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FAMILY EYE CARE
Vision Screenings Are Not Eye Exams
Is it really that important to have routine eye exams? What if you just passed a vision screening at work or school — do you still need an eye exam? The one and only answer to this question is YES. Vision screenings are not comprehensive eye exams. Screenings usually take only a few minutes and are often performed by volunteers who are not eye care professionals. In many cases, vision screenings are nothing more than a visual acuity test where you're asked to identify the smallest letters you can on a vision chart across the room.
Vision screenings typically are designed to only detect subnormal visual acuity and major vision problems — as quickly and cost-effectively as possible. They generally are ineffective for detecting more subtle vision problems and potentially sight-robbing eye diseases. People who fail a vision screening (usually because their visual acuity is worse than 20/40) are made aware of this and are encouraged to visit an eye doctor so they can have their vision problem professionally diagnosed and treated with eyeglasses, contact lenses, medicine or surgery.
Eye exams, on the other hand, are performed by licensed eye doctors (an optometrist or ophthalmologist) and evaluate not only your visual acuity, but also the complete health of your eyes, from front to back — including checking for early signs of serious eye problems such as glaucoma, cataracts, macular degeneration and detached retina. Your eye doctor also can detect early signs of serious health problems such as diabetes, high blood pressure and risk of stroke, based on the appearance of delicate blood vessels and other structures within the eye.
Today's Technology and Our Children
Children are using computers and other digital devices much more extensively and start using these devices at a much younger age than children in the past. The illuminated screens of these modern devices tend to be more visually demanding than books and other printed text. Increased use of digital devices by children has occurred simultaneously with another significant trend — an unprecedented increase in myopia among children in the U.S. and worldwide. These two trends have led many eye care professionals to believe computers and digital devices play an important role in the development of nearsightedness and myopia progression. This makes it more important than ever for children to have their eyes examined routinely to identify and treat vision problems.
Vision screenings are helpful to identify children who already have significant myopia, but screenings aren't sensitive or thorough enough to identify all children who have vision problems that can affect their learning.
ABOUT EYE EXAMS
Did You Know?
  • Of all the information we process each day, 80% of it reaches us via our eyes.
  • Our vision uses a whopping 25% of our entire body energy consumption.
  • Up to 50% of eye performance can be lost due to the lack of proper eye protection.
What is an Eye Exam?
An eye examination is a series of tests performed by an ophthalmologist (medical doctor), optometrist, or orthoptist assessing vision and ability to focus on and discern objects, as well as other tests and examinations pertaining to the eyes.
Why are Eye Exams Important?
For people of all ages, eye exams are an important part of one’s general health. Your eyes should be checked regularly to ensure that they are providing the best sight possible. Eye exams assist your doctor in detecting signs of eye disease or conditions that can affect not only your vision but your overall health. Eye exams play a critical role in detecting vision threatening eye diseases such as glaucoma, macular degeneration, cataracts, or diabetic retinopathy. Many of these diseases have minimal or no symptoms until the disease has progressed. In these cases, early detection and treatment is essential to halting or slowing the progression of the disease and saving eyesight.
Tests Included in an Eye Exam
Below this a brief description of the tests your doctor may perform during an eye exam.
Applanation Tonometry
This test measures the amount of pressure it takes to flatten a portion of your cornea. Pressure readings help your doctor diagnose and keep track of glaucoma. Your doctor will give you drops to numb your eye, then press lightly on it with a tool called a tonometer.
Corneal Topography
This computerized test maps the curve of your cornea. It can show problems with your eye’s surface, like swelling or scarring, or conditions such as astigmatism. You might have it before you have surgery, a cornea transplant, or a contact lens fitting.
Fluorescein Angiogram
This lets the doctor see how well blood moves in your retina. It helps diagnose diabetic retinopathy, retina detachment, and macular degeneration. The doctor will inject a special dye, called fluorescein, into a vein in your arm. It travels quickly to blood vessels inside your eye. Once it gets there, the doctor uses a camera with special filters to highlight the dye. He takes pictures of the dye as it goes though the blood vessels in the back of your eye. This helps him spot circulation problems, swelling, leaking, or abnormal blood vessels.
Dilated Pupillary Exam
The doctor uses special drops to expand your eye’s pupil (he’ll call this dilate). That lets him check your retina for signs of disease.
Refraction
This is what the doctor uses to get your eyeglasses prescription. You look at a chart, usually 20 feet away, or in a mirror that makes things look like they’re 20 feet away. You’ll look through a tool called a phoropter. It lets the doctor move lenses of different strengths in front of your eyes. You can tell him if things look clear or blurry. Your answers give him your prescription for your glasses or contact lenses. The test will also help him spot presbyopia, hyperopia, myopia, and astigmatism.
Slit-Lamp Exam
The doctor uses this microscope to shine a beam of light shaped like a small slit on your eye. He may also dilate your pupils during the test. It can help diagnose cataracts, glaucoma, detached retina, macular degeneration, cornea injuries, and dry eye disease.
Non-Contact Tonometry
This test helps diagnose glaucoma. The doctor will use a tool called a tonometer that blows a tiny puff of air, measuring eye pressure indirectly by the eye's resistance to the puff. Applanation instruments can also measure pressure. They are the most accurate, but you'll need local anesthetic.
Retinal Tomography
This computerized test maps the surface of your retina. You might get it if you have a serious retina condition, like age-related macular degeneration or retinal detachment.
Corneal Topography
This computerized test maps the curve of your cornea. It can show problems with your eye’s surface, like swelling or scarring, or conditions such as astigmatism. You might have it before you have surgery, a cornea transplant, or a contact lens fitting.
Ultrasound
This test uses sound waves to make picture of the inside of your eye. It helps your doctor diagnose and treat tumors, cataracts, or bleeding in your eye. You might also get it before cataract surgery.
Visual Acuity Testing
This measures how well you see at near and far distances. If your child can’t yet read, the doctor will use a special test. Your child will look at a letter "E" then tell the doctor the way the legs point with her fingers. You can practice this at home before the test.
Visual Field Test
This measures your peripheral (side) vision. You’ll stare at on object in the center of your line of vision (like the doctor's eyes or a computer screen). As you look at the target, you’ll note when you see an object moving into your field of vision. This test lets the doctor know if conditions like stroke or glaucoma have hurt your vision.
ADULT & PEDIATRIC EYE EXAMS
How Often Should Adults Have an Eye Exam?
It depends on three important factors, your age, your eyes and your family history. Adults between the ages of 18 and 40, with no obvious risk factors, should have a comprehensive eye exam every two years. Adults over 40 should have a comprehensive eye exam every one to two years. Because the risk of eye disease continues to increase with advancing age, adults over the age of 60 have a routine eye exam every year. Adults with any kind of eye issue in the past or the risk for developing eye issues in the future, due to family history, should have a routine eye exam every year or as indicated by your doctor. Individuals with a health condition like high blood pressure or people with jobs that require constant or prolonged use of your eyes or patients with prescriptions for drugs that can affect eyesight, should talk with their doctor to see if more frequent eye exams would be beneficial.

Individuals with Type 1 diabetes should have an eye exam within 5 years of the initial diagnosis and every year after that. Individuals with Type 2 diabetes should have an eye exam ASAP upon initial diagnosis and every year after that.
Recommended Eye Exam: Adults
  Exam Frequency
Patient Age Risk Free At Risk
18 - 39 2 Years 1 to 2 years or as recommended
40 - 59 1 to 2 years or as recommended Annually or as recommended
60 & Over Annually As recommended
Adults at Risk
  • People with diabetes, hypertension, or a family history of eye disease
  • Occupations that are highly demanding visually or eye hazardous
  • Taking prescription or nonprescription drugs that can affect your sight
  • People who wear contact lenses
  • People who have had eye surgery
  • People with other health concerns or conditions
How Often Should Children Have an Eye Exam?
According to experts, 80% of learning is visual, which means that if your child is having difficulty seeing clearly, his or her learning can be affected. This also goes for infants who develop and learn about the world around them through their sense of sight. To ensure that your children have the visual resources they need to grow and develop normally, their eyes and vision should be checked by an eye doctor at certain stages of their development. If there are any signs that there may be a vision problem or if the child has certain risk factors (such as developmental delays, premature birth, crossed or lazy eyes, family history or previous injuries) more frequent exams are recommended. A child that wears eyeglasses or contact lenses should have his or her eyes examined yearly.

Undetected or uncorrected vision problems can cause children and teens to suffer academically, socially, athletically and personally. If your child is having trouble in school or afterschool activities, there could be an underlying vision problem. Proper learning, motor development, reading, and many other skills are dependent upon not only good vision, but also the ability of your eyes to work together. Children that have problems with focusing, reading, teaming their eyes or hand-eye coordination will often experience frustration, and may exhibit behavioral problems as well. Often they don’t know that the vision they are experiencing is abnormal, so they aren’t able to express that they need help. Children’s eyes can change rapidly as they grow.
Recommended Eye Exam: Children
  Exam Frequency
Patient Age Risk Free At Risk
Birth - 24 Months 6 months 6 months or as recommended
2 - 5 3 years 3 years or as recommended
6 - 18 First grade, then every 2 years Annually or as recommended
Signs of Vision Problems in Children
  • Short attention span
  • Headaches
  • Frequent blinking
  • Avoiding reading
  • Tilting the head to one side
  • Losing their place often while reading
  • Double vision
  • Poor reading comprehension
Pediatric Assessment
In addition to a basic visual acuity test, an eye exam can assess the following visual skills that are required for learning and mobility:
  • Binocular vision: (how the eyes work together as a team)
  • Focusing
  • Peripheral Vision
  • Color Vision
  • Hand-eye Coordination
  • Tracking
In addition to an eye exam, your doctor will also examine the area around the eye and inside the eye to check for any eye diseases or health conditions. You should tell the doctor any relevant personal history of your child such as a premature birth, developmental delays, family history of eye problems, eye injuries or medications the child is taking. This would also be the time to address any concerns or issues your child has that might indicate a vision problem.

If the doctor determines that your child does have a vision problem, they may discuss a number of therapeutic options such as eyeglasses or contact lenses, an eye patch or surgical referral. Since some conditions are much easier to treat when they are caught early while the eyes are still developing, it is important to diagnose any eye and vision issues as early as possible.