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Your Eye Exam: What We Do and Why

Are your eyes healthy?

There’s no way to really be sure without periodic, comprehensive, dilated eye examinations. During the exam, your eye doctor will carefully inspect your eyes for signs of common vision problems as well as serious eye diseases, several of which have no early symptoms.

Detecting eye diseases such as glaucoma, diabetic retinopathy or macular degeneration early — so they can be addressed in their most treatable stages — vastly reduces the risk of vision loss.

Comprehensive Eye Exam, Step-by-Step

First step is the patient history. The patient may be asked to complete a questionnaire covering specific eye or vision problems, visual needs, family history of eye problems, medical history, medications, and other issues. During the exam, the eye doctor will review, discuss and further explore the history with the patient.

Next comes initial testing, usually performed by a highly-trained eye care technician. The tech checks the vision and the existing glasses, then often will measure the power of the eye and its shape using sophisticated automated instruments. This preliminary exam may also include screening tests of the pupils, eye movement, depth perception, and side or peripheral vision. (Diminished peripheral vision may be a sign of glaucoma.)

Finally, the tech will check the eye pressure. High eye pressure can be an important sign of glaucoma.

The next step is a careful inspection of the health of the eyes. This includes a slit lamp examination which uses a special microscope to carefully examine the outer and inner parts of the eyes. To enable the doctor to get a clear view of the inside of the eyes, the pupils are enlarged, or dilated, using eyedrops. Full dilation can take as long as 45 minutes to an hour, depending on the individual, although in many cases, dilation is sufficient after about 20 to 30 minutes. Dilation makes the patient sensitive to light and renders the vision blurry for several hours afterwards. (Coastal Eye recommends that dilated patients have a driver to get home.)

“We want to look inside the eye, which we can see much better when the pupils are dilated,” observes Dr. Lee Wan, Coastal Eye’s Medical Director.   “We look at the lens of the eye, which is behind the pupil. It is here that we can see and evaluate cataracts. And then we look at the retina and the optic nerve, which are very important parts of the eye. That’s where we see signs of glaucoma, diabetes, as well as macular degeneration and other problems of the retina.”

A careful look inside the eye can discover more than eye diseases. Eye doctors are often among the first health care professionals to detect chronic systemic diseases such as hypertension (high blood pressure), diabetes or high cholesterol — particularly in patients overdue for their regular physical examinations. It is not unusual for eye doctors to refer patients to their general medical physicians for further evaluation and care for these disorders.

Refraction:  A Different Examination

Separate and distinct from the comprehensive eye examination is the refraction, which is a vision care procedure, a measurement for glasses prescription. Annual refractions to update the glasses prescription are typically covered by vision plans, but because the refraction is a vision test, it is not considered a medical procedure. Therefore, the refraction is not a benefit of Medicare or medical insurances. Refractions are, however, often done at the same time as the comprehensive eye exam if the patient so desires (at the patient’s expense if they do not have a vision plan).

In the refraction, the eye doctor shows the patient a series of lens choices and asks the patient to compare their vision with each. This enables the doctor to determine whether the patient is nearsighted or farsighted and how much astigmatism is present. The doctor measures the prescription for far distance, intermediate (including computer distance), and reading.

The doctor’s recommendations for eyeglasses must be carefully tailored to each individual’s visual needs, observes Dr. Meiya Liao, Coastal Eye optometrist.  Visual needs vary widely depending on occupation, lifestyle, hobbies and age.

Focusing on the Whole Person

Patients can benefit from continuity of care within the Coastal Eye practice over time with periodic comprehensive eye and vision exams, Dr. Liao believes.

When she knows more about the patient’s health, lifestyle, interests and concerns, she is better able to tailor her recommendations and explanations to each patient, and watch for certain diseases that have a hereditary component.

“I enjoy the challenges of my profession and providing care for my patients’ eyes and health,” says Dr. Liao. “But what I really find rewarding is the doctor-patient relationship that develops over time, and getting to know them as individuals and not just as patients.”

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