We’ve pretty much all had one. And no. The one at your Primary Care Physician’s office or at the DMV doesn’t count!
Why? Because those are generally screenings. They tell your visual acuity – what your eyes are capable of seeing – but they don’t give you the means to correct it (a prescription) and they don’t evaluate the health of your eyes.
We’ve talked a lot about “full comprehensive eye exams”, but what does that really mean? How is it different from what you have done with your primary MD?
So… at your PCP’s office, you stand on a piece of tape twenty feet away from an eye chart tacked to the wall, cover one eye and read the chart. Terrific. You now know that the best line that you can read is 20/40. Now what?
Now, you come to Hollywood Eyes and get a full, comprehensive eye exam which includes:
A general health and ocular history. Often patients will ask, “Why do you have to know what conditions I have and what medicine I take? That’s got nothing to do with my eyes?” The short answer is, it might. Or we wouldn’t ask you. Certain systemic conditions like diabetes, thyroid disorders and autoimmune diseases can cause anything from dry eye to blindness!
And some medications, like Plaquenil – or hydroxychloroquine – can cause vision or eye problems. Some may be reversible when you stop taking the medication, others may be permanent. Anything from blurred vision to color vision changes to optic nerve damage and elevated pressure within the eye.
We also like to know any family history as several systemic and ocular conditions can be hereditary.
The autorefractor is the instrument that shows you a picture of a red balloon or a house at the end of a long road or something similar. Always we are asked, “Is this the air puff??!” It isn’t. And we don’t do that. More on that later.
The autorefractor takes measurements that give the doctors an idea of what your current prescription might be. These are measurement that they will fine tune in the exam room.
Visual Acuity. As mentioned before, this gives the doctors information on how you are seeing with your current glasses or contact lenses or what you are capable of seeing without correction. Again, this does not give us your prescription. It simply tells us what you are seeing. It is the “20 number” as in 20/20, 20/40, etc.
Visual acuity of 20/20 is the baseline. What some people consider “normal” vision. So, a visual acuity of 20/100 means that a person must be as close as 20 feet to an object that a person with “normal” vision can see from 100 feet away.
Confused? Sorry. Let’s move on.
Refraction. This is where the measurements from the autorefractor get the fine-tuning that they need to determine your actual prescription. Easiest way to describe it? It’s when the doctor places an instrument – phoropter – in front of your face and flips different lenses asking “What’s better? Number one or number two?”
The refraction is subjective. That means that the numbers that the doctor writes for your prescription is based on your verbal responses to his questions. The final refraction gives the doctors your level of nearsightedness (myopia), farsightedness (hyperopia), astigmatism and/or presbyopia (the need for a reading prescription usually after 40).
Slit Lamp Examination. A slit lamp is a large, binocular microscope that allows the doctor to see magnified views of all the components of your eyes. He will examine the lids and lashes for conditions such as blepharitis, which is an inflammation of the oil glands at the base of your eyelashes.
He will examine the outer structure of your eye – – the cornea (the “bubble” over the colored part of your eye), the iris (the colored part of your eye) and the conjunctiva (the membrane covering the front of your eye and the inside of your lids).
He’ll also check the health and clarity of your eye’s natural lens or implant if you’ve had cataract surgery. The lens is the clear disc behind the pupil that allows light to enter your eye so that you can see.
Finally, he will examine the internal aspects of your eyes. The retina, macula, optic nerve and blood vessels. To aid him in this part of the exam, he will sometimes use a drop that will dilate the pupil. Dilating drops block – or freeze – the tiny muscles that control your pupil allowing it to get larger in low light and smaller in bright light. Because he uses a bright light to see the back of your eye, the drops keep the pupil from constricting and reducing by a great deal how much he can see.
Sometimes, as is the case at Hollywood Eyes, we can take a high-definition digital image of the inside of your eye which allows him to zoom in on areas of interest when he looks through the slit lamp.
The retinal imaging also allows the doctor to save the photos to your chart for more in-depth study and for comparison from year to year.
Glaucoma Test. Ah. The dreaded air puff! We.Don’t.Use.It. It’s called an NCT or non-contact tonometer. A tonometer is used to check the pressure within your eye. Elevated intraocular pressure can be a symptom of glaucoma. Dr Kay and Dr Deweese use a small, hand-held instrument to evaluate your pressure. No air puff. Ever.
There are other tests that are performed that will assess whether your eyes move in sync, whether they have a full range of motion and whether or not you have a full field of vision.
He will also inspect your pupils’ reaction to light and your eyes’ ability to focus from far to close up.
Many of the tests that the doctors perform as required by law in order for an examination to qualify as “comprehensive”. Some go above and beyond to ensure that you are getting the best care. Anywhere!
Hollywood Eyes is open and we are seeing patients for full, comprehensive annual exams, ocular emergencies, glasses selection and contact lens purchases.
Some of our office policies have been altered in response to the coronavirus pandemic. Most important of these is that we are scheduling appointments for all of your needs. When you call to set up a time to come in, we will give you instructions on the remaining policies.
Take care of yourself and stay well. We are here for you!