An Annual Comprehensive Eye Exam should be done annually to ensure good vision and good eye health.  Pediatric eye diseases exist so children should not be excluded in routine eye health care.  Here are some tests that are part of a comprehensive eye exam:

Patient/Family Ocular and Medical History

The first part of the eye exam will include documenting the ocular and medical history of the patient and of the patient's genetic relatives.  This helps determine if a patient is at a higher risk for any ocular or medical conditions. 

Visual Acuity Tests:

Visual acuity tests measure how well a patient can see and are usually performed using a computerized eye chart to measure the distance visual acuity and a hand-held small acuity chart to measure the near visual acuity (reading).

Color Blindness Test:

This is a screening test that checks a patient's color vision and it measures the severity of the deficiency.  It is performed if there is a suspicion of color deficiency or a family history of color blindness.

Cover Test to Check Eye Alignment:

This is a test used to assess strabismus (crossed eye) or a more subtle binocular vision problem that could cause eye strain and/or amblyopia (lazy eye).

Ocular Motility (Eye Movements) Testing:

Ocular motility testing is performed to determine how smoothly and how accurately a patient's eyes can both follow a moving object and/or move between two separate targets. This is also a neurological test.

Pupil Reaction Testing:

Pupil testing tests the size and reaction of the pupils under various conditions to check for any abnomalities.  This is also a neurological test.

Stereopsis (Fine Depth Perception) Test:

When binocular vision issues are suspected, this is used to test Stereoscopic vision or stereopsis, the highest level of binocular vision. Stereopsis requires the “simultaneous perception” of each eye separately, as well as the “matching” of the two images in the brain which results in the perception of depth and three-dimensional structure through binocular vision (the combined visual information from two eyes).

Retinoscopy:

This test is used to estimate which lens powers will best correct distance vision. Based on the way the light reflects from the eye, autorefractors (automated computerized refractor) may be used to automatically estimate the eyeglass prescription in only a few seconds. This is helpful as a starting point and for determining an eyeglass prescription for young children and other patients who may have trouble sitting still, paying attention and/or providing the feedback that the doctor needs to perform an accurate manual refraction. 

Keratometry:

An autokeratometer (automated computerized keratometer) measures the curvature of the cornea or the front surface of the eye.  This is important in determining the patient's refraction, in fitting contact lenses and in assessing the patient for abnormal corneal conditions.

Screening Visual Field Testing (Perimetry):

Using Automated Perimetry, our visual field instrument measures a patient's sensitivity to light in their peripheral vision area.  While fixating at a central light target, the patient presses a button whenever they see a flash of light.  This test checks for the possible presence of blind spots (scotomas) in the peripheral (side) vision. These blind spots can originate from eye diseases like glaucoma or may help identify specific areas of brain damage caused by a stroke or tumor.

Subjective Refraction with a phoropter:

This is the test used to determine the exact eyeglass prescription by fine-tuning the power based on a patient's responses.

Slit-Lamp (Biomicroscope) Exam:

A slit lamp is a binocular microscope (or biomicroscope) used to examine the structures of the eye under high magnification, including eyelids, cornea, conjunctiva, iris, and lens. When dilated and with the help of a hand-held lens, the doctor may also use the slit lamp to examine structures located farther back in the eye, such as the macula and optic nerve.  The slit lamp exam can be used to detect a wide range of eye conditions and diseases, including conjunctivitis, iritis, corneal ulcers, corneal foreign bodies and when dilated, macular degeneration, and diabetic retinopathy to name a few.

Tonometry (Eye Pressure Test):

Testing for glaucoma typically begins with measuring the pressure inside the eyes. This can be done with the Non-Contact Tonometer or "air puff" machine.  Based on the cornea's resistance to the puff of air, the machine calculates intraocular pressure (IOP).  High eye pressure patients may be at risk for glaucoma, but low eye pressure DOES NOT RULE OUT glaucoma. The test is completely painless, and the tonometer does not touch your eye.  In some cases, Dr. Kubota may use an applanation tonometer where she first numbs the patient's eye with drops and then gently touches a probe to the cornea to measure the eye pressure.

Ophthalmoscopy:

Using a hand held scope (ophthalmosope) Dr. Kubota can look into the back of they eye to get a glimpse of only a small part of the central retina.  But since the view is so limited, ocular health cannot be determined until more of the retina is examined with the Retinal Scan and OCT or Dilated Fundus Evaluation.

Optos Retinal Scan or Dilated Fundus Evaluation (Extended Ophthalmoscopy):

These procedures examine your central and peripheral retina allowing a thorough eye health examination.

The Optos Retinal Scan requires no dilation and it takes digital images of the central and peripheral retina allowing for close detailed analysis of the optic nerve, macula, blood vessels and peripheral retina.  It can also provide a more in depth examination of the retina by allowing analysis of the different layers of the retina and allowing the comparison of previous images to check for subtles changes over time.

During a Dilated Fundus Evaluation (Extended Ophthalmoscopy), eye drops are instilled to dilate your pupils. Once fully dilated, using a head-mounted device with a light and a hand held lens, your central and peripheral retina can be viewed by Dr. Kubota in small sections.  You will be light sensitive and possibly blurry for up to 8 hours after the examination so you need a driver to take you home where you should stay indoors and avoid sunlight.

Optical Coherence Tomography (OCT): 

Optical Coherence Tomography takes a scan of specific structures in the back of the eye, like the macula and/or optic nerve.  The OCT measures the thickenesses of your retinal nerve fiber layer in microns, then statistically analyzes the results by age to determine if your eyes are normal for your age.  It also allows Dr. Kubota to compare past OCTs to determine if a patient's eyes have changed over time.  This instrument can pick up subtle, early nerve fiber layer loss, allowing glaucoma to be diagnosed even earlier than just by visually observing changes in the optic nerve alone.
 

How long will a Comprehensive Eye Exam appointment take?

A Comprehensive Eye Exam usually takes about 1 hour or longer, depending on the number and complexity of tests required to fully evaluate vision and the eye health.  Sometimes tests like the refraction are difficult and take more time to complete accurately.  Then if glasses are desired, it could take another 30 minutes or so to pick the appropriate fashion eyewear and have all the measurements taken.  If the eyes are to be dilated, a SEPARATE 90-minute appointment should be specifically scheduled and planned.
 

Can I drive after my eyes are dilated?

After a Dilated Fundus Evaluation (Extended Ophthalmoscopy), you will be light sensitive and possibly blurry for up to 8 hours after the examination so you need a driver to take you home where you should stay indoors and avoid sunlight.