Did you know there are 4 distinct parts to an eye exam as billable to insurance (both medical and vision plans alike)? If you are receiving less than stellar service, sometimes you don’t know it because some offices don’t regularly meet the minimum requirements of an exam. To view the minimum exam elements or minimum equipment list required by law in Illinois click on the respective links. These exam elements help make up the 4 parts of an eye exam:
- Patient medical, ocular, social, and family (medical and ocular) history. The patient history is the most important part of a visit; without it the doctor doesn’t know how s/he can help you. A lot of that boring entrance paperwork prior to your exam will streamline the conversation with the doctor, but each component from those questions should be reviewed with the doctor. Patient history should also include your reason for visit, and the doctor should be asking the right questions to illicit at least one aspect of your vision, health, or experience that might be made better for being at the eye doctor that day (it may be as simple as wellness visit for eye health and vision to provide piece of mind or as complicated as chronic or acute conditions that require medical visits). This history should feel like a conversation, and you should be able to share anything with your doctor that might impact your eye health or well-being.
- Ocular measurements. Often done by a technician, certain measurements using specialized equipment will give the doctor metrics of your eyes that provide context about your eyes. At some offices that specialized equipment is new and advanced to the latest standards including wavefront analysis, corneal topography map, macular pigment optical density measur
ments, and visual field mapping; at others these are rudimentary like a standard auto-refractometer, an air puff, and an auto-keratometry machine. At many offices attended by eye surgeons’ (ophthalmology) the refraction (determination of glasses) is considered among these tests and is therefore performed by a technician instead of a doctor. It is important that for each of these tests you place you chin down in the chin rest and you forehead forward against the strap so that the measurements can be as accurate as possible for the doctor.
- The visual acuity and refracion. When performed by a doctor of Optometry, these tests provide standardization of your current vision versus your vision with new glasses. It’s the quickest before and after presentation in the medical world. Usually you’ll “see results” in a before and after if you take a picture or measure something like bloo
d then modify behavior like exercise, diet or prescribed medication and measure again or take an after picture over the course of months or years. A glasses refraction should simply be a demonstration of your best vision. The phoropter (refraction machine) made famous by images like that of Justin Timberlake’s is nothing more than a modifiable giant pair of glasses. Doctors are asked daily, “should I get new glasses?” Sometimes the answer is so obvious, we doctors wonder why it needs to be asked, but not everyone gets the concept that this is a before and after: At the start of any good refraction, you put your current glasses on, test one eye at a time, and read the smallest print you possibly can while your doctor randomized the letters. You refrain from squinting, and the doctor asks the necessary comparison questions (longer doesn’t always mean better or worse — it just means that you are discerning and the office likely doesn’t have access to wavefront data). If you can read smaller letters than you started, you can certainly get better vision at distance if you update the glasses! If you cannot, then the numbers for near still need to be compared, but if new glasses are recommended it’s because your focus or near vision can be improved, not your distance vision. The decision to update prescription really is that simple. You start with the 20/30 and finish with 20/15 = buy new glasses and you’ll see two times the detail. You start with 20/50 in your better eye and finish with 20/20 = buy new glasses because you can remove the restriction for day-time only driving on your license. It’s all about before vs. after!
- The eye health exam. In our opinion, if this is the shortest part of the exam, you did not get a quality evaluation of eye health! It should be a detailed view of the lids, lashes, conjunctiva, cornea, iris, angle, lens, vitreous, and posterior aspect of the eye. Technology can make evaluation of the optic nerve, center of vision (macula), and blood vessels more efficient and more detailed, but overall if an office is focused on your eye health, the first investment should be in the equipment to manage your eye health.
In other words, the parts of an eye exam that frequently get shorted are history and eye health; the reason you came in and the most critical part of an annual eye exam!