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Complete Comprehensive Ocular & Retinal Exam
Having a complete, comprehensive eye exam every year is the best way to enjoy and maintain your vision throughout your life. During a Complete Comprehensive Ocular & Retinal Exam, your eye doctor will perform several different tests and procedures to check your vision as well as the overall health of your eyes. A comprehensive Retinal eye examination includes examination and diagnostic testing. It will consist of the following parts:
The Vital Signs of Your Eye:
History of Your Eyes
We will ask how your vision has been affecting your life and how it appears to you. These questions are very important to the doctor in helping them determine the best way to treat and preserve your vision. Some serious eye diseases may not be noticed in your vision, but can threaten vision later. If you have noticed: blurry, distorted, wavy, foggy, floaters (spots in your vision), dark shadows or curtains, please inform the technician when it started, where, how long your problem has been going on.
Visual Acuity
A visual acuity test is used to measure how well you see or the sharpness and clarity of your vision. Your eye doctor will ask you to read letters on a chart. The smallest letters you are able to read will be recorded as your acuity.
Your visual acuity may be written as 20/20 if your vision is normal. If your vision is reduced, it might be recorded as less than 20/20, such as 20/100.
If you have 20/100 vision, it means that you must be as close as 20 feet to see what a person with normal vision can see at 100 feet. Someone with 20/60 vision would need to move up to 20 feet away to read what a person with normal vision could read from 60 feet away.
Having lower than normal vision can indicate retinal or ocular eye disease.
Visual Fields
A visual field test is a quick check of your basic field of view, including your central and side (peripheral) vision. Your eye doctor or technician will sit in front of you and ask you to cover one eye. You will then be asked to say when you can see his or her hand as it enters your field of vision from the sides.
Extraocular Movements (Muscle Check)
This test measures the muscles that control eye movement. It is usually a simple test conducted by moving a pen or small object in different directions of gaze. Restrictions, weaknesses or poor tracking could be symptoms of a disorder.
Pupillary Tests
Pupillary reactions (the way your pupils dilate and constrict in response to light) can reveal a lot about the health of the eyes and of your body. The nerves that control the pupil travel through a long pathway within the body. Certain pupillary reactions can reveal neurological problems, including some serious conditions. Your pupil reactions are tested with a very bright light directed toward one or both of your eyes. Your doctor may focus on one eye or swing the light back and forth to study the ways your pupils change.
Tonometry (Eye Pressure)
Tonometry is the measurement of the eye’s pressure, better known as IOP, or intraocular pressure. A technician will put a drop of anesthetic into your eye. A small device called a TonoPen is moved close to your eye so that it gently touches the cornea, measuring the pressure of your eye. If your eye pressure is higher than normal, you might be at risk of developing glaucoma.
Dilation
Dilation is used to open the pupil and in turn allow the doctor to see the retina and internal structures of the eye clearly. When seeing a Retinal Specialist, we will dilate both eyes every office visit unless otherwise indicated. We also recommend having a driver if possible.
How Long Will Your Eyes Be Dilated?
Dilation usually will last 3-4 hours for most people. You will be more light sensitive during this time and temporarily lose you ability to read up close. All of this is temporary, once the medication wears off, all the side effects will be gone.
Diagnostic Testing
Depending on your eye condition, your retinal specialist may order diagnostic imaging to see fine retinal structures that cannot be seen by the necked eye. These may include:
Fundus Imaging: A still image marking how your eye/s look on a specific day. It is used to compare, at a later date, the changes in your eye condition.
OCT (Ocular Coherent Tomography): Allows your doctor to see the retina in a highly magnified view and be able to see individual layers of your retina. This will allow the doctor to see defects and diseases that may be occurring that can affect your vision.
Intravenous Fluorescein angiography (FA): is a technique for examining the circulation of the retina’s microscopic blood vessels using a fluorescent dye and a specialized camera. A skilled photographer will inject dye into your arm and photograph as the dye circulates through the eye over a 10 minute period.
Indocyanine green (ICG): is a procedure which images a layer of the blood vessels in the outer most part of the eye, under the retina. This layer, the choroid, is normally unable to be seen by the doctor. The choroid contains a unique network of blood vessels. It requires a special dye (ICG) and an infrared camera to capture the images. Some diseases of the eye originate from the choroid and will need to be examined by the retinal specialist to determine what the cause of you eye condition may be.
The Doctor’s Exam
Review of Chart and Diagnostic Images
The doctor will review everything that has been said and done up to this point, confirming that it is correct. These all play a crucial role in the doctors decision making and plan for care. After this is done, the doctor will examine your eyes using high powered microscopes and lenses.
Slit Lamp Examination
Your retinal specialist may choose to use an instrument called a slit lamp, (biomicroscope,) to examine the front (anterior segment) and back (posterior segment) part of your eye. The instrument magnifies your eyes and uses a bright light to illuminate the eye structures. Each part of your eye, including your eyelids and eyelashes, conjunctiva, cornea, iris, crystalline lens and anterior chamber, are examined to reveal any defects or diseases. Cataracts can be diagnosed using the slit lamp.
Dilated Fundus Examination
The dilated fundus examination is usually the last step in a comprehensive eye examination. During your visit, you will have already been dilated. This increases the size of your pupil, giving your retina doctor a larger window in which to inspect your internal eye health. The doctor is able to examine the vitreous, optic nerve, blood vessels, macula and retina.
An instrument called a binocular indirect ophthalmoscope, (BIO) is worn on the doctor’s head. This frees the doctor’s hands in order to use a powerful lens to focus light emitted from the ophthalmoscope into your eye. With this instrument, the image is a bit smaller but the field of view is much larger, allowing the doctor to view your entire retina. This is a crucial part of an eye exam, as many eye diseases can be detected during the test. With all of the information in place the doctor can come to diagnosis, and plan, to preserve your vision.