This Is Exactly What Happens During and After an Eye Exam [CNET]

Regular eye exams are essential, even if you have perfect vision. This is exactly what happens during an eye exam and after.

From squinting and dry eyes to cataracts and blurred vision, more than three in five Americans have vision and eye problems, according to the US Centers for Disease Control and Prevention. There is concern about prolonged screen use and its damage to eye health, but other lifestyle habits and environmental factors also impact your eyes, potentially contributing to various conditions. 

That being said, you can do many things to protect your eye health, including getting regular eye exams.  

What is an eye exam?

An eye exam is a thorough evaluation of the health and function of the eyes. It typically includes a series of tests to assess various aspects of vision and eye health, ensuring comprehensive care and early detection of potential issues.

The duration of an eye exam can vary but generally takes about 30 minutes to several hours, according to WebMD. Costs for an eye exam range from $10 to $40 for those with insurance, and $50 to $250 for those without, according to Warby Parker. 

Each type of exam serves specific purposes in assessing and maintaining eye health and visual function. Different types of eye exams include:

• Comprehensive eye exam: A thorough evaluation of eye health and vision.
• Follow-up eye exam: Conducted to monitor changes in eye health or vision after previous treatment or diagnosis. 
• Vision screening: Often a basic screening done at the DMV or a school to test visual acuity to ensure safe driving or academic performance, respectively.

Tests to expect during an eye exam

The tests performed during an eye exam can detect issues with vision and eye health and medical conditions such as heart disease and diabetes. 

“You can think of the eye exam as three components: the first component is pre-test or screening exam,” Dr. Jennifer Wademan, told CNET. “This is gathering information about your eyes, like difficulty you may have seeing your phone or maybe its difficulty driving at night. We also gather information about your general health.” 

Looking into your general health may offer your doctor clarity and point to conditions and medications that can impact your eye health and vision.

“We also gather diagnostic information. Things like your visual acuity (how well you are seeing at a distance and near) and visual field screening (this gathers information about how you are seeing in your peripheral and central vision),” Wademan stated. “We also test your eye pressure. This screens for several eye conditions, more commonly, risk of glaucoma.”

According to Johns Hopkins Medicine, individuals aged 60 and up have a higher risk of developing glaucoma, so annual exams are recommended. 

“The second component is the vision exam,” Wademan continued. “This is where the doctor is checking for a spectacle prescription, nearsighted, farsighted and/or astigmatism and presbyopia [when your eyes gradually lose the ability to see up close]. Lastly, the third component is the eye health exam. This is where the doctor looks at different structures inside and outside the eye, assessing health.” 

Eye exam machines

During these exams, doctors use specialized equipment and eye exam machines, including: 

• Phoropter: Determines the appropriate prescription for corrective lenses.
• Keratometer: Measures the curvature of the cornea.
• Ophthalmoscope: Allows the doctor to examine the inside of the eye, including the retina and optic nerve.
• Autorefractor:  Measures a person’s refractive error and determines the prescription needed for eyeglasses or contact lenses.
• Tonometer: Measures intraocular pressure to screen for glaucoma.
• Visual acuity charts: Tests clarity of vision at different distances.
• Slit lamp biomicroscope: Provides a detailed view of the front of the eye and its structures.
• Retinal camera: Captures images of the retina for detailed examination and documentation.

How often should I get an eye exam? 

The frequency of eye exams varies with age. According to the American Optometric Association (AOA), adults aged 64 and under generally require exams every two to three years, while those age 65 and up should consider annual visits to detect age-related conditions early. However, yearly exams for all adults can be beneficial. 

“For the vast majority of people, yearly comprehensive eye exams are sufficient to proactively monitor eye health and vision,” Wademan said. “Even if some patients have ‘good’ vision, meaning they don’t need glasses, we still recommend yearly eye exams. While these patients may not need correction for vision, they still need to be monitored for changes in eye health.” 

In addition to the more obvious conditions, eye exams can detect serious, “silent” problems that may be occurring.

“Dry eye, glaucoma, cataracts, macular degeneration, just to name a few conditions that can present without little symptoms on the patient’s behalf. However, these patients may need additional visits outside of their yearly comprehensive eye exam to monitor the respective eye disease or treatment,” Wademan said.

What do eye exams evaluate? 

During an eye exam, the following factors are evaluated, according to the American Academy of Ophthalmology: 

• Medical history: Your vision, health, family medical history, medications and use of corrective lenses
• Visual acuity: How well you see at different distances
• Prescription: Best eyeglass or contact lens prescription
• Pupil response: How your pupils react to light
• Peripheral vision: Side vision
• Eye movement: Eye alignment and muscle function
• Eye pressure: Intraocular pressure
• Front of eye: Condition of cornea, iris, lens and eyelids
• Retina and optic nerve: Signs of disease-related damage

What should I expect after an eye exam? 

After an eye exam, the doctor will review the results with you and discuss any prescriptions or treatment recommendations the same day. 

“I usually let patients know what I’m seeing or not seeing with respect to their vision and eye health as I am doing the exam. We go over the screening tests, whether they look normal or if any one test looks outside of their normal,” Wademan said. “I let them know the type of vision correction they need and what my recommendations would be in terms of the type of glasses, based on the type of correction and what their visual complaints are.”

There may be a need for a follow-up or other appointment after an eye exam to monitor conditions, adjust prescriptions or address newly detected issues.

“I also go over their eye health portion of the exam — again, what I’m seeing or not seeing in terms of their eye health,” Wademan explained. “If I need additional testing for a condition, I may have the patient come back on a different day since that would be a different exam. Or I may have a patient return sooner for follow-up after I initiate treatment like eye drops or a therapy for dry eye.”  

Additionally, if eye dilation was performed, your pupils may remain enlarged for a few hours, causing sensitivity to light and blurry vision up close. The Cleveland Clinic advises wearing sunglasses and avoiding driving if you’ve had dilation to ensure comfort and safety post-exam.

Difference between an ophthalmologist, optometrist and optician 

Understanding the distinctions between various types of eye care professionals is necessary for selecting the right provider for your vision needs. Here’s a breakdown of ophthalmologists, optometrists and opticians, per WebMD:

• Ophthalmologists: An ophthalmologist is a medical doctor specializing in complex eye treatments. They provide comprehensive eye care, including vision services, medical treatment and surgical interventions for conditions like glaucoma and cataracts, and address eye issues related to systemic diseases like diabetes. Specializations within ophthalmology include pediatric care for children’s eye issues, neuro-ophthalmology for brain-related eye conditions and ocular oncology for eye cancer diagnosis and treatment.
• Optometrists: Optometrists specialize in comprehensive vision and primary eye health care. They focus on conducting eye exams, prescribing corrective eyewear, managing eye conditions related to diseases like diabetes, treating issues such as dry eye and glaucoma and providing low-vision aids and vision therapy. Some optometrists pursue further clinical training or specialize in areas such as pediatric optometry for children, neuro-optometry for brain injury-related vision problems or low-vision optometry for individuals with significant visual impairments.
• Opticians: Opticians fulfill prescriptions for glasses and contact lenses provided by optometrists. They also fit, adjust and repair glasses and frames, take facial measurements, assist in lens and frame selection and order and verify products like contacts and eyeglass lenses.

Ways to find an eye doctor 

When you’re ready to take control of your eye health and schedule an eye exam, here are effective ways to find the right eye care professional for your needs.  

• Ask family or friends about their eye care providers, including their experiences and recommendations.
• Request a referral from your primary care physician, who can recommend trusted eye specialists.
• Use online directories or search engines to find ophthalmologists or optometrists practicing in your area.
• Contact the ophthalmology or optometry department at nearby hospitals for information on qualified doctors and their specialties.

If you have vision insurance, obtain a provider list from your health plan or insurance company to ensure the eye doctor you choose is not only in your area but also in-network for a reasonable cost. However, it’s possible to get affordable eye exams without insurance or to get glasses without an exam.