At Focal Pointe Eye Care, we believe there’s a lot more to eyes than making sure you see 20/20. We want you to see 20/20 for your whole life.
To make that goal a reality, we do far more than prescribe glasses or contact lenses. We take a proactive approach to your complete eye health, making sure your eyes are functioning as they should not only today, but for the rest of your life.
What to Expect at Your Eye Exam
Focal Pointe Eye Care administers a wide array of tests and procedures to examine your eye health and visual acuity. These tests range from reading eye charts to using sophisticated high-powered lenses to visualize the microscopic anatomical structures of your eye. We pride ourselves at always being on the frontline of new technological developments and bringing those technologies to our patients. Depending on the complexity of the test required, a comprehensive exam can take up to an hour to fully evaluate your vision and the health of your eyes.
Here are eye and vision tests that you are likely to encounter during a comprehensive eye exam:
An autorefractor is an instrument that uses light to automatically determine the power and curvature of your eye, providing a very accurate estimate of your prescription and parameters for the contact lens fitting. With an autorefractor, a chin rest stabilizes your head while you typically look at an image of a hot air balloon. You will see a series of lights and hear sounds during this brief test. Rest assured you will feel no “puff” of air!
Color Deficiency Test
A color vision screening often is performed early in a comprehensive eye exam to rule out color blindness. In addition to detecting hereditary color vision deficiencies, color blind tests can also alert Dr. Lyons to possible eye health problems that may affect your color vision.
A corneal topography is just like a topography of the earth – it gives the doctor a map of the microscopic hills and valleys of the front surface of the eye, called the cornea. You will be instructed to place your chin on a chin rest and look into the instrument one eye at a time staring into a fixation target to stabilize the eye. A light is then reflected off of the surface of the eye while the instrument calculates the map. The data can then be used to monitor unwanted tissue changes as a result of contact lens wear or other corneal pathology, such as Keratoconus. This data is also important for selecting the proper contact lens for a patient.
While there are many ways to check how your eyes work together, the cover test is the simplest and most common. The cover test checks how well your eyes work together to focus on an object. During a cover test, Dr. Lyons will have you focus on a small object across the room and then he will cover each of your eyes alternately while you stare at the target. A cover test can detect strabismus or more subtle binocular vision problems that could cause eye strain or amblyopia (“lazy eye”). The test is performed while looking at distance and then up close.
Dilated Retinal Exam
A thorough retinal exam is performed by dilation of the pupils. This allows Dr. Lyons to obtain a better view of the eye’s internal structures. Pupil dilation is achieved by instilling 1 or 2 dilating drops into the eyes, usually taking about 20 to 30 minutes to start working. Once the drops have taken effect, Dr. Lyons will use various instruments to look inside your eyes. Pupil dilation is very important because it allows for the most thorough evaluation of the health of the inside of your eyes. A dilated retinal examination is recommended for all new patients, every other year for those people under the age of 40 and healthy, and then every year after the age of 40.
When your pupils are dilated, you will be sensitive to light (because more light is entering your eyes) and you may notice difficulty focusing on objects up close. These effects can last for up to several hours, depending on the strength of the drop used. You should bring sunglasses with you to your eye exam to minimize glare and light sensitivity on the way home. If you do not have sunglasses, a disposable pair of sunglasses will be made available for you for your convenience.
Electroretinography measures the electrical responses of various cell types in the retina of the eye. This allows functional testing of the retina without you having to even click a button! This is useful when analyzing retinal conditions such as macular degeneration, diabetic retinopathy, and hereditary retinal conditions such as retinitis pigmentosa and Stargardt’s disease.
Electrodes are placed on the skin under the eye and your forehead using a temporary and easily removable gel. You will then be instructed to look at a computer screen for approximately one minute per eye. During a recording, the eyes are exposed to standardized stimuli and the electrodes measure the activity of the retina.
Gonioscopy describes the use of a specialized contact lens to gain a view of the anatomical angle formed between the eye’s cornea and iris. The importance of this process is in diagnosing and monitoring various eye conditions associated with glaucoma.
For this test, anesthetic eye drops will be instilled in your eyes to temporarily numb them. Your eyes will feel slightly heavy within seconds. While your head is resting in the slit-lamp chin rest, Dr. Lyons will gently place the gonioscopy lens on your eye. The lens contains small mirrors that allows viewing of this very important structure called the “angle”.
The tonometer is an instrument designed to measure the pressure inside your eyes. Tonometers have several vatiations, but all help determine whether you have glaucoma. The standard method of measuring your eye pressure is using a Goldmann applanation tonometer. For this test, yellow eye drops will be instilled in your eyes to temporarily numb them. Your eyes will feel slightly heavy within seconds. You will then stare straight ahead into the slit lamp while Dr. Lyons brings the tip of the Goldmann tonometer to the surface of your eye to measure the pressure. Applanation tonometer is painless and at most you may feel the tonometer probe tickle your eyelashes.
Patients typically have no warning signs of glaucoma until they have significant vision loss. For this reason, routine eye exams that include tonometer are essential to rule out early signs of glaucoma and protect your eyesight.
A common, and often dreaded glaucoma test, is the “puff-of-air” test, technically known as non-contact tonometer. Due to the unpopularity and inaccuracy of the “puff test”, we do not perform this pressure screening.
The Icare tonometer is the one of the newest ways to measure intraocular pressure. It is based on a new measuring principle, in which a very light probe is used to make momentary contact with the cornea. The measurement is barely noticed by the patient – see more at the Technology at Focal Pointe page.
Ocular Coherence Tomography (OCT)
An OCT can help in the detection of vision threatening conditions, such as diabetes, glaucoma, and macular degeneration. As time moves on, your vision may change from a retina condition that is difficult to analyze from a dilated exam alone. An OCT allows Dr. Lyons to view below the surface of the retina to detect issues earlier, preventing unnecessary vision loss.
An OCT can usually be performed without any dilation drops. You will be instructed to place your head in a rest while you look at a pleasant light. You will see a series of mild flashes as it takes the scans. The scans usually take around thirty seconds to capture – see more at the Technology at Focal Pointe page
Corneal pachymetry is the process of measuring the thickness of the cornea. The pachymeter utilizes ultrasound to screen patients for LASIK candidacy and for patients suspected of developing glaucoma.
For this test, anesthetic eye drops will be instilled in your eyes to temporarily numb them. Your eyes will feel slightly heavy within seconds. You will then stare straight ahead while the tip of the ultrasound briefly rests against the surface of your cornea, measuring the thickness. The measurements are complete in under 15 seconds.
This is the test that determines your preferred eyeglass prescription. Dr. Lyons uses a phoropter to determine your prescription for eyeglasses and contact lenses. During a refraction, Dr. Lyons puts the phoropter in front of your eyes and shows you a series of lens choices. He will then ask you which of the two lenses in each choice looks clearer. Based on your answers, Dr. Lyons will continue to fine-tune the lens power until reaching a final eyeglass prescription.
By capturing an image of the inside of the eyes, Dr. Lyons can monitor the health of your eyes for the years to come. The image is invaluable since some eye conditions develop slowly over time. Imaging will be done with the presence of glaucoma, diabetes, macular degeneration, and other conditions. Even if your eyes are healthy, the image provides a “snapshot” of the health of your eyes when the image was taken.
Imaging is usually best performed when the eyes are dilated. As your head is positioned in the rest, you will experience a single bright flash as the image is captured. The days of film are over – the image instantly appears on the screen, allowing us to visualize the entire back of your eye.
Your eye doctor may perform this test early in the eye exam to obtain an approximation of your eyeglass prescription. In Retinoscopy, the room lights will be dimmed and you will be given a large target (usually the big “E” on the chart) to fixate on. As you stare at the “E,” Dr. Lyons will shine a light at your eye and place lenses in front of your eyes. Based on the way the light reflects from your eye, Dr. Lyons can obtain a prescription for glasses. This test is especially useful for infants, children, and patients who are unable to accurately answer the doctor’s questions.
The slit-lamp, also called a biomicroscope, is an instrument that you eye doctor uses to examine the health of your eyes. The slit lamp is a sophisticated microscope that magnifies the structures of your eyes. It allows Dr. Lyons to evaluate your eye health and detect any signs of infection or disease. A wide range of eye conditions and diseases can be detected with slit-lamp examination, including cataracts, macular degeneration, corneal ulcers, diabetic retinopathy, etc.
During this test, you will be asked to place your chin on the chin rest of the slit-lamp and Dr. Lyons will then shine the lamp’s light at your eye. He will look through a set of oculars and examine the structure of your eyes. He will first examine the structures of the front of your eye (lids, cornea, conjunctiva, iris, etc.). Then, with the help of a special high-powered lens, Dr. Lyons will view the inside of your eye (retina, optic nerve, macula and more).
Visual Acuity Tests
Among the first tests performed in a comprehensive eye exam are visual acuity tests that measure the sharpness of your vision. These usually are performed using a digital eye chart to measure your distance visual acuity and a small, hand-held acuity chart to measure your near vision.
Visual Evoked Potential(VEP)
VEP measures the electrical activity in the vision system. When light from an image enters your eye, it is converted into electrical energy at the retina and travels through the optic nerve to the visual cortex of the brain which processes vision. Any delay in the VEP indicates a potential issue in the visual system.
Electrodes are placed on your forehead and rear of your head using a temporary and easily removable gel. You will then be instructed to look at a computer screen for approximately one minute per eye. During a recording, the eyes are exposed to standardized stimuli and the electrodes measure the activity of the visual system – see more at the Technology at Focal Pointe page.
Visual Field Test
A visual field test is an automated machine that detects blind spots in your peripheral vision. These types of blind spots can originate from eye diseases such as glaucoma. Analysis of blind spots also may help identify specific areas of brain damage caused by a stroke or tumor. You will wear a patch over one eye and be instructed to fixate on a light on a screen. You will then be asked to click a button each time the instrument flashes a light in your peripheral vision. The visual field test typically takes anywhere from 5 to 10 minutes per eye to complete. The machine will then analyze the data and provide a detailed printout of the results.
Other Eye Tests
The above list represents the most common testing performed at Focal Pointe Eye Care. However, if Dr. Lyons detects an abnormality, there are many more tests that he can utilize to ensure you receive the best eye care.