The Dreaded Eye Exam

An eye exam can be a pretty traumatic experience for some people. For others, it may just be frustrating. Why exactly are we poking and prodding at your eyes so much, when all you wanted was a pair of glasses? I think if we can clarify exactly what goes on at the eye doctor’s office, it can all be a little less scary, and a lot less exasperating. When you see your optometrist for an eye exam, the doctor will evaulate your visual system in four general areas.
These are your…

  1. refractive error: what sort of glasses or contacts prescription will have you potentially seeing your best? Patients sometimes get a little anxious during this part of the exam, worried that if they make one mistake in choosing which one is better — one? …or two? — then they will have a bad prescription and it will ruin their eyes for life. This simply is not true. From our very first classes in optometry school, we as optometrists are trained in different methods to get to the right prescription even if you couldn’t tell us which one is better. A key part of those methods is to check, and double check, your responses. So don’t worry if you’re not 100% sure which one is better every once in a while. Or if they look the same to you — just tell us that; because that just means we’re getting closer to getting you the right prescription;
  2. binocular vision — how well do your eyes work together as a team? There is a particular direction that each eye would like to point at when it’s resting. In order to clearly see an object, however,  your eyes have to overcome that resting position and point at the object instead — otherwise, you may see two images of that object. How well your eyes can do this together is what’s referred to as binocular vision. In some cases, where a person occasionally gets double vision, there are eye exercises and special prism lenses that can help him or her see single again. In other cases of double vision, there may be something more serious preventing the eyes from working together, requiring futher medical evaluation and treatment;
  3. ocular health — are there any subtle (or not so subtle) signs in your eyes of disease that could potentially affect your vision, or even your general health? This is the reason we like to put those dilating eye drops in your eyes that make your pupils so large and pretty. The dilation allow us to get a good look inside your eyes and make sure everything is healthy. This is also the reason some doctors may blow a puff of air into your eyes. That puff lets us measure the pressure in your eyes. Many eye diseases can develop gradually and so quietly, that you won’t notice any symptoms at all until they have progressed signifcantly. Fortunately, for many of these conditions, an optometrist can see their signs and diagnose them early enough to recommend treatments. There are also a number of systemic conditions, such as hypertension and diabetes, that show specific signs within the eye to help us diagnose and make recommendations on their treatment. And finally;
  4. visual perception — is the picture of the visual world getting back to your brain properly, and is it being interpreted correctly? Sometimes, even when the eye itself is in perfect health, and there’s no need for a new glasses prescription, you may still have trouble seeing things the way everyone else does — and that’s not meant to be metaphorical. A simple and most often benign example is color blindness (or color deficiency).  The inability to differentiate certain colors in the same way that everyone else does can be of little consequence if it’s congenital, but it can be very serious if it’s acquired.

An eye doctor needs to evaluate each of these four areas in order to be certain that there really isn’t anything wrong with your eyes or your vision. As I said, a lot of things can go wrong without you noticing any symptoms until it’s too late. This is why it’s important for you to get a regular eye exam — at least once every two years, and even more frequently if you have any eye conditions or are particularly near-sighted. Hopefully now all the tests we do are a little less mysterious; and perhaps going through all the different tests as a patient will be a little less frustrating.

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