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Table of Contents
Purpose
Risks
Before the Test
During the Exam
Interpreting Results
Post-Exam
A comprehensive eye exam, also sometimes called a routine eye exam, consists of a series of tests to measure how well you can see and to look for any problems that might be affecting the overall health of your eyes.
How often you should have an eye exam depends on a variety of factors, including your overall risk for specific problems.
During a comprehensive eye exam an eye doctor will assess:
During an eye exam, signs or symptoms of a health problem unrelated to your eyes also may be discovered. According to the American Academy of Ophthalmology (AAO), this is because “the eye is the only place in the body where a doctor can have an unobstructed view of our blood vessels, nerves, and connecting tissue—without the need for surgery.
Examples of diseases and conditions that can be discovered during a comprehensive eye exam include diabetes, high blood pressure, autoimmune diseases, sexually transmitted diseases, and cancer.”
Who Should Have an Eye Exam and How Often
Although generally regarded as a yearly event, when and how often a person should have their eyes examined depends on factors such as age, general health, risk of eye disease, and other factors. For most people, the guidelines are as follows:
Children 3 and under:Although a little one this age won’t need an eye exam, the pediatrician will keep a close watch for problems such as strabismus (when the eyes are not aligned) and amblyopia (lazy eye) at regular well-child checkups.
Children ages 3 to 5:Preschoolers should have their first eye exam when they reach a stage at which they’re able to cooperate with the doctor (can identify simple shapes on an eye chart, for example).
School-age children and adolescents:All kids should have an eye exam before starting first grade and every one to two years thereafter (or per the advice of their eye doctor).
Adults are advised to have regular eye exams according to this schedule:
You may need to have your eyes checked more often if you wear glasses and/or contact lenses, have a family history of eye disease, or have a chronic condition such as diabetes that increases your risk of eye problems.
What’s Causing Pain in the Corner of Your Eye?
Risks and Contraindications
When you’re due for a comprehensive eye exam, you’ll want to consider which type of doctor to see. There are two practitioners who focus on vision and eye health. Here’s how they differ:
Ophthalmologistsare medical doctors (MDs) or doctors of osteopathic medicine (DOs). They attend medical school for four years, do a residency for four years, and often do one- to two-year fellowships in order to specialize in a particular field of interest, such as pediatrics or strabismus. Ophthalmologists can treat all eye diseases and also perform surgery, in addition to providing general eye care.
Optometristsgo to optometry school for four years in order to earn a doctor of optometry degree (OD). Besides basic care and vision assessment, they are qualified to handle nearly all types of medical issues related to ophthalmology. They can prescribe medication and treat eye diseases, although some states may limit the specific conditions an optometrist can treat. Optometrists are not able to do surgery.
Timing
A comprehensive eye exam will take at least an hour, including the 20 to 30 minutes that it takes for pupils to fully dilate after drops are put in. If you plan to shop for and be fitted for glasses at your appointment, plan to be there longer.
Location
Comprehensive eye exams can be done at the private or group practice of an eye doctor or at a freestanding or hospital-based clinic. Often, an ophthalmologist or optometrist will have an eyeglass shop on the premises so that patients can choose frames and be fitted for glasses at the same time as their appointment, if desired.
Many eyeglass stores employ optometrists to give customers eye exams as well. You can even have an eye exam and purchase glasses or contact lenses from a retail store such as Targetor Walmart.
Cost and Health Insurance
Health insurance will pay for routine examinations for people who have ongoing medical problems that affect eyes, but for people whose eyes are healthy, coverage for routine eye care can be baffling.
Some plans will cover an eye appointment for a medical problem (a scratched cornea, say, or an infection), but not routine check-ups.
Often, a health insurance plan will include a separate rider for comprehensive eye exams. Others may be a hybrid, covering medical visits and routine exams, but the latter only at specific intervals (every two years, for instance).
And still other vision plans provide coverage for glasses andcontact lensesor at least offer a discount.
If you’re paying out-of-pocket, the average cost of a routine eye exam with a private doctor is around $150. In some regions of the country, it could be $115 or less, and in others, more than $300.
Stores that sell eyeglasses, including dedicated frame shops and big-box stores like Costco, may offer complete eye exams at a price that’s less than a private doctor would charge when you purchase glasses or contact lenses.
What to Bring
You will need to have your health insurance or vision insurance card with you.
If you only wear eyeglasses, be sure to do so the day of the exam. If you wear contact lenses, put them in for the appointment, but bring your lens case and glasses. The doctor will want to look at your eyes with and without your lenses to make sure they’re fitting properly. You’ll need to remove your lenses for certain tests, as well as to have your pupils dilated.
In addition, bring a list of all medications you take, including prescriptions and over-the-counter and herbal supplements. Certain substances can affect vision, and your doctor will want to take that into consideration while examining your eyes. Finally, if you have an eyeglass or contact lens prescription from another provider, bring a copy of that as well.
Pre-Exam
If this is your first visit to the practice, you may have to fill out routine new-patient forms and hand over your vision insurance card to be copied. Beyond that, you will start and finish your appointment in an exam room.
You will be seated in a comfortable padded chair with various medical apparatus attached that the doctor will use to perform different tests and procedures to check your vision and the overall health of your eyes.
Your exam is likely to begin with a series of questions about your vision and general health. Your doctor may ask if you:
After this discussion, testing begins.
Visual Acuity
Avisual acuity testis a measure of the clarity of your vision—in other words, how well you can see.
The most common way to test visual acuity is with an eye chart that may be posted on the wall or projected onto a wall or screen 20 feet away from where you will be standing or sitting. Your eye doctor will ask you to read the letters on the chart starting with the bottom row, where the letters are smallest. The smallest letters you are able to read will determine your acuity.
Your visual acuity may be written as20/20if your vision is normal. If you have 20/100 vision, it means that you must be as close as 20 feet to see what a person with normal vision can see at 100 feet. Someone with 20/60 vision would need to move up to 20 feet away to read what a person with normal vision could read from 60 feet away. If you have less than 20/20 vision you havemyopia or hyperopia.
Pupillary Response Testing
The way the pupils dilate and constrict in response to light can reveal a lot about the health of the eyes and the body. The nerves that control the pupil travel through a long pathway. Certain pupillary reactions can reveal neurological problems.
Sometimes the acronym PERRLA is used to describe the findings of a pupillary response test. It stands for:PupilsEqualRoundReactive toLight andAccommodation—the ability of the eyes to focus on objects that are close-up and far away.
The doctor will look for uniformity between bothpupilsand note their shape and size prior to starting the test. He’ll then move a small flashlight back and forth between the eyes every two seconds (the “swinging flashlight test”) to see if the pupils get smaller in response to direct light, and, if so, if one constricts when the other does or they constrict separately (which would be abnormal).
The doctor also will ask you to follow a pen or index finger as he moves it in all directions to see how well your eyes are able to stay focused on it and how the pupils respond. Normally, the pupils constrict while fixated on an object that is being moved close or far away.
Confrontation Visual Field Test
Aconfrontation visual field testis a quick check of your field of vision, including your central and side (peripheral) vision. Your eye doctor or a technician will sit in front of you and ask you to cover one eye. They will then move their hand in and out of your field of vision from the sides and have you tell her when you can see it.
Cover Test
This simple test measures how well the eyes work together. The doctor will have you fix your gaze on an object, cover one eye, pause, and uncover it. They are evaluating your eye as it is uncovered and re-fixes on the target. The cover test helps to detect crossed eyes (strabismus), lazy eye (amblyopia), or a decrease indepth perception.
Color Blindness Test
You may be shown a series of images called Ishihara color plates to test your ability to distinguish shades of red from shades of green, or blues from yellows. Both types of color blindness are congenital (inherited) traits and very rare—so rare, in fact, that there are no official guidelines for including the Ishihara test in a routine eye exam, according to the AAO.
What Do Color Blind People See?
Retinoscopy
Retinoscopy is a test that gives your eye doctor a way to measure refraction. Usually performed early in an exam, retinoscopy provides your doctor a starting point to estimate your prescription for glasses, if needed.
Refraction
This will be repeated using different lenses and combinations of lenses until the doctor determines which will correct your vision most adequately. The results of a refraction test are primarily what the doctor uses to develop your finaleyeglassand/or contact lens prescription.
Slit Lamp Examination
To examine the front and back of your eye as part of an overall test of general health, the doctor will use an instrument called a slit lamp, or biomicroscope. It both magnifies the eye many times and illuminates it with a bright light so individual structures can be examined, including the lids and lashes, conjunctiva (the membrane that lines the eyelid and white of the eye), cornea, iris,lens, and anterior chamber. This will reveal any defects or diseases of the eye, such ascataracts.
Applanation Tonometry
Some physicians prefer to measure eye pressure with the “air puff test” in which a non-contact tonometer (NCT) exerts a painless puff of air onto the cornea to measure the pressure. This, however, is considered to yield less accurate results.
Retinal Examination
Sometimes called funduscopy orophthalmoscopy, this typically is the last step in a comprehensive eye examination. It starts withpupil dilation. Your eye doctor will place drops of a medication that will cause your pupils (the black circle in the very middle of the colored part of the eye) to increase in size. This gives the doctor a larger window through which to inspect the inside structures of the eye, including theretina, vitreous,optic nerve, blood vessels (choroid), and macula.
It takes 20 to 30 minutes for your pupils to fully dilate. You may stay in the exam chair while this is happening or be asked to return to the waiting room.
Once you’re dilated, the doctor will put an instrument called abinocular indirect ophthalmoscope(BIO) on their head. This frees their hands so that he can operate a powerful lens on the BIO that emits light into your eye, allowing him a clear view of the entire back of the retina and the optic nerve. (When the pupil isn’t dilated, only small portions of the retina and nerve are visible.) The dilated fundus examination is a crucial part of an eye exam, as many eye diseases can be detected with the test.
Your doctor will be able to share the results of your exam while you’re still in the exam room.
Normal results from an eye exam include:
Because so many different aspects of visual acuity and eye health are evaluated during a comprehensive eye exam, it’s possible to have just one abnormal result among a long list of normal ones. A few examples include:
If the visual acuity test showed that you need corrective lenses or a change to your current prescription, your eye doctor will write that out for you. You can use that to purchase contacts, pick out frames for an entirely new pair of glasses, or simply have your current eyeglass lenses swapped out at a shop of your choosing.
You will also need to submit a copy of this prescription if you are buying from an online retailer. If you want to try contact lenses, you will need to schedule aseparate examto be fitted for them.
You will then be free to leave. If you want to put contact lenses back in, ask if it’s OK to do that. Note, though, that wearing contacts may be irritating while your pupils are still dilated.
You also will want to put on the sunglasses you brought before you head outside, especially if it’s really bright. Your vision may be a bit blurry for several hours. If you brought someone to drive you, let them, or take public transportation, a taxi, or a car service.
Nearsightedness vs. Farsightedness: What Are the Differences?
If the visual acuity tests show that your distance vision is 20/30 or better (there is such a thing as 20/15 vision), that you are able to read at a normal distance, that you don’t have astigmatism, and that your overall eye health is normal, you will not need to be tested until your next exam.
If your doctor discovered a problem with the health of your eyes, such as glaucoma or cataracts, you will need more testing and/or treatment to address the issue directly. The same holds if your exam revealed signs of a non-ophthalmological disease or condition that can be detected via an eye exam. In that case, the doctor will refer you to your primary care physician or to a specialist.
According to the U.S. Centers for Disease Control and Prevention, as many as 93 million adults in the United States are at high risk for vision loss, but only half have seen an eye doctor in the past year. Fewer than 15 percent of preschool children get an eye exam.
Most eye problems can be detected before they cause symptoms or serious vision problems, so it makes sense to be proactive and have a checkup (or make sure your family members do) regularly. It only takes an hour or so of safe and painless testing to make sure that you and your loved ones are able to view the world clearly and with healthy eyes.
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Ophthalmology.Your Eyes Could Be the Windows to Your Health.American Optometric Association.Comprehensive eye exams.Standard eye exam. MedlinePlus Medical Encyclopedia.Hirshfield GS.Can a Dilated Eye Exam Harm My Unborn Child?American Academy of Ophthalmology.The 8-Point Eye Exam. American Academy of Ophthalmology.American Academy of Ophthalmology.How Color Blindness Is Tested.Chatziralli IP, Kanonidou ED, Keryttopoulos P, Dimitriadis P, Papazisis LE.The value of fundoscopy in general practice. Open Ophthalmol J. 2012;6:4-5. doi:10.2174/1874364101206010004American Optometric Association.Championing children’s eye care.Additional ReadingAAO.What to Expect When Your Eyes Are Dilated. Sept 1, 2017.AAO.The 8-Point Eye Exam. May 24, 2016.American Academy of Opthalmology (AAO).Can a Dilated Eye Exam Harm My Unborn Child?Mar 10, 2015.American Refractive Surgery Council.5 Reasons Why You Should Get an Eye Exam Annually. July 3, 2018.Cleveland Clinic.Optometrist or Ophthalmologist: Which Is Best for Your Eye Care?June 29, 2017.Mayo Clinic.Is it necessary to have my eyes dilated during every eye exam?Feb 7, 2018.National Eye Institute.Get a dilated eye exam.
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Ophthalmology.Your Eyes Could Be the Windows to Your Health.American Optometric Association.Comprehensive eye exams.Standard eye exam. MedlinePlus Medical Encyclopedia.Hirshfield GS.Can a Dilated Eye Exam Harm My Unborn Child?American Academy of Ophthalmology.The 8-Point Eye Exam. American Academy of Ophthalmology.American Academy of Ophthalmology.How Color Blindness Is Tested.Chatziralli IP, Kanonidou ED, Keryttopoulos P, Dimitriadis P, Papazisis LE.The value of fundoscopy in general practice. Open Ophthalmol J. 2012;6:4-5. doi:10.2174/1874364101206010004American Optometric Association.Championing children’s eye care.Additional ReadingAAO.What to Expect When Your Eyes Are Dilated. Sept 1, 2017.AAO.The 8-Point Eye Exam. May 24, 2016.American Academy of Opthalmology (AAO).Can a Dilated Eye Exam Harm My Unborn Child?Mar 10, 2015.American Refractive Surgery Council.5 Reasons Why You Should Get an Eye Exam Annually. July 3, 2018.Cleveland Clinic.Optometrist or Ophthalmologist: Which Is Best for Your Eye Care?June 29, 2017.Mayo Clinic.Is it necessary to have my eyes dilated during every eye exam?Feb 7, 2018.National Eye Institute.Get a dilated eye exam.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Academy of Ophthalmology.Your Eyes Could Be the Windows to Your Health.American Optometric Association.Comprehensive eye exams.Standard eye exam. MedlinePlus Medical Encyclopedia.Hirshfield GS.Can a Dilated Eye Exam Harm My Unborn Child?American Academy of Ophthalmology.The 8-Point Eye Exam. American Academy of Ophthalmology.American Academy of Ophthalmology.How Color Blindness Is Tested.Chatziralli IP, Kanonidou ED, Keryttopoulos P, Dimitriadis P, Papazisis LE.The value of fundoscopy in general practice. Open Ophthalmol J. 2012;6:4-5. doi:10.2174/1874364101206010004American Optometric Association.Championing children’s eye care.
American Academy of Ophthalmology.Your Eyes Could Be the Windows to Your Health.
American Optometric Association.Comprehensive eye exams.
Standard eye exam. MedlinePlus Medical Encyclopedia.
Hirshfield GS.Can a Dilated Eye Exam Harm My Unborn Child?American Academy of Ophthalmology.
The 8-Point Eye Exam. American Academy of Ophthalmology.
American Academy of Ophthalmology.How Color Blindness Is Tested.
Chatziralli IP, Kanonidou ED, Keryttopoulos P, Dimitriadis P, Papazisis LE.The value of fundoscopy in general practice. Open Ophthalmol J. 2012;6:4-5. doi:10.2174/1874364101206010004
American Optometric Association.Championing children’s eye care.
AAO.What to Expect When Your Eyes Are Dilated. Sept 1, 2017.AAO.The 8-Point Eye Exam. May 24, 2016.American Academy of Opthalmology (AAO).Can a Dilated Eye Exam Harm My Unborn Child?Mar 10, 2015.American Refractive Surgery Council.5 Reasons Why You Should Get an Eye Exam Annually. July 3, 2018.Cleveland Clinic.Optometrist or Ophthalmologist: Which Is Best for Your Eye Care?June 29, 2017.Mayo Clinic.Is it necessary to have my eyes dilated during every eye exam?Feb 7, 2018.National Eye Institute.Get a dilated eye exam.
AAO.What to Expect When Your Eyes Are Dilated. Sept 1, 2017.
AAO.The 8-Point Eye Exam. May 24, 2016.
American Academy of Opthalmology (AAO).Can a Dilated Eye Exam Harm My Unborn Child?Mar 10, 2015.
American Refractive Surgery Council.5 Reasons Why You Should Get an Eye Exam Annually. July 3, 2018.
Cleveland Clinic.Optometrist or Ophthalmologist: Which Is Best for Your Eye Care?June 29, 2017.
Mayo Clinic.Is it necessary to have my eyes dilated during every eye exam?Feb 7, 2018.
National Eye Institute.Get a dilated eye exam.
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