalities are discussed. If applicable, the difference between your old and new corrective lenses is demonstrated. The function and health of the eye muscles and eye motility is then examined. Depending on age or findings, depth perception and color vision may be assessed. Peripheral vision is examined, and your pupillary responses are checked.

The pressure inside of the eye, or intraocular pressure, is measured with the newest instrument available that requires no eye drops and does not involve an uncomfortable puff of air. Certain ocular conditions may require other types of testing.

Next, the the health of the eyes is examined under a specialized high-magnification microscope known as a slit-lamp. The specific steps and structures examined here would take pages and pages to describe alone, I will not dive into details.
A digital photo of a healthy retina

Digital retinal photography is performed on all new patients age 6 and older. This specialized camera negates the need for our physicians to dilate most of our patients under the age of 60. Certain findings, health conditions, and complaints require dilation as a standard of care. I or our other physicians will inform you if this is needed at this time. Dilation will always be performed if requested, of course. Neither the dilation nor digital photography cost the patient anything extra as they do at many other offices. I believe these are essential components of a completely thorough exam. The dilation or photography allows a physician to view the inside of the eye in its entirety. Your eyes may stay dilated for 3-5 hours during which your vision may be blurry and you will be sensitive to bright light. Disposable dark sunglasses will be provided. Most patients feel comfortable driving while dilated, but if you are unsure, we request you bring someone to the appointment so they may drive you home.

OCT scans of the macula
I am particularly proud to offer a High-Definition 3D OCT, or Optical Coherence Tomography, examination for an additional charge. If this test is medically necessary, medical insurance is billed. The HD OCT is the most advanced ocular imaging instrument available in any Ophthalmology or Optometry practice, and can pick up early warning signs of common ocular diseases years before the diseases develop, allowing our doctors to intervene early or recommend preventative steps. The results reviewed on a large format display and are clearly explained to the patient.

If necessary, we may order additional testing to explore any abnormal or at-risk findings further. Sometimes the testing can be done on the same day, but you may be asked to return another day.

All of your examination and testing results are entered in real time into our state-of-the-art Electronic Medical Records (EMR) system. A mock exam is found on our website as an example. If we are watching the health of your eyes at the recommendation or referral of another medical physician, a letter with all pertinent findings will be sent.

At the conclusion of the exam and testing I will discuss the overall health of the eyes. If you are having any problems with your eyes, the best treatment and management regimen is discussed.

Optician fitting a patient with her new glasses!
The timeframe for your next eye exam is then determined. This varies widely depending on your diagnosis or treatment, but is typically one year for comprehensive exams not requiring medical treatment.

If the patient wears spectacle correction, they are then handed off to the optician to handle all eyewear needs.

Thanks for reading and be sure to watch for next month’s entry when I take the time to discuss the importance of annual eye exams specifically pertaining to school age children.
Dr. Andrew Neukirch practices at Carillon Vision Care in Glenview, IL. You may comment on this blog entry or contact him directly here.