Comprehensive Routine Eye Care

Many surveys have been taken asking people what their most valued sense is. While there are arguments to be made for all of them—and few among us want to lose any of them—the sense of sight is consistently listed as supreme. Through our eyes, we can enjoy the rosy glow of the sun setting over a snow-capped mountain range. We navigate through the hustle and bustle of a street market at high noon. Our eyes recognize the danger of a busy city street corner, and the calm tenderness of a smile on our child’s face.

The eye is the window to the soul, and can also be a window through which Eye MDs can glimpse problems that may affect or have already affected our general health. Narrowed blood vessels in hypertension, inflammatory spots on the lining of the cornea in a patient with rheumatoid arthritis, hemorrhages in the retina associated with anemia. All can be subtle signs of systemic disease that may be hovering below the radar.

Just as it is vital that we receive consistent and thorough general physical exams to keep our bodies functioning properly, it is also important to monitor and care for the health of our eyes. An Eye MD is specially trained to not only diagnose eye conditions—everything from the simplest refractive error to the most complicated surgical dilemma—but also to treat them. Many people are nervous about seeing any doctor, let alone someone who is going to examine one of our most precious and sensitive body parts. This article is intended to allay those fears by illustrating the various components of a general eye exam, and to give the reader a sense for how frequently this should be done.

A general eye exam is something few people look forward to. Eye drops that sting and blur the vision for hours, bright lights and medical professionals poking and prodding their eyes is not many people’s idea of a good time. In truth, an eye exam is relatively quick and painless. A typical complete eye exam performed by a comprehensive ophthalmologist takes about 45 minutes to an hour and consists of the following components:

1. A review of your general health history including medical conditions and medications, family history and ocular history. As an MD, we are concerned about not only your eyes but you. Also, a comprehensive understanding of your health history helps us to better care for your eyes by allowing us to assess risk factors that may affect your ocular health.
2. An assessment of your visual acuity including a measurement of the refractive error is the most recognizable portion of the eye exam. The Eye MD and her medical staff carefully check the vision on an eye chart, and use multiple techniques to refine the vision by correcting near sightedness, far sightedness and astigmatism.
3. The pupils are the portal into the hidden depths of the eye, and examining them and their reactions to light is important. Malfunctioning pupils can indicate serious ocular disease and must be worked up further.
4. Ocular motility is an important component of the exam. Coordinated eye movements are important for reading, following the ball in sports, or for maintaining good depth perception to negotiate our environment. Loss of eye alignment or of coordinated movements can be evidence of serious neurological illness.
5. Eye pressure is a result of the normal fluid that is produced and circulates inside the eye. The eye is a closed space, and thus the fluid gives the eye its pressure. If the pressure is too high or too low, problems arise. The most common problem Eye MDs are concerned about is glaucoma. This is a disease of the eye nerve that is typically associated with high eye pressure. Glaucoma can lead to blindness if unchecked, and is virtually symptom free until it is advanced. The only way to screen for this is with a comprehensive eye exam.
6. Peripheral vision is important for many reasons and can be lost due to the effects of multiple ocular and neurologic diseases. A careful assessment of your peripheral vision is a part of your eye exam.
7. An eye MD will examine the area of the face surrounding the eye including the facial skin, the eye socket or orbit and the eyelids.
8. The anterior portion of the eye is evaluated using a special microscope called a slit lamp. This instrument allows your ophthalmologist to examine the surface of the eye including the cornea and conjunctiva. He can view your lens looking for cataract, and also the vitreous gel for floaters. With a special lens, an Eye MD can also view the deeper structures of the eye.
9. The inside of the eye is examined using specialized lenses. This is typically done with the aid of eye drops that dilate or enlarge the pupil, allowing the ophthalmologist a better view of all of the structures inside of the eye. These important parts include the lens, the vitreous gel, the retina and the optic nerve.

For the vast majority of people, this examination will identify any problems with the eye or with the visual system. If concerns are identified, the Eye MD has a myriad of other tests to use such as formalized visual field testing, OCT imaging of the retina or optic nerve, and angiography to view the vasculature of the retina. All of this information will help your ophthalmologist maintain your healthy eyes.

A question one might ask is how often is an eye exam necessary? For Children, the American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus recommend an eye exam as a newborn, an infant of up to one year, a preschooler and at school age. These can consist of basic screening exams to measure visual acuity, to look for ocular alignment issues and to identify gross problems in the front or back of the eye. A properly trained healthcare provider such as a pediatrician, family doctor or eye physician can screen for pediatric eye disease. If the baby is premature, or if any abnormalities are suspected, the child should be referred for a comprehensive eye exam by an ophthalmologist.

While it is advisable to have an eye exam every 3-5 years as a young adult, The American Academy of Ophthalmology recommends a baseline exam at the age of 40. This should be followed by regular eye exams every two years or so until the age of 65 or 70, when a yearly eye exam is important. This is because the risks of age related eye diseases such as cataract, glaucoma and macular degeneration are much more common. People with diseases such as diabetes, or with a strong family history of an eye disease such as glaucoma, should have eye exams on a regular basis starting in adulthood.

A comprehensive eye exam is an important aspect of health maintenance for an organ that we take for granted. Eyesight is invaluable and irreplaceable, and it is our job as Eye MDs to keep your eyes healthy, and to help you behold the wondrous sights this world has to offer.