A New Look at Eye Exams by Marc Grossman, OD, LAc

Getting a thorough eye exam has always been about more than reading letters off an eye chart. That’s even more true today. One reason: We’re harder on our eyes than ever before. Many of us spend hours each day staring and squinting at screens, developing digital eyestrain and exposing our eyes to potentially damaging blue light. But the typical tests offered during a standard eye exam, even one during which your pupils are dilated, may not go far enough to find problems as early as possible.

Your eye exam will still include the basics, such as testing your vision and doing a refraction to find the right strength to correct any near- or far-sightedness as well as testing your eye muscles by following your doctor’s finger, to see how your eyes move together and track objects.

Here’s a list of innovations in standard tests and newer, high-tech testing options with important benefits—not every eye doctor offers them, but it could be worth your time to find an eye doctor who does.

Taking your history. Your doctor should ask about your health, family history, medication use and any eye problems, such as blurry vision, floaters and trouble seeing at night.

Beyond the basics: The most important question may be about how you use your eyes and, in particular, how many hours you spend each day looking at electronic devices. If you work at a computer for more than 8 hours a day, ask your doctor if you need to use a blue light filter to reduce eyestrain. If your monitor doesn’t have it built in, you can download an app or simply wearing blue-light filtering eyeglasses when you work.

Eye pressure testing. This test screens for glaucoma, the build-up of fluid in the eye that can damage the optic nerve and cause blindness. The basic test can be done with a puff of air from a machine called a tonometer or with a device called an applanation tonometer, which is gently pressed on the front of the eye.

Beyond the basics: There is now a tonometer called the ocular response analyzer that measures corneal hysteresis, the rigidity of the cornea, the eye’s clear protective outer layer. An additional simple test can be used to measure the thickness of the cornea. These measurements help put eye pressure readings in perspective, since thicker or more elastic corneas may withstand more pressure. Results might help you avoid medications you’d otherwise be prescribed or alert your doctor to a problem that might otherwise be missed.

Retina exam. Every eye exam should include a check of your retinas, the light-sensing layer of tissue at the back of your eyes to check for several conditions, including macular degeneration (retinal damage common with age that can ultimately lead to blindness). Changes in the retina and underlying blood vessels also can suggest health problems such as diabetes and high blood pressure. Traditional testing involves dilating your pupils and then using a strong light to look inside your eyes.

Beyond the basics: Optomap is a digital retinal scanner that doesn’t involve dilation. It takes pictures of the retinas and the images that can easily be shared with other health care providers if needed. A newer additional retina-testing option is optical coherence tomography, which uses light waves to take cross-sectional pictures of your retina and the vascular layers beneath it. Such images can help to diagnose and track conditions, including macular degeneration, glaucoma and diabetic eye disease. If you’re over age 50, consider baseline testing with this technology. It might help spot early signs of trouble and lead to taking preventative steps, such as supplements for eye health.

Slit lamp testing. Using a microscope attached to a bright light, the doctor can examine the front parts of your eye, including the lids, and your tear ducts. He/she may introduce a dye to see how quickly your tears evaporate to check for signs of dry eye.

Beyond the basics: Special lenses used with the slit lamp are available to enable the doctor to better see deeper parts of the eye, such as the optic nerve.

Visual field testing. A variety of tests assess your visual field, both the center and sides of your vision, which can be affected by glaucoma, retina problems, flashes and floaters. The most basic screening test involves the doctor moving his or her fingers to the side while you look straight ahead and count the fingers.

Beyond the basics: More formal testing involves looking through a machine called a visual field tester and responding to light cues or patterns.

Next Steps

When planning your next eye exam, call eye care offices near you and ask which of these tests they offer and the charges. The new optional tests will likely add between $35 to more than $100 each (often depending on where you live) to the basic exam fee and are less likely to be covered by insurance than the basic exam. But the investment in your future vision could be more than worth it.


Marc Grossman, Doctor of Optometry and New York State Licensed Acupuncturist is author of several books, including Natural Eye Care – Your Guide to Healthy Vision.  Since 1980 Dr. Marc Grossman has helped many people maintain healthy vision and even improve eyesight. He is best described as a Holistic Eye Doctor, dedicated to helping people with such conditions ranging from myopia and dry eyes to potentially vision threatening diseases as macular degeneration and glaucoma. His combined multi-disciplinary approach using nutrition, eye exercises, lifestyle changes and Chinese Medicine provides him with a wide array of tools and approaches to tackle difficult eye problems. Dr. Grossman founded the Rye Learning Center in 1980, a multidisciplinary center for learning problems, in 1996 co-founded Integral Health Associates in New Paltz, New York, and in 1999 co-founded Natural Eye Care, Inc. For more information go to www.naturaleyecare.com or call 845-255-3728.

Photo credit: The Mayo Clinic