What is an Eye Exam? An eye exam is more than just an eye chart – it is a complete, comprehensive exam and detailed examination of your visual ability, vision and eye health. This examination is defined in regulation under Ontario’s Health Insurance Act as:
1. Relevant History (ocular medical history, past medical history, family history) In this step, your optometrist will assess your past and current medical history, and the medical history within your family, in order to determine your risk factors for certain eye health conditions and overall health conditions that may affect your eyes. Your ocular history – incidences of eye conditions, prescriptions, eyewear, work with any other eye doctors, etc – will also be assessed. 2. Visual Acuity Examination As a baseline, your optometrist will examine your visual acuity by means of an eye chart. The placement, sizing and gradations on the eye chart will help your optometrist gauge your current visual acuity (the clearness of your vision). 3. Ocular Motility Examination In order to determine how well your eyes and visual system function in terms of movement, reflexes and tracking, your optometrist will conduct a number of motility tests to determine if there are any underlying problems with your ocular motility that may need remediation, or be symptomatic of other physiological or neurological conditions. 4. Refraction and the Provision of a Written Refractive Prescription if Required As part of this step, a phoropter or similar device can be used to determine rate of refractive error and determine the standards and measurements needed to inform a prescription for eyeglasses if one is needed. A series of lenses and settings are used to assess refractive error in your vision and define any corrective prescription. 5. Slit Lamp Examination of the Anterior Segment (Biomicroscopy) A slit lamp is used to shine a high intensity light into the eye to facilitate an examination of the anterior segment of the human eye – including the conjunctiva, iris, natural crystalline lens and the cornea. The binocular slit-lamp examination provides a stereoscopic magnified view of the eye structures in detail, enabling anatomical diagnoses to be made for a variety of eye conditions. 6. Ophthalmoscopy by one of Direct, Binocular Indirect Ophthalmoscope, Monocular Indirect Ophthalmoscope or Non Contact Fundus Lens Ophthalmoscopy is a test that allows your optometrist to see inside the fundus of the eye and other structures (including the retina, optic disc, macula and fovea). This is conducted to help detect symptoms of conditions such as retinal detachment or glaucoma. 7. Advice or Instruction to the Patient Pending your individual needs for care and follow-up, your optometrist will provide advice and/or referrals on a case by case basis. At this time, your optometrist will also advise you on how often to return for an eye exam.
And if required in accordance with generally accepted professional standards, any or all of the following elements may be included in the eye exam: 1. Tonometry Tonometry is conducted by your optometrist in order to determine the intraocular pressure, the fluid pressure inside the eye. It is an important test in the evaluation of patients with glaucoma and to assess risk factors for glaucoma. 2. Visual Field examination by Confrontation Field A visual field examination is used to detect and measure visual field loss. Visual field loss is the condition of having lost degrees of peripheral vision as a result of one or more eye health conditions. Such conditions may be of the eye alone, of the optic nerve or of the brain. Your optometrist can help determine causal factors in any visual field loss and implement a referral if needed. 3. Dilated Fundus Examination by one or more of Direct, Binocular Indirect Ophthalmoscope, Monocular Indirect Ophthalmoscope or Non-Contact Fundus Lens Similar to the fundus examination mentioned above, but with the pupils dilated to enhance what your optometrist can see during the examination. The Prescription If the eye examination reveals that a vision problem exists and treatment with eye glasses or contact lenses is recommended, all of the information obtained from the examination is considered and a formula for eye wear is then determined. That formula becomes the prescription and cannot be determined unless all of the above elements of an examination have been performed and the results considered together. The portion of the eye examination that assesses the refractive system of the eye in isolation has been described as a “refraction test” by the College of Opticians. A prescription for eye wear cannot be determined simply on the basis of the “refraction test” alone. Providing eye wear is merely one component in overall vision health. There are many conditions that affect vision and often times the patient’s focus is more on the symptoms, rather than on the condition itself. Optometrists are trained to diagnose the underlying causes and to ensure a full scope of eye and vision healthcare, to refer patients to other healthcare providers if needed. What is the Difference Between an Eye Test and an Eye Exam? The official terminology in use in Ontario is Eye Exam. It may in some cases be referred to as an “eye test” but in general such a term may be used to cover many different types of tests and procedures and is not fundamentally the same as the official Eye Exam or Eye Examination What does an Eye Exam cost? The cost of an eye exam will vary. OHIP provides eye exam coverage for patients aged up-to-and-including 19 years of age, and for patients 65 years of age and older. For others, there may be dispensation available from OHIP for certain eye health and overall health conditions that would influence the coverage of the eye exam. Optometrists are free to set their own fee schedule based on the market costs of business in most other cases. For more information on how eye exams are covered by OHIP, click here. What are the Differences Between the “Three O’s” – Optometrists, Ophthalmologists and Opticians? Optometrists Optometrists are your primary care eye doctors. Doctors of optometry are trained to provide the best standards of comprehensive eye care, ranging from an assessment and review of overall eye health and visual function, to informing a prescription for eyeglasses or referring for secondary treatment by an ophthalmologist with surgery or drugs. Optometrists are your frontline care providers in eye health. Ophthalmologists Ophthalmologists are medical doctors who have completed specialized residency training in the study, diagnosis, and treatment of eye disease. They are secondary-level health care providers and they usually use drugs and/or surgery for treatment. A person that requires ophthalmological care (to obtain cataract surgery, for example) would usually require a referral from the optometrist or family doctor. Opticians Opticians are trained through a college program to fabricate and fit vision aids on the prescription of an optometrist or physician. Opticians are licensed to provide spectacles, and they may also dispense contact lenses and other optical aids. They do not assess, diagnose, or treat eye conditions, nor do they write out prescriptions for eyeglasses or contact lenses.