What is Involved in a Complete Eye Exam?


A comprehensive eye exam is an important part of your health regiment. An annual eye exam can help detect many eye problems such as: glaucoma, cataracts, strabismus, etc. An eye exam can also help in evaluating health issues such as high blood pressure, diabetes (or diabetic retinopathy) and high cholesterol.

I have been in the eye world my whole entire life. I grew up in Optica Nicaraguense. I would go after school and on Saturdays and watch as people would come in complaining about how they couldn't see. They would then go have their eyes checked by the doctor and he/she would prescribe eyeglasses. Then they would get to choose eyeglasses and I was jealous! How come they get eyeglasses and I don't?

It was amazing to me as a child and I always wondered, "how come I can't get eyeglasses?" When I had the chance to get my eyes checked I tried to answer the age old question "Which is better, one or two?" in a way that would make the doctor prescribe me eyeglasses! Little did I know that its an exam that is hard to cheat on!

As I became older I learned that there is more to an eye exam than the question, "Which one is better...one or two?" A comprehensive eye exam has several components.

The first part is the pre-test which consists of at least an Auto-Refractor/Keratometer (ARK) and a Non-Contact Tonometer (NCT). The ARK will automatically estimate your eyeglass prescription by determining the lens power needed to accurately focus light on your retina. The Keratometer portion of the digital device determined the curvature of the anterior surface of the cornea, particularly for assessing the extent and axis of astigmatism (it also helps in contact lens fitting). The NCT checks the pressure of your eye performing the puff-of-air test. If your pressure is too high than your optometrist will refer you out to an opthalmologist for further evaluation.

The next part includes Visual Acuity (VA), Cover Test, Retinoscopy, Refraction, Slit Lamp, and Pupil Dilation. All of these components are performed by the independent optometrist at Optica Nicaraguense. A VA test measures the sharpness of your vision. It is usually performed using a projected eye chart to measure distance visual acuity and a small, hand-held chart to measure near vision.

The cover test is done to see how your eyes work together. During this part you will cover one eye with something that looks like a spoon. The doctor will ask you to focus on something far away and something near. The doctor will be looking at the uncovered to see if there are any issues like strabismus or amblyopia.

Retinoscopy is a test to approximate your eyeglass prescription. This is done by dimming the room lights and having the patient to focus on the big E on the chart while the doctor shines a light at your eye and flipping lenses in front of you. Then comes a Refraction which is where the famous "Which is better one or two?" comes into play. Based on your answers your doctor will continue to fine-tune the lens power until reaching a final eyeglass prescription. Since the doctor has performed all the other tests they already now more or less what your prescription should be. This is why its nearly impossible to cheat!

The last two parts are the Slit Lamp exam and Pupil Dilation are the most important part of the exam. A slit lamp is a binocular microscope that the doctor uses to examine the structures of your eye under high magnification. The doctor will examine your eyelids, cornea, conjunctiva, iris and lens, retina and optic nerve. Many eye conditions can be detected with the slit lamp exam, including cataracts, macular degeneration, corneal ulcers, diabetic retinopathy, etc. With pupil dilation the doctor puts drops in your eyes and after 20 minutes your pupils will be dilated and your doctor will be able to look deep into the back of your eye. This is very important especially for people with risk factors for eye disease.

I hope this helped in explaining on what is actually going on during an eye exam. Contact us at 305-559-3942 to book your next appointment.

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