Ask Dr. Pat · Health

Eye “Doctors” and Eye Examinations

For healthy adults, the American Academy of Ophthalmology recommends a complete eye examination at 40 years of age, again at 65 years of age, and then every one or two years after that.  Your eyes may be examined by your medical doctor in the course of a general physical examination and this may lead to a referral to an Eye MD if he sees any signs of disease in your eye, but the general rule above should be followed despite a normal physical exam.

Whether you have your eyes examined by an optometrist or an Eye MD, may depend on your needs, access, what type of eye disease you have, and/or costs – costs being higher for an Eye MD.  Obviously, if you need surgery for cataracts, glaucoma, retinal detachment you will have to see an Eye MD.  There are three times as many optometrists available around the country as there are Eye MDs, so access to Eye MDs may be more difficult.   In many practices around the country, Eye MDs and optometrists work together and you may see them both if you go for a complete eye examination in many practices or clinics.   It goes without saying that some doctors are better than others and even “good” doctors are not infallible.  If you have any unanswered questions or unresolved issues regarding your eye care after you have been seen, this may warrant a second opinion by a disinterested Eye MD.

So that you may be prepared, it helps to know what is involved in a complete eye examination.  Your medical, surgical, and ocular history, as well as the medications you are taking and any allergies to medications you may have, are all important for you doctor to know and ask about.  Also make sure you bring your glasses and contact lenses with you. Visual acuity is tested and a refraction (improving one’s vision with glasses) is performed to determine best-corrected visual acuity.  External anatomy around the eye (including the eyelids, tear ducts, eyelashes) is examined.  The movement of the eyeballs and their alignment is tested. Pupillary function is tested (as it is in most medical and neurologic examinations).  The eyeballs are then looked at in a “slit-lamp biomicroscope”, where details of the front surface and inside of the eyeball can be seen.  Intraocular pressure (which is different than, and relatively independent of blood pressure) is then determined.  This is usually preceded by the instillation of anesthetic eyedrops to numb the eye to help prevent blinking.  The pupils should then be dilated by using different eyedrops allowing a good view for detailed examination of the inside of the eyeball.  Once the pupils are dilated, a better look at the crystalline lens (to check for cataract) can be obtained.  Examination of the back of the eye includes the retina (the central portion of which is the macula with the Fovea Centralis in the very center- see Figure), the retinal blood vessels, and the optic nerve.  This latter part of the examination is done with an ophthalmoscope which means shinning a bright light in your eye.  There are different devices to accomplish this part of the examination, and we now have sophisticated noninvasive diagnostic machines which can perform aspects of this examination in greater detail if your Eye MD feels this is warranted.

If you are visiting your eye doctor for a specific problem, such as when you have scratched your eye or some foreign material has gotten in your eye, you may not have a complete examination, or it may not even be possible.  Regardless, it is still important to prepare for a complete examination, as mentioned above.  Take good care of your eyes.

Wayne G. Whitmore, M.D, F.A.C.S.


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