What to Expect at a Comprehensive Eye Exam

Unlike a quick vision screening using the Snellen eye chart, comprehensive eye exams at Eye to Eye Family Vision Care in Sapulpa, OK, provide a full picture of your eye health, from vision testing to anatomical assessments. Among other things, our eye exams include assessments of your intraocular pressure, retina, and optic nerve – so your doctor can detect conditions like glaucoma and macular degeneration early. Complete eye exams utilize innovative testing and screening tools to evaluate peripheral vision, the cornea, the lens, and the retina. These are a far cry from the bare-minimum exams administered at schools or the DMV. When you leave our office after a comprehensive eye exam by our own Dr. Cook or Dr. Morrison, you’ll have an accurate lens prescription and any further information you need to proactively protect your eye and vision health. After more than 28 years serving families in the Sapulpa, OK, region, Eye to Eye Family Vision Care has become the area’s go-to optometrist for complete eye exams for patients of all ages.

What Makes a Comprehensive Eye Exam Different?

We can tell quite a bit about a patient’s visual acuity (the clarity and sharpness of their vision) from a basic eye chart reading. And with a couple of extra steps, those standard eye chart vision screenings tell us which prescription is best for short-, medium-, and long-distance vision. From that, we can prescribe contact lenses and eyeglasses. However, this type of basic vision screening doesn’t tell us anything about the health, anatomy, and functionality of your inner eye. For that, you need a comprehensive eye exam.

During a comprehensive eye exam, which we’ll explain in detail below, we determine:

• Vision prescription.
• Eye muscle coordination.
• Scope of your peripheral vision.
• Eye pressure.
• Corneal health.
• Retinal health.
• And more.

Many of the most serious eye conditions are asymptomatic (meaning you may not experience any symptoms). So, comprehensive eye exams are the only way to catch early signs and provide patients with the treatment they need to preserve vision health.

Best of all, many health insurance companies cover part or all of the cost of comprehensive eye exams once a year.

How to Prepare For Your Appointment

A comprehensive eye exam typically takes between 30 and 60 minutes. It’s important that you bring a copy of your most current vision prescription (if you have it and didn’t get it from our office), along with your current eyeglasses. You should also bring an updated list of your current medications and supplements. Your general physical health and vision health are closely linked. Plus, vision care may differ for patients with certain medical conditions or those taking serious prescription medications. The more we know about your current medical history, the better we can serve you.

Other things you can do to support the most accurate results from your complete eye exam are to:

• Wear your contact lenses to your appointment. Bring that prescription with you if you did not get it from our office.
• Bring a list of any known eye conditions (past and present).
• For a comprehensive exam, we plan to dilate your eyes so we can fully evaluate the health of the inside of the eye. Dilated pupils lead to light sensitivity and blurred vision at near. If you feel that dilation could make driving difficult, please bring a driver to your appointment or we can schedule you back on a day you have a driver.

Reminder of what to bring to your comprehensive eye exam appointment:

• Current vision prescription (if you have it).
• Current eyeglasses.
• List of any known eye conditions.
• List of current medications and supplements.
• A general description of current/historical medical history.
• A friend or loved one to drive you home if your pupils will be dilated and you prefer to have a driver. Most people are comfortable driving home after dilation.

What Happens During Your Eye Exam

Your eye exam is conducted methodically, and none of the tests are painful or overly uncomfortable. If you’re feeling nervous or have questions, please let us know. We want to make sure patients feel as relaxed and comfortable as possible. There is nothing to be afraid of. In fact, many of our patients find these diagnostic exams fun because few take very long and almost all are interactive in some way. The time we spend together helps us get to know each other better and learn more about you and your family.

Here is a step-by-step description of what happens during a comprehensive eye exam.

Step 1. Medical and vision history

Once we’ve greeted you and checked in on how you’re feeling in general, one of our competent staff members or Dr. Cook/Dr. Morrison will ask questions about any current vision complaints, medical history, and family vision/medical history. We’ll also want to review your list of current medications. If this is your first time visiting us here at Eye to Eye Family Vision Care, this part may take a few more minutes than normal as we enter all of the information into our system.

This is a very important first step. As mentioned above, physical and eye health are connected. Certain health conditions put you at risk for particular eye conditions, such as diabetic eye diseases, glaucoma, macular degeneration, and others. We want to identify any risk factors, so we keep a close eye (pun intended) on them from year to year.

Step 2. Visual Acuity Test

Visual acuity is the most familiar part of the exam. During the acuity test, you’ll read letters one by one from the Snellen eye chart. If this is a pediatric eye exam and your child is not reading yet, we have a range of additional charts and measures to assess their acuity.

This test is very low stress. All you have to do is sit there in the chair and identify letters, line by line, from larger to smaller. This is the beginning of establishing a baseline for your refractive error, which is the way your eye bends the light to form clear images. Any anatomical changes that alter how that process happens create larger errors, leading to blurred images.

Step 3. Refraction Test

The refraction test measures the degree of refractive error, so we can prescribe the correct lens(es). To do this, we use a machine called a phoropter, which looks like an oversized, flat pair of binoculars that contains various lenses with increasing degrees of refraction.

You’ll continue looking at various versions of the Snellen eye chart, often projected onto the wall in front of you, as we try various combinations of lenses. We say, “Which is better: one or two? Two or three?” and we continue changing the lens combinations until we find the right pair to bring things into clear focus.

In some cases, we’ll learn that the most stable prescription is the one you have. Other times, one or the other eye may need additional support, and we’ll give you a new, more accurate prescription.

Step 4. Eye Muscle and Alignment Tests

This part of the exam is very quick, usually taking less than two or three minutes. Part of it takes place with both eyes, and for a step or two, we use a concave eye cover on a stick and cover one eye at a time. Each assessment allows us to evaluate how the eye muscles move and whether they move in alignment. The uncovered eye is tested for:

• Ocular motility. This is an evaluation of how your eyes move when they track light or a moving target.
• Color vision. We use the Ishihara plates, which feature a series of colored dots in various patterns, to assess how your eyes perceive color.
• Depth perception. Some vision changes or brain changes alter depth perception. We use a stereopsis test to evaluate 3-D vision and assess how well your eyes work together.

Again, most of these tests take just a couple of minutes or less. These are the tests we use to diagnose conditions like strabismus (wandering or crossed eyes), amblyopia (lazy eye), or binocular vision problems, which occur when your eyes don’t coordinate well, leading to issues with reading or depth perception.

Step 5. Visual Field Test

Peripheral vision refers to what you can see in the field outside of your central sight line without moving your eyes or your head. Peripheral vision range shrinks or disappears with certain eye conditions like glaucoma or with certain brain changes caused by neurological conditions. We perform a cursory check, called a confrontation visual field, by having the patient cover one eye and we present a peripheral object to check the ability and degree at which they can see. If this seems abnormal we schedule you back for a comprehensive, automated visual field test to examine the range of your peripheral vision.

Many of our patients find this test to be meditative in its stillness. You sit and stare straight ahead into the machine and let us know, saying “yes,” when you notice flashes of light in the peripheral.

Step 6. Eye Pressure Test

Eye pressure tests measure intraocular pressure (IOP), the pressure inside the eye. We use this test to determine whether a patient may have glaucoma - a condition where the pressure inside the eye is higher than it should be. Glaucoma is one of those conditions that doesn’t usually have any symptoms until it progresses beyond the point where we can treat it effectively.

Here at Eye to Eye Family Vision Care, we use the iCare tonometer device. This is a hand-held device that doesn’t require numbing eye drops or the dreaded “puff of air” you may have experienced in the past at other offices. Instead, our iCare device utilizes a light, disposable probe that delivers the gentlest of taps on the cornea. It doesn’t hurt at all. In fact, the tap is so light that some patients don’t feel it at all.

Another version of the test is called applanation tonometry. In this version, we add numbing drops to the eye's surface. These feel just like regular eye drops, and the numbing effect wears off long before you leave our office. While the surface is still numb, the optometrist uses a device to gently tap the eye's outer surface to measure the rebound. Because of the temporary numbing agent, you won’t feel a thing. We only use applanation topometry for specific cases, so you’re most likely to have the iCare version here.

Step 7. Slit Lamp Examination

Here’s another step where all you have to do is sit down, relax, and follow our instructions while we use a specialized microscope to inspect the interior of your eye through your pupil. We adjust the machine to match your seated height, and you’ll rest your chin on the chin support.

The light we shine into the eye is quite bright, so you may blink more than usual, but it shouldn’t hurt. If you experience any discomfort, you let us know, and we’ll adjust accordingly. You’ll be asked to do things like look left or right, up or down, without moving your head.

The slit lamp examination is our chance to look for any signs of cataracts, corneal abrasions (scratches on the cornea, which you may not feel), anterior uveitis (inflammation of the middle wall of your eye), and early signs of any changes in your eyes’ lenses.

Step 8: Pupil Dilation and Retinal Examination

Pupil dilation allows us to widen the pupil, providing a better view of the retina and retinal blood vessels, the macula, and the optic nerve. The dilation is performed with drops that take about 15 to 20 minutes to take effect. Once they are wide, you’ll be more sensitive to light, and things will usually appear blurry for a while. This is why we ask that you have a safe ride home from the office. This could be a friend or family member, a rideshare driver, or you can drive yourself home if you feel comfortable, as distance vision only becomes slightly blurry. We compare dilated driving to driving at night if you have mild night vision.

A retinal examination with pupil dilation is not part of every comprehensive exam, but it is used to detect signs of some of the more serious eye conditions that affect vision, such as macular degeneration, diabetic retinopathy, or retinal tears. Your optometrist is most likely to recommend it based on age, risk factors, and your vision or medical history. Some offices, including ours, appreciate having a baseline retinal examination for first-time patients.

Step 9. Advanced Imaging or Optical Coherence Tomography (OCT)

Optical Coherence Tomography, or an OCT exam, is another optional test, typically recommended based on other clinical findings. It is comparable to an ultrasound, but it uses light instead of sound to create detailed cross-sectional images of the optic nerve and retina. Our office is also equipped with a retinal camera, which captures detailed photographs of the back of the eye so subtle changes can be tracked from visit to visit.

As with some of the other tests, you sit still in front of the machine, looking straight ahead at a target image. This keeps your eyes as still as possible while the machine creates the OCT images. When we review the images, we look for subtle retinal or optic nerve changes before they become visible on standard ophthalmoscopy. We are proud that our office offers such a high-tech testing option, saving our patients from the time and energy required to travel elsewhere if needed.

What Your Doctor Is Looking For

Ultimately, the comprehensive eye exams provided by optometrists are looking for any issues that affect vision or the health of your eyes. Most commonly, this includes:

• Nearsightedness (myopia).
• Farsightedness (hyperopia).
• Natural age-related changes that lead to blurriness (presbyopia).
• Astigmatism (which can cause blurriness both near and far).
• Issues with eye muscle movement/coordination (amblyopia or strabismus).
• Signs of cataracts.
• Glaucoma.
• Macular degeneration.
• Retinal tears.
• Corneal scratches.
• Diabetic retinopathy.
• And others.

We also look for signs of disease markers that show up in the eyes, such as:

• High blood pressure (which can show up in the eye’s vascular system and may be the first sign of hypertension if a patient hasn’t had their blood pressure taken in a while).
• High cholesterol (evidenced by changes in the cornea).
• Inflammation of the optic nerve (a sign of multiple sclerosis).

So, can an eye exam detect multiple sclerosis or other systemic diseases? Yes. However, we never make a formal diagnosis of a disease outside of our field. If we detect signs of systemic disease during an eye exam, we will let you know and recommend that you schedule an appointment with your general physician as soon as possible.

After Your Eye Exam

Can you drive home after an eye exam? Yes, in most cases you’ll be able to drive immediately after your exam. The exception is patients who don’t feel comfortable after pupil dilation, in which case you should get a ride home or plan to wait at least an hour after your appointment before driving. You’ll also want a dark pair of sunglasses to minimize light sensitivity after pupil dilation.

If you have a new lens prescription, we’ll provide it in print and via email, if requested. You can use that to select glasses at our office. The prescription can also be used at any authorized eyeglass vendor.

In most cases, we recommend adults between 18 and 40 - and without risk factors - to schedule their next appointment in the next one to two years. Adults between 40 and 60 should have an exam every year, prioritizing annual exams if there is a vision prescription or if presbyopia is an issue. Adults 60+ typically get eye exams every year.

If you have a diagnosed eye disease or are at increased risk of eye disease due to your medical history, we may recommend scheduling eye exams every 6 months.

Eye exams are easy to schedule online.

Frequently Asked Questions

1. Does a comprehensive eye exam hurt?

No. All of the tests involved in a complete eye exam are painless. That includes a tap on the eye's surface during a tonometry test. Those may startle the patient, causing an instinctive blink reflex, but there is no pain involved. Even light-sensitive patients don’t tend to feel much discomfort because we prepare them for the light and the test is relatively short.

2. How long does a comprehensive eye exam take?

Most patients are in and out of our office within 60 minutes. If you need pupil dilation and a retinal exam or an OCT exam, the appointment could take as long as 90 minutes. The appointment window may also be longer if you opt to select eyeglass frames in our office after your appointment.

3. Does a routine eye exam include dilation?

No, not necessarily. At Eye to Eye Family Vision Care, Dr. Cook and Dr. Morrison decide on dilation based on your age, medical history, and clinical findings. Patients over 40, diabetic patients, and those with a family history of retinal disease are more likely to need dilation.

4. What should I bring to my eye exam?

Bring your current eyeglasses or contact lenses, your medical and vision insurance card, a list of any medications you take, and the names of any eye conditions you have been diagnosed with.

5. What is the difference between a basic and a comprehensive eye exam?

A basic or screening exam checks only visual acuity (the eye chart). A comprehensive exam evaluates the full health of your eyes, including eye pressure, peripheral vision, the cornea, the lens, and the retina. A school or DMV vision screening cannot detect glaucoma, cataracts, or early signs of diabetic eye disease.

6: How often should I get a comprehensive eye exam?

Adults with no known eye conditions or risk factors are generally recommended to have a comprehensive eye exam every 1 to 2 years. Adults over 60 and those with diabetes, high blood pressure, a family history of glaucoma, or other risk factors should be seen annually.

7. Can an eye exam detect health conditions beyond the eyes?

Yes. The retina is the only place in the body where blood vessels can be viewed directly without surgery. Eye exams can reveal signs of high blood pressure, diabetes, high cholesterol, and, in some cases, optic neuritis, which can be an early marker for multiple sclerosis. This is one reason annual exams matter even when your vision feels fine.

Schedule Your Comprehensive Eye Exam at Eye to Eye Family Care

For nearly 30 years, Eye to Eye Family Vision Care has provided attentive, compassionate, and expert eye care to Sapulpa, Oklahoma, families. Give our office a call at (918) 227-3937 or contact us online to schedule your comprehensive eye exam. We promise to provide the very best level of care to each and every one of our patients. Everyone is welcome here.