The typical exam takes about an hour, but it starts from the moment our patients check in because we do a lot of data collection before I start taking measurements. So, from the time our patient checks in, we have medical history questionnaires that a lot of people wonder, “Why are you asking me all these medical questions? I am here for my eyes.” But there’s a direct correlation. We ask what we call review of systems, which is if they have any heart problems, if they have any lung problems, if they have any diabetic problems. Problems of the circulation system, high blood pressure, high cholesterol can also affect the blood vessels within the eye. So we need to know if that’s a systemic problem that already exists and what medications they’re on, if any, because those medications that affect the blood systems throughout the body, again, affect the blood system in the eye.
If they have diabetes, diabetes is the leading cause of blindness in the country and so I need to know if they are aware of it, if they are properly being treated and then we will thoroughly check for any diabetic damage within the eye and we have a lot of correspondence with our patients, endocrinologists, and family practice doctors that are monitoring and treating their diabetes.
So we give them feedback and if there is damage showing up in the eye and if there is then that means the current system needs altering. We are not going to tell the other doctors who to practice, we just work as a team to give them more information if the current system is thoroughly correcting and helping with the health of the eye or if there’s an adjustment needed.
When we get into allergies, allergies can cause a lot of problems with the eye, of causing bumps to form under the eyelids, causing irritation, affecting the quality of the tears, affecting discharge of the eye. So we need to know if they are aware of allergies and then analyze the effects of that on the eye. Also we need to know if they have any infections throughout the body and if there’s infections that can spread into the eye and cancers, cancers of the body, especially breast cancer can metastasize to the eye and we need to check and see if there are issues there.
So a lot of people feel, unfortunately, invaded when we started asking so many medical questions, but it’s really for the good of the patients so we can get a thorough comprehensive evaluation to help them, not only with their eyes, but systemically to give feedback to their other doctors.
So that’s a lot of data collection at the beginning. From there, our assistants take them and start doing what we call preliminary testing and data collection. We check peripheral vision; we do screening tests there because the peripheral vision can give us information if there is something blocking vision being transmitted from the eye to the brain such as cancers, tumors, many strokes. We have detected many patients with those disorders that were not aware of it from our visual field, our peripheral vision testing.
We check blood pressure because, again, blood pressure problems can show up in damage in the eye. We check color vision. Now color vision, well if that, the quality of life it will affect occupation. There are lots of things that demand accurate color vision. If you are going to go into the electrical fields, if you are going to go into flying, things that require color coding of systems, people on water treatment plants, you have to know what color buttons and wires you are dealing with because that’s making critical decisions in a lot of occupations.
So we analyze color vision and educate patients appropriately on that. We analyze depth perception and let people know if there are disorders there that has to be maximized to give best vision for driving or for sports that can be affected as well. We analyze the focusing mechanism throughout the exam. We have instruments that are computerized instruments that will measure the way the eyes are focusing, give us computerized printouts, and it saves a lot of the time that used to be which is better, 1 or 2. We still do that in the process of the exam but that’s minimized with the technology that we now have.
The technology we have measures pressure of the eye. We spoke earlier about checking for glaucoma or eye disease through pressure. We are monitoring that and a lot of the testing is done with our technicians, but that’s still part of the exam. So between the check in of acquiring medical data and history, between the preliminary testing that our technicians take and put them, bring them to the exam room with the doctor, there’s a good 30 minutes of data acquisition there.
Once we are in the exam room, the doctors are another probably 20 minutes of taking more measurements analyzing data, analyzing the health of the eye and then determining what type of focusing problem exist, educating our patients on that focusing problem and what solutions there are, and going back over the health issues of the eye. If everything is healthy, the structures from front to back, if there are normal changes starting to take place, or precautions that should be done.
When we are in our exam room we use special microscopes to examine the quality of the tears, the volume of the tears. That will affect the quality of vision and health of the eye. So that’s another important aspect of the comprehensive eye exam.