Getting a thorough eye exam has always been about more than reading letters off an eye chart. That’s even more true today.
There are now innovations in standard tests and high-tech options with important benefits. Not every eye doctor offers them, but it could be worth your time to find one who does. Newer approaches…
• Taking your history. Your doctor should ask about your health, family history, medication use and any eye problems, such as blurry vision, floaters and trouble seeing at night.
Beyond the basics: Thorough questioning should zero in on how you use your eyes and, in particular, how many hours you spend each day looking at electronic devices. If you work at a computer for more than eight hours a day, ask your doctor if you need to use a blue-light filter to reduce eyestrain. If your monitor doesn’t have it built in, you can download an app or simply wear blue-light–filtering eyeglasses when you work.
• Eye pressure testing. This test screens for glaucoma, the buildup of fluid in the eye that can damage the optic nerve and cause blindness. The basic test can be done with a puff of air from a machine called a tonometer or with a device called an applanation tonometer, which is gently pressed on the front of the eye.
Beyond the basics: There is now a tonometer called the Ocular Response Analyzer that measures corneal hysteresis, the rigidity of the cornea, the eye’s clear protective outer layer. Another simple test can be used to measure the thickness of the cornea. These measurements help put eye pressure readings in perspective, since thicker or more elastic corneas may withstand more pressure. Results might help you avoid glaucoma medications you would otherwise be prescribed or alert your doctor to a problem that might have been missed. Ask your doctor about getting one or both of these tests.
• Retina exam. Every eye exam should include a check of your retinas, the light-sensing layer of tissue at the back of your eyes, to detect several conditions, including age-related macular degeneration, or AMD (retinal damage common with age that can ultimately lead to blindness). Changes in the retina and underlying blood vessels also can suggest health problems such as diabetes and high blood pressure. Traditional testing involves dilating your pupils and then using a strong light to look inside your eyes.
Beyond the basics: Optomap is a digital retinal scanner that doesn’t involve dilation. It takes pictures of the retinas, and the images can easily be shared with other health-care providers, if needed.
An additional new retina-testing option is optical coherence tomography, which uses light waves to take cross-sectional pictures of your retina and the vascular layers beneath it. Such images can help diagnose and track conditions, including AMD, glaucoma and diabetic eye disease. It might spot early signs of trouble and encourage preventive steps, such as taking supplements for eye health. I suggest it for all my patients over age 40. The findings of the test will determine how often it should be repeated.
• Visual field testing. Your visual field (the center and sides of your vision) can be affected by glaucoma, retina problems, flashes and floaters. For the basic screening test, you look straight ahead while the doctor moves his/her index finger from the side to the center and up and down to check your peripheral view.
Beyond the basics: More formal testing involves looking through a machine called a visual field tester. This measures an individual’s entire scope of vision—central and peripheral vision. It maps the visual fields of each eye individually and can detect blind spots and subtle areas of dim vision, as well as problems caused by glaucoma, stroke, brain tumors and pituitary diseases.
Have a baseline visual field test at age 50 or sooner if you have a history of pituitary disease, brain tumor or have suffered head trauma.
• Dark adaptation and macular-pigment testing. These are two new tests that can help spot AMD. Dark adaptation testing relies on a new machine called the AdaptDx. It measures how quickly your eyes adjust when switching from a light to a dark environment, mimicking what happens when you walk into a movie theater or turn off the light at night. Slow adjustment can be an early warning sign of AMD—and an opportunity to take preventive steps such as improving your diet.
The second test involves using a machine called a macular pigment screener. It measures your level of macular pigment—a low level is a risk factor for AMD. If you have a family history or early signs of AMD or drusen (deposits under the retina that raise risk for macular degeneration), ask your doctor when you should have these tests.
Before your next eye exam, call eye-care offices near you and ask which of these tests they offer and the charges. The new optional tests will likely add from $35 to more than $100 each (depending on where you live) to the basic exam fee and are less likely to be covered by insurance than the basic exam. But the investment is well worth it.
A NOTE ON EYE PROFESSIONALS
Most eye exams are done by optometrists, doctors trained to detect and treat most eye problems and diseases but who are most focused on vision care. Exams also can be done by ophthalmologists, specialized medical doctors who perform surgery and prescribe a full range of medications, and who are most focused on eye health and diseases that affect eye health. An optician is the professional who fills your doctor’s prescription for eyeglasses or contact lenses and helps you make frame choices and perfect their fit.
There is now at least one online service offering basic testing for eyeglasses or contact lens prescription renewals. This service may be OK in a pinch—if you’ve lost your glasses and cannot see your provider right away, for example, but it does not check your eye health. It’s no substitute for a yearly in-person exam.